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Otolaryngologists Look to APPs and Stronger Coding Practices to Improve the Bottom Line

One conversation taking place more frequently among otolaryngologists concerns advanced practice providers (APPs). There are a few reasons. First, during the pandemic, primary care providers were overwhelmed with patients, and many were seeing those patients via telemedicine. Since it’s difficult to properly examine an ear, look inside the nose, or palpate the neck during a virtual visit, many PCPs asked their patients to see an otolaryngologist in situations they might not have prior to the pandemic.

Second, there’s a shortage of PCPs and other healthcare professionals. “What we’re seeing is a confluence of factors that involve not only a shortage of primary care professionals but also too few nurses and office staff, with pent-up demand for care,” Dr. Michael Brenner told ENT Today.

Third, COVID-19 itself is driving demand. Says Dr. Eugene Brown, an otolaryngologist in Charleston, SC: “COVID-19 has wreaked havoc in the ear, nose, and throat region, and this has driven demand for our services. I think that fear of long-term viral complication has driven demand for otolaryngologic services. Concerned patients are seeking specialty advisement early to try to minimize complications.”

APPs Bring Significant Benefits

Increases in appointment demand are leading some otolaryngologists to consider (or reconsider) incorporating more APPs into their practice. Dr. William Blythe, managing partner of an East Alabama ENT practice, told Bulletin that APPs make his practice more efficient.

Each of the practice’s three teams have a physician, an APP, and two medical assistants, he said, adding that each uses the APP in a slightly different way. One APP has a separate schedule from their supervising doctor, and other physicians utilize a team, with their APP on a single combined schedule. “There is no single right way to do it, but you have to fine-tune the schedules to find the most efficient system,” Blythe says.

Importantly, Blythe says adding an APP allowed him to move from seeing 100 patients in his 2.5-day week to seeing 200 patients in that time frame. “That not only improved our availability for our patients, it reduced wait times, improved patient satisfaction, and increased surgeries. My APP is also my patient coordinator for our cochlear implant and Inspire programs, making her and the patients happy,” he says.

Dr. Brown agrees that APPs are the answer for many practices. “Advanced practice providers will be vital to creating greater access into our practices,” said Dr. Brown. “These are bright, well-trained professionals who flourish under our guidance, with our tutelage, and under our supervision. They can see many of our return patients, especially for cerumen impactions, and many of our acute care patients, creating revenue for our challenged practices and allowing surgeons to practice at the top of our licensure.”

Of course, those revenue levels should be carefully measured and monitored. Otolaryngology practices that don’t have a robust program for measuring and reporting key performance indicators (KPIs) should strongly consider developing one. Today’s advanced, cloud-based practice management software makes this process much easier than in the past, when spreadsheets were the only tracking option.

Coding is another important consideration. Dr. Blythe recommends surgeons always code their own surgical cases. “If you go to a coding and reimbursement course, this is the very first thing they recommend. If you resort to a staff member reading operating procedure notes and coding correctly, you will lose substantial money,” he says, adding that “an experienced, knowledgeable insurance manager is worth whatever you pay them and is essential to lead the revenue cycle management team.”


  1. Robinson, Katie. “Managing the Increasing Primary Care Burden in Otolaryngology.” ENT Today, 16 August 2022.
  2. Ibid.
  3. Manning, Lance. “Pearls From Your Peers: Improving Efficiency in Otolaryngology Practice.” Bulletin, 27 May 2021.

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