Category: Uncategorized

Provided by: Andrew J. Tompkins, MD MBA (ENT)

Many of us have recently completed the familiar period of open enrollment, where we select health insurance plans for the upcoming calendar year.  These exercises typically involve an attempt to project costs in order to reduce our out-of-pocket spend and decrease the downside risk of large, out-of-pocket payments.  These projections would be easier if our healthcare landscape didn’t have such cost opacity, making such attempts frustrating and near futile.  Healthcare costs and cost shifting have forced us to take these exercises much more seriously.

According to the Kaiser Family Foundation¹, the average annual family premium for employer-based coverage has grown 4.5% annually over the last 10 years, now standing at $21,342.  These premiums, and worker contributions to them, have easily surpassed wage growth and inflation over that time period.  In order to reign in employer premium growth, costs are increasingly being shifted to employees not just through premiums but deductibles as well since high deductible plans are cheaper.  Employer plans now involve some level of deductible for 83% of workers, up 30% from 2006.  The average deductible has also risen 6% annually for the last 10 years and currently stands at $1,644 for single coverage.  Further, we have seen a marked shift toward high deductible health plan (HDHP) enrollment, rising from 4% in 2007 to 31% in 2020.  The trends are undeniable – healthcare is getting more expensive, and as more of that cost burden is being shifted to employees discretionary income is getting squeezed.

These trends naturally motivate all of us to seek value in healthcare – we want the best quality for the best price.  Providers should also be seeking to provide value for our patients because focusing on value optimizes the total patient care experience, particularly when so many of us incur costs based on the decisions that are derived from our visits.  Pursuing a value priority compels us to provide the best quality of care – outcomes, timeliness of care, compassion, and communication, just to name a few components of quality care.  This has been the standard for years.  But, the market now demands that we should also seek to be good stewards of our patients’ discretionary income.  I have been proud to be part of Ohio ENT & Allergy Physicians (OENTA), where we epitomize quality care delivery and also seek to be cost-effective for our patients.

OENTA’s quality starts with the people.  Our physicians are trained at the best institutions and collaborate to achieve the best outcomes for our patients.  We review current literature and technology advances so we can optimize care delivery for our patients.  This ethos is bolstered further by our robust system of internal review.  Our staff work tirelessly to support these efforts both directly with our patients and behind the scenes to improve the patient experience.  Our physicians are accessible at all hours and have same day availability.  We have a high quality and low radiation emitting CT scanner available, reducing long-term side effects.  Our partnership with the Ohio Surgery Center (OSC) has several quality advantages as well.  Ambulatory surgery centers have been shown to be safer centers of care, even when adjusting for the underlying health of the patients being treated.² The OSC has experienced pediatric and adult anesthesiologists and staff that have been working exclusively with ENT surgery for years.  They have been serving central Ohio for decades, with leadership requiring the highest quality standards in the industry.  We also adapt to new challenges that have arisen from our current pandemic.  OENTA has been lauded for our COVID protocols, which have allowed us to keep our patients and staff safe while still providing high quality care.

While these quality metrics alone would have been impressive in the past we recognize that more must be done to reduce our patient’s out of pocket costs.  Our patients demand it.  We demand that of our own care.  And, it fulfills our mission to optimize our service towards our patients.

At OENTA we will never charge our patients a hospital facility fee in addition to your office visit.  Health Affairs, a leading health policy journal, points out that these facility fees can make your outpatient visits at least twice as expensive for the same service.³  Our electronic medical record is suited to guide generic and cost effective prescribing patterns with no reduction in quality.  Should imaging be necessary, we don’t add-on hospital fees for the scan, keeping your costs low.  And, should surgery be a mutually agreed treatment, our partnership with the Ohio Surgery Center has several advantages.

The OSC will work with our patients to provide full cost transparency in advance of any procedure. Studies have revealed that, in general, ASC (Ambulatory Surgery Center) prices are significantly lower than hospital outpatient department (HOPD) prices for the same procedure in all markets, regardless of payer.⁴  Those savings are passed on to you by lower out of pocket expenses.

The healthcare market now demands that we focus on quality and patient costs when we serve our patients.  OENTA has risen to this challenge and is always seeking other opportunities to optimize the patient care experience on both of these important fronts.  As fellow Ohioans, colleagues, neighbors and friends we will continue working to serve you as we would want to be served.  We at OENTA want to thank you for entrusting us with your care and wish you a safe 2021.

References:

1.  (2020, Oct 8).  2020 Employer Health Benefits Survey.  Kaiser Family Foundation.  Retrieved from: https://www.kff.org/health-costs/report/2020-employer-health-benefits-survey/

2.  Munnich EL, Parente ST.  Returns to Specialization:  Evidence from the Outpatient Surgery Market.  Journal of Health Economics.  2018; 57: 147-167.

3.  Cassidy A.  (2014, July 24)  Health Affairs.  Retrieved from:  https://www.healthaffairs.org/do/10.1377/hpb20140724.283836/full/

4.  Healthcare Bluebook and HealthSmart via Advancing Surgical Care (2016) Study: Commercial Insurance Cost Savings in Ambulatory Surgery Centers. Retrieved April 5, 2021, from https://www.ascassociation.org/advancingsurgicalcare/reducinghealthcarecosts/costsavings/healthcarebluebookstudy.

Provided by Megan Goebel, MD

Hives are one of the most common reasons for a visit to an Allergist, with up to a quarter of the population experiencing hives at some point in their life. Hives, or welts, are red or white raised areas on the skin that itch. The itching can interfere with school, work and sleep. There are many causes for hives including allergic reactions to foods, medications, animal dander, insect stings or bites, or pollen. Typically with a food allergy, a patient will develop hives within 30 minutes of eating. This may be accompanied by swelling, throat tightness, trouble breathing, or vomiting which is called anaphylaxis. The most common food allergens are peanuts, tree nuts, fish, shellfish, cow’s milk, eggs, wheat and soy. If your symptoms are suggestive of a food or environmental allergy, your Allergist may perform skin prick testing to help diagnose this. In children, hives often develop during an infection which may occur with fever, runny nose, sore throat, vomiting, diarrhea or burning with urination. These hives will resolve on their own as your immune system fights the infection.

Hives that last longer than six weeks are called chronic urticaria. These hives are less likely to be caused by an allergic reaction and more often are due to your immune system releasing a chemical called histamine, which causes itching and swelling. Physical triggers including heat, cold, pressure, sunlight and sweat. This condition can be treated with high doses of antihistamines and your doctor may order some blood tests to look for other causes.

While itchy and uncomfortable, the good news is that hives are not dangerous on their own and can be treated. Typically a twice daily antihistamine such as cetirizine or fexofenadine will be recommended. A medication called Xolair® has been very successful in treating chronic hives and can be administered as an injection at your Allergist’s office if needed.

Provided by: Roger Friedman, MD and Philip Rancitelli, MD (Allergist / Immunologist)

The recent FDA emergency use authorization of two mRNA COVID-19 vaccines (Pfizer-BioNTech and Moderna) has increased optimism that an end to the pandemic is within reach.  However, reports of anaphylactic reactions following vaccine administration have caused concern, especially among allergy sufferers.

Significant reactions to vaccines in general are very rare.  The incidence of anaphylaxis, the most severe type of allergic reaction, is estimated to occur in 1.31 per 1 million doses.  Thus far, there have only been a handful of apparent severe allergic reactions reported following COVID vaccination among the millions of doses already administered.

This is a rapidly evolving issue that the Food and Drug Administration (FDA), the Centers for Disease Control (CDC), the American Academy of Allergy, Asthma, and Immunology (AAAAI), and the American College of Allergy, Asthma, and Immunology (ACAAI) are following very closely.  The CDC recently issued the following guidance with regards to the mRNA COVID-19 vaccines and allergic reactions:

• Do not get the COVID-19 vaccine if you have experienced a severe reaction to one of its ingredients. The cause of apparent allergic reactions hasn’t been confirmed, but the leading candidate is polyethylene glycol (PEG).
• If you’ve had a severe allergic reaction to another vaccine or injectable therapy, you should discuss with your doctor if you should get the COVID-19 vaccine. Most likely, you’ll still be able to get vaccinated.
• You CAN be vaccinated if you have a history of:
  • Severe allergic reactions to foods, venom, latex, or environmental allergens (pets, pollen, dust, mold, etc.)
  • Allergies to oral medications
  • Family members who have had severe allergic reactions
  • Milder reactions (not anaphylaxis) to vaccines.
• If you have a severe allergic reaction to the first dose of the COVID-19 vaccine, you should not get the second dose.

A good way to assess your risk is to answer the following questions:

1. Do you have a history of a severe allergic reaction to an injectable medication (intravenous, intramuscular, or subcutaneous)?
2. Do you have a history of a severe allergic reaction to a prior vaccine?
3. Do you have a history of a severe allergic reaction to another allergen (food, venom, or latex)?
4. Do you have a history of a severe allergic reaction to polyethylene glycol (PEG), a polysorbate or polyoxyl 35 castor oil (paclitaxel) containing injectable or vaccine?

If you answer “no” to all four questions, you would be labeled “low risk” and can receive the vaccine with a 15-minute observation period.

If you answer “yes” to question #1, #2, or #3, you would be labeled as “medium risk” and can receive the vaccine with a 30-minute observation period.  However, if you answer “yes” to either #1 or #2, it should first be verified that the product in question did not contain PEG, polysorbate or polyoxyl 35.

If the answer to #4 is “yes”, you are considered “high risk” and should consult with a board certified allergist-immunologist prior to getting the vaccine.

These two COVID-19 vaccines appear to be very safe and effective, but keep in mind that all vaccines have the potential to cause side effects.  Rest assured that vaccine providers have been advised by the CDC to have certain safeguards in place to protect you.

• You should be prepared to be monitored following vaccination (up to 30 minutes).
• Vaccination providers will be equipped with appropriately trained staff and emergency medications (including epinephrine) to address potential allergic reactions.

Provided by: Michael Goodman, MD (Allergist/Immunologist)

A frequent question that we receive from our patients with asthma is: Am I at increased risk from COVID due to my asthma? The CDC states that “having moderate-to-severe asthma might increase your risk for severe illness from COVID-19.” Intuitively one would think that since both COVID and asthma are respiratory disorders that people with asthma would be at increased risk for a more severe course should they become infected. We also know that asthmatic patients often have a more severe course when infected with influenza, also a respiratory virus.

However, most COVID studies have NOT found asthmatic patients to be at increased risk of severe disease when infected with COVID-19. Also, asthmatic patients appear to have similar COVID infection rates as the general population. There have been a few studies that seemed to show that nonallergic asthma was a risk factor to become infected and to have a more severe course, but these studies had certain limitations that may have skewed their outcomes, such as potentially misclassifying some patients with COPD as asthmatic, or not correctly accounting for other medical conditions. Overall, while the research is ongoing, asthma does not appear to be a risk factor at this time.

There are some things that asthma patients should keep in mind regarding COVID. For example, many cleaning supplies can trigger asthma attacks in asthma patients. Cleaning products should be used according to their directions, not mixed with other products, and used with ample ventilation where possible. Another aspect to consider is that nebulizers generate aerosolized particles and may potentially increase the spread of COVID if used by an infected patient. MDI “puffer” devices are preferred when administering medications around other people. During the pandemic, asthma patients should be even more diligent about ensuring that they are using their asthma medications as instructed and not missing scheduled doses. There is no evidence that asthma medications increase your risk of becoming infected with COVID-19 and having control of your breathing to begin with will hopefully help you better cope with COVID-19 should you become infected.

Provided by Megan Goebel, MD (Allergist/Immunologist)

Eczema, sometimes referred to as atopic dermatitis, is a bothersome and chronic skin condition characterized by dry and itchy patches that can be exacerbated by exposure to allergens and irritants. Eczema typically appears in infants and young children but can persist into adulthood. The face, neck, arms and legs are most commonly involved.

Uncontrolled eczema can significantly decrease the quality of life of patients and is associated with depression, anxiety and trouble sleeping. Environmental allergy testing can be helpful to identify pollens, dust mites, pet dander, and/or molds that may be triggering eczema. In some patients food allergens can also play a role in eczema.

Many times irritants including fragrances in soaps, lotions, perfumes and laundry detergents can lead to eczema flare ups. Allergists play a key role in the diagnosis and treatment of this skin condition by identifying relevant allergens and counseling patients on avoidance measures. Restoring the skin barrier to retain moisture and keep out allergens and irritants is crucial. After a warm bath or shower with a mild and unscented soap, it is helpful to apply a thick cream or ointment to the skin. Applying a topical prescription to specific areas may be recommended. Occasionally the skin can become infected from scratching and treatment with topical or oral antibiotics is indicated. In severe cases, an injectable medication may be recommended to reduce inflammation and itching as well as prevent exacerbations.

Provided by: Roger Friedman, MD (Allergist/Immunologist)

Oral Immunotherapy, also called OIT, has been a life-changing therapy for patients, parents and physicians. Food allergies have been dramatically increasing over the last 25 years and affect 8% of the population. Most concerning has been the severe food allergies, especially to peanuts and tree nuts.
 
One year ago, we began a program at Ohio ENT and Allergy Physicians for OIT.  Since that time, we have enrolled 50 patients, and seven of them are now graduates of the program.

There are three parts to the program; Day-one; in which the patient spends about five hours with us receiving increasing microscopic quantities of the food they are allergic to. The patient then continues to eat the final day-one dose at home for the next 1-2 weeks. They then return for an up-dose at the office. This continues for about 6-8 months. Eventually, our patients reach a maintenance dose of between 2-8 peanuts or tree nuts a day.
 
Although the patient is not cured, they are desensitized, and it is much safer for them, especially if they inadvertently ingest a small quantity of their allergy. We have now expanded the treatment to include other foods such as egg and wheat. The treatment involves a great deal of time and effort for the families and our healthcare providers but has been incredibly rewarding for everyone, and we are finally on the road to making the world a safer place for food-allergic patients.

Provided by: David Hauswirth, MD (Allergist / Immunologist)

Often we are asked to evaluate someone with ear problems and asked, “do allergies cause ear problems?” The simple answer is yes. The Eustachian tube drains the middle ear into the back of the nose. In someone suffering from allergies, the Eustachian tube can swell or not work correctly. This lack of function and drainage will cause fluid to build in the middle ear, leading to temporary hearing loss and sometimes ear infections.

Patients with allergies will often have ear symptoms. Sometimes the ears will itch, feel full, pop or have pressure. Manytimes clear fluid is found in the middle ear when someone has allergies. This fluid will often drain as allergies are treated. However, if allergies are not treated, this fluid can stay in the middle ear and become infected. Once someone develops an ear infection, the cause and the infection must both be treated.

Children are unique, and they will naturally have more issues with their Eustachian tubes. In a young child, the Eustachian tube is in a more horizontal or flat position. This positioning decreases natural drainage by gravity. When allergies and allergic inflammation are added, kids can have even more trouble clearing fluid. Sometimes when the fluid does not clear and recurrent ear infections are an issue, external drainage tubes (“ear tubes”) are necessary to help clear fluid from the middle ear to prevent infection.

In children, it is important to determine the cause of ear problems. It may simply be upper respiratory infections, young age, and anatomy or allergies. It is important to talk to your doctor if you think allergies are causing symptoms, and if you have ear infections, they may be related.

Provided by: Michael Goodman, MD (Allergist/Immunologist)

Sinusitis is a common problem seen in both ENT and allergy offices. Sinusitis is inflammation of the sinuses, air-filled cavities located in facial bones around the nose. Sinusitis is often due to an infection in these cavities. It can feel like a bad cold with facial pain, runny nose (rhinorrhea), headache, nasal congestion, and a sore throat. While the common cold is a viral infection, sinus infections are often bacterial and treated with antibiotics (antibiotics are not of help in the treatment of viruses).

Many conditions can contribute to the onset of a sinus infection. Many of them involve blockage of the natural drainage of the sinuses and the nose. When this drainage is blocked, bacteria present in the nose have an easier time replicating and increasing their numbers to the point that a sinus infection occurs. Inflammation that starts as a cold can increase the chances of a sinus infection starting. Allergic rhinitis (allergic inflammation of the nose) can also create inflammation that results in blockage and increase the likelihood that a bacterial infection will take hold and cause sinusitis.

Allergists at Ohio ENT and Allergy Physicians are trained to diagnose sinus infections and many of the conditions that can lead to sinus infections. Allergy testing can help determine a patient’s allergic sensitivities and what allergens may be causing inflammation in the nose. In some cases, an examination of the immune system checks for immune deficiencies. Recurrent sinus infections are sometimes an initial presentation of an immune deficiency. We frequently partner with our ENT colleagues in the care of sinusitis patients, as an ENT physician can perform a thorough evaluation of anatomical abnormalities that can increase the likelihood of a sinus infection