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doi: 10.1097/01.HJ.0000293308.31429.e0
Hj Report
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The American Speech-Language-Hearing Association (ASHA) has withdrawn from the America's Hearing Healthcare Team Initiative (AHHTI), an effort launched in May 2001 by the American Academy of Otolaryngology-Head and Neck Surgery (AAO) to educate Americans about hearing loss and its prevention and care. The team, which ASHA joined in September, also includes the International Hearing Society (IHS) as well as AAO.

In its May 20 announcement that it was pulling out of the coalition, ASHA cited the inability of the member groups to agree on how to define the roles of each profession—the audiologist, the otolaryngologist, and the hearing instrument specialist. Nancy Creaghead, PhD, president of ASHA, explained, “Consumers need to clearly understand what services each member of the hearing healthcare system can and cannot provide consistent with laws and regulations. Because we could not reach agreement on acceptable definitions for AHHTI members, ASHA can no longer remain a partner in the initiative.”

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Controversial from the start

The AHHTI had been a subject of controversy among audiologists ever since ASHA decided to join it. Leaders of the American Academy of Audiology (AAA) charged that the initiative defined the audiologist as being subservient to the otolaryngologist, while placing audiologists and hearing instrument specialists on an equal plane.

AAA contended that the only reason that ASHA was willing to accept the terms of the agreement was that AAO agreed to include the statement, “The nationally accepted certification standard for audiologists is the ASHA Certificate of Clinical Competence (CCC-A).” The CCC-A has long been the primary bone of contention between the two organizations. ASHA promotes it as the most significant credential for audiologists. AAA contends that it is becoming increasingly obsolete, as educational standards and state licensure supersede ASHA certification in importance.

When it joined the AHHTI, ASHA acknowledged that the definitions of the participating professions needed work. However, the association said that it welcomed the opportunity to help increase public awareness of hearing loss and its treatment. ASHA also praised the initiative for recognizing audiologists as “autonomous professionals” who “may practice independently to identify, assess, and manage disorders of the hearing and balance systems.”

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No agreement in sight

In an interview last month with The Hearing Journal, ASHA president Creaghead said that the association originally decided to join the AHHTI because “we believed that it was better for us to be at the table” than to have the initiative proceed without input from audiology. Although acknowledging that some audiologists opposed the decision, Creaghead said that response from ASHA members was “overwhelmingly in support of giving it [the initiative] a try.”

She said that ASHA was successful in getting agreement on an appropriate definition of audiologist. However, she continued, after many months of discussions among the team members, “our view was that we were never going to come to an agreement on all three definitions.” She said that the definitions of the participating professionals “were overlapping” and “we didn't feel that the distinctions among them were clear to consumers.” Specifically, she said, they failed to differentiate the roles of the audiologist and the hearing instrument specialist. Also, she said, ASHA could not support AAO's position that the definition of otolaryngologist include the implication that the physician exercises a supervisory role over the audiologist in the testing of hearing and balance.

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Reactions from other organizations

In response to ASHA's decision, G. Richard Holt, MD, executive vice-president of AAO, expressed disappointment. He added, “We respect ASHA's decision and will continue the productive professional relationships among many otolaryngologists, audiologists, and hearing aid specialists that ultimately benefit our patients.”

Following ASHA's withdrawal, the definition of audiologists on the AAO web site was revised. It no longer includes any statement about the independence and autonomy of audiologists and the reference to the CCC-A was dropped. Asked about the changes, Holt told the Journal that AAO had negotiated those parts of the definition in good faith and was prepared to stand by them. However, he said, AAO felt that these were part of ASHA's message and that once ASHA had left the hearing healthcare team, it was that organization's job, not the team's, to carry the message.

Scott Austin, BC-HIS, president of the International Hearing Society, said, “We're saddened that ASHA chose not to participate in this important health education effort.” He added, “IHS, which has both hearing aid specialist and audiologist members, is proud to be on America's Hearing Healthcare Team.”

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Approval from AAA

On the other hand, Angela Loavenbruck, EdD, president of AAA, welcomed ASHA's decision. “They did the right thing,” she told the Journal. “We're pleased that they withdrew in the interest of audiologists.”

In recent months, there have been anecdotal reports that many audiologists had resigned from ASHA over the issue. Was that a factor in ASHA's decision?

Creaghead said that it was not, adding that by ASHA's best estimate fewer than 20 audiologists have relinquished their certification or membership in the association over its joining the AHHTI.

Loavenbruck declined to speculate on ASHA's reasons for leaving the team and said that she did not know how many audiologists had resigned from ASHA over the issue. However, she reported that AAA had received more new membership applications in January 2002 than in all of 2001.

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Under legislation passed last July 1, the Louisiana Commission for the Deaf (LCD) will soon begin providing basic hearing aids, at no charge, to qualified older residents of the state. Nan Faulkner, the executive director of the commission, said that she expects LCD to begin processing hearing aid applications in September.

To qualify for hearing aids, which will be limited to behind-the-ear, in-the-ear, and in-the-canal instruments with a manufacturer's single-unit wholesale price of no more than $400, an applicant must have a documented hearing loss of 40 dB or greater. Applicants must generally be age 50 or over. They must not be eligible for other state or federal hearing aid assistance programs and their household income cannot exceed 250% of the federal poverty guidelines. That means that the cut-off point will be about $22,000 for an individual and about $29,000 for a couple.

Individuals whose applications are approved will pay nothing for hearing aids or the related services. The state will reimburse participating audiologists and hearing aid specialists up to $400 per hearing aid (with a 30-day trial period), $65 for the evaluation, a dispensing fee of $325 for one hearing aid and $500 for a binaural fitting, $50 for each earmold, and $32.50 per session for up to two follow-up appointments. The dispenser will also be required to provide the patient with a 30-day supply of batteries.

The state will pay for the program largely from the LCD Telecommunication Fund for the Deaf, which, since 1988, has been receiving the proceeds from a 5-cents-per-month tax on every telephone line in Louisiana. Originally, the fund paid only for devices designed to give hearing-impaired people equal access to telecommunications. However, money began accumulating in the fund (Faulkner said the balance was about $6 million), so the 2001 law expanded the permissible uses. Last year, it became available for assistive devices. This year, the fund, supplemented by a $750,000 appropriation by the legislature, will start paying for hearing aids.

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Concerns from professionals

Hearing professionals in Louisiana and on the national level applauded LCD's desire to make hearing help available to people who might not otherwise be able to afford it. However, while reluctant to speak on the record, some criticized the specifics of the program, despite its good intentions.

One fear is that by limiting reimbursement to $400 per hearing aid, the program will fail to achieve its stated goal of providing “a hearing aid that best meets the needs of the consumer.” Instead, professionals warned, participating consumers may be dissatisfied with the hearing aids they get, which will be bad for them and create negative reports about hearing aids. Also, some say, the program will discourage people who might otherwise get a better fitting. While some applicants might be unable to afford any hearing aids without the program, others who meet the program's income eligibility standards could afford more advanced instruments.

An advocate of third-party coverage of hearing aids told the Journal that the best plans are those in which the state or insurance company pays a specified amount toward the purchase of hearing aids, allowing consumers to spend more if they choose. He said that a defined benefit, such as that in Louisiana, discourages innovations by manufacturers and limits treatment options.

Some practitioners in Louisiana also said that the reimbursement for fitting patients is too low to make it worth their participating in the program.

Faulkner is aware of these concerns, but said, “We have to help as many people as we can with what we have, and $400 is all we can afford.”

She also noted that the final measure reflects input from dispensers and manufacturers. Originally, the program would have provided lower payments for dispensers' fees ($275 for one aid, $400 for two) and set no income limit on clients.

As for the possible reluctance of dispensers to participate, Faulkner said that even when the reimbursement was lower, a third of the dispensers in Louisiana indicated that they would take part in the program. With the higher reimbursement, she said, “I'll bet that 65% to 70% will say, ‘count me in.’”

Although Louisiana represents less than 1% of the U.S. hearing aid market, national professional and industry organizations are watching the state's new program closely, since programs adopted in one state are often copied in others.

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Amplifon USA and Sonus Corp. announced on June 19 that they had reached an agreement for Amplifon to purchase Sonus for $38.4 million in cash.

Based in Portland, OR, Sonus is one of North America's largest networks of audiology centers. It owns 88 retail stores in the U.S. and Canada, and the Sonus Network includes an additional 900 independently owned affiliates. Amplifon USA, of Minneapolis, already owns Miracle-Ear, which operates hearing aid centers at 160 corporate retail and 850 franchise retail locations in the U.S. Amplifon USA is a subsidiary of the Milan-based Amplifon S.p.A., Europe's largest hearing aid distributor.

Under the agreement, which is scheduled to take effect October 31 if Sonus stockholders approve it, the Sonus Network will continue to operate under that name.

Owners of common stock in Sonus will receive $1 per share, 19 cents more than its price when the announcement was made. Earlier in the year, the stock price dipped as low as 37 cents. Its 12-month high was $3.20 and it sold for nearly $10 in 1988 when Sonus was first listed on the American Stock Exchange

There will be more about Sonus and Amplifon in next month's cover story on dispensing networks.

© 2002 Lippincott Williams & Wilkins, Inc.