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Editorial: ADA ‘18x18’ Initiative Change, but No Change

Smith, Kenneth E. PhD; Engelmann, Larry AuD

doi: 10.1097/01.HJ.0000429412.38667.f4

Dr. Smith, left, and Dr. Engelmann are private practitioners and past presidents of the Academy of Doctors of Audiology.





The Academy of Doctors of Audiology (ADA) should be applauded for developing the “18x18” initiative. It positions audiologists as an entry point into the healthcare system for hearing and balance services, representing a real improvement in public access to audiologic care.

The legislation proposed by the ADA would amend Title XVIII of the Social Security Act by 2018. Currently, Medicare requires a written order/referral from a physician or other specialist in order to cover diagnostic audiology services. The order/referral cannot include any statement about evaluating the patient for the purpose of fitting hearing aids. The documentation of medical necessity is the audiologist's responsibility, regardless of the referral source.

Several glaring problems are addressed by this initiative:

  1. The referral technically can come from any medical specialty, including obstetrics, dermatology, podiatry, optometry, and other disciplines unrelated to hearing and balance issues.
  2. The evaluation can be repeated only if a change in hearing and balance is suspected and that change has a high probability of being a medical issue.
  3. This latter requirement leads to additional expense for the patient and to Medicare, as well as more appointment time for the physician.

Adding audiologists to the list of direct providers would result in more efficient, timely, and cost-effective care to patients from practitioners eminently qualified to diagnose and treat hearing and balance disorders. The result would be a direct savings of time and cost, as well as the implied option to address the Medicare referral and reimbursement requirements.

The Academy of Doctors of Audiology has made it clear that “18x18” is not merely an ADA project. Rather, this initiative creates a golden opportunity to unite the profession and include all national organizations representing audiology, as well as state audiology organizations; doctoral programs, including faculty and students; and licensing boards. This initiative combines the American Academy of Audiology's work advocating for direct access to audiologists and the American Speech–-Language–Hearing Association's efforts promoting reimbursement to audiologists for aural rehabilitation and vestibular rehabilitation services, which currently are reimbursable to speech–language pathologists and physical therapists, respectively, but not audiologists.

The ADA-proposed legislation would recognize audiologists as limited license physicians under Medicare for reimbursement purposes. There is a risk that this change might diminish the role of primary care physicians. Why is this issue relevant to patient care? Every bit of survey data available to us supports the fact that the primary care physician is the main motivator of patient behavior and action to seek hearing healthcare. The role of the primary care physician assumes even more importance when one considers the impact of hearing loss on quality of life, depression, dementia, Alzheimer's disease, and other critical medical issues.

In our opinion, unless audiologists continue and expand their education of primary care physicians, market penetration figures will stay exactly where they are, regardless of the entry point for services. This issue requires more, not less, attention in AuD programs.

Change? Yes. The audiologist should be an entry point to hearing and balance care.

Change? No. The role of the primary care physician remains critical to the early identification and treatment of hearing and balance problems.

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More on ‘18X18’ Next Month

HJ's cover story explores scope-of-practice issues in hearing healthcare, and how this initiative can help.

© 2013 Lippincott Williams & Wilkins, Inc.