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ACA in 2014: Potential for Drastic Changes

Parker, Mark A. PhD

doi: 10.1097/01.HJ.0000449896.78914.d9

Dr. Parker is director of audiology at Steward St. Elizabeth's Medical Center and assistant professor of otolaryngology at Tufts University School of Medicine in Boston.



On April 17, the White House announced that 8 million Americans had signed up for private insurance through the Affordable Care Act (ACA)’s Health Insurance Marketplace.

As the implementation of the ACA continues to unfold and the individual mandate requiring most people to purchase health insurance or pay a penalty goes into effect, what do these reforms mean for our profession? Although it is difficult to predict the future, the changes could have a drastic effect on our methods of delivering hearing healthcare.

First, the enrollment of more people in health insurance may lead to more patients referred to our clinics for hearing- and balance-related diagnostic evaluations.

Second, the Affordable Care Act provided states the option to expand Medicaid eligibility so that individuals and families at up to 133 percent of the federal poverty level are included. To date, 25 states have accepted this expansion. There may be an increase in Medicaid hearing aid sales in states with expanded coverage and hearing aid benefits.

The degree to which health insurance exchange plans will offer hearing aid benefits to their customers is to be determined. However, the trend in my state—Massachusetts, the home of “Romneycare,” a precursor of “Obamacare”—is that more insurance carriers are providing hearing aid benefits to their customers.

In my experience, this increase in coverage has resulted not only in people purchasing hearing aids at a lower out-of-pocket cost, but also in decreased reimbursement from some insurance providers to our clinics.

Finally, restructuring Medicare from a fee-for-service system to a bundled payment system has the potential to significantly change the way we practice.

Currently, bundled payments are being tested primarily by Accountable Care Organizations (ACOs), which attempt to tie provider reimbursement to quality metrics. ACOs are mostly focused on general procedures, such as maternity care and hip replacement, rather than specialty services.

Depending upon the success of these pilot programs in delivering quality care at a lower cost, a similar transition may await our field as well.

Fortunately, where there is change, there is opportunity. A synergistic increase in the older population and in the number of people enrolled in health benefits that include hearing aid coverage may require us to meet the demand by employing additional audiology assistants and hearing instrument specialists and using more tele-audiometry in our practices.

Demonstrating that we can deliver high-quality hearing healthcare at a lower cost than other professionals may also promote direct access to our services.

There are new opportunities to develop ACOs that include global payments for the comprehensive treatment and rehabilitation of hearing and balance disorders. In such a scenario, rather than being reimbursed for diagnostic services, such as comprehensive audiometry, our reimbursement would be tied to improving patient outcomes.

Fortunately, several validated metrics for patient-centered outcomes already exist in our field, such as in-situ audiometry and Hearing Handicap Inventories to assess hearing aid outcomes.

Moving from technical metrics, such as real-ear validation of target gain, to a patient-centered metric, such as aided soundfield thresholds and discrimination, would redirect the focus from optimal fitting algorithms to optimal patient-based outcomes.

If implemented, this change alone would go a long way toward our achievement of professional recognition within the broader healthcare community.

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