Hearing healthcare organizations stand divided on the Medicare Audiology Services Enhancement Act of 2015 (H.R. 1116), which supporters say would increase access to care by allowing Medicare beneficiaries to receive diagnostic and treatment services from audiologists, and opponents say would accomplish just the opposite, in effect restricting access to audiology services.
The legislation was introduced Feb. 26 by Rep. Gus M. Bilirakis (R-FL). The bill's language remains the same as that used in the Medicare Audiology Services Enhancement Act of 2013 (H.R. 2330), which also saw strong opposition in the audiology field.
The American Speech–Language–Hearing Association (ASHA) continues to support the legislation, which would allow audiologists to be reimbursed for hearing and balance assessment services, auditory treatment services, vestibular treatment, and intraoperative neurophysiologic monitoring.
“The current bill is the result of gathering feedback on what members want, what is feasible within the current political climate, and what best positions audiology in the future of healthcare,” said Neil DiSarno, PhD, ASHA's chief staff officer for audiology, in an email to The Hearing Journal (HJ).
The American Academy of Otolaryngology–Head and Neck Surgery (AAO–HNS) also continues to support the Medicare Audiology Services Enhancement Act, said James C. Denneny III, MD, executive vice president and CEO of AAO–HNS, in an email to HJ.
“As the healthcare system continues to evolve, lawmakers are seeking ways to improve efficiency, reward quality, and ensure timely access to healthcare for patients within the Medicare program. We view H.R. 1116, and our collaboration with ASHA, as a means to accomplish that goal.”
OPPOSED BY AAA & ADA
The American Academy of Audiology (AAA) and the Academy of Doctors of Audiology (ADA) oppose the legislation because it goes against their pursuit of greater professional autonomy and would not improve patients’ ability to get the audiology care they need, representatives of the organizations said in email interviews.
“The Academy believes that, if passed, this bill would increase physician oversight for audiologists for the added services that are already within audiology's scope of practice,” said AAA President Erin L. Miller, AuD. “Audiologists are licensed in all 50 states and the District of Columbia to provide treatment and rehabilitation services directly to patients, within their scope of practice, without physician oversight.
“We cannot support legislation for our nation's seniors that reduces or impedes access to audiology services, particularly when they differ from what patients under the age of 64 can receive. Additionally, the expanded services included in the bill do not include some of the services audiologists provide in their practices, namely tinnitus and cerumen management.”
The bill, the ADA said, will have negative impacts for both patients and audiologists.
“Under this legislation, many audiologists would likely be unwilling to provide rehabilitative services, which they're currently providing to Medicare beneficiaries now at no charge or on a private-pay basis,” said ADA President Kim Cavitt, AuD. “This would restrict access to audiologic and vestibular rehabilitative care, not enhance it.
“It could also add unnecessary bureaucracy and paperwork to an already burdened system. It could take an audiologist as much time to meet the plan-of-care requirements and obtain this certification as it does to actually treat the patient.”
Dr. Cavitt was referencing H.R. 1116’s requirement that the audiologist establish a plan of care for providing these Medicare-covered services, and that the plan be periodically reviewed by the referring or ordering physician.
She also said the bill affects the Medicare therapy cap, or the limit Medicare law imposes on payments for medically necessary outpatient therapy services provided within a single calendar year.
“Given that these services, if provided by a physician, speech pathologist, or physical therapist, are currently being provided within the Medicare therapy cap, we see the inclusion of the services in that same structure to allow for additional providers to drain dollars from the much-needed therapy cap reimbursement pool. This could affect a patient's reimbursement for needed physical or speech therapies.”
Dr. DiSarno, however, said ASHA doesn't believe this bill will subject audiologists to the therapy cap any more than other Medicare audiology bills would, and the legislation does not include amendments or references to therapy cap law.
“Private-practice audiologists are under tremendous pressure from online hearing aid sales, nonprofessional sellers, rapid technology changes, and more,” he said. “Being recognized as a provider of treatment services by the largest medical payer (the federal government) is key to the future of the profession.”
The AAA and ADA are encouraging their members to contact their congressional representatives and express opposition to this legislation.
Dr. Cavitt said, “ADA, through our lobbying firm, will also be on Capitol Hill actively opposing this legislation, as well as continuing our push for the Audiology Patient Choice Act,” which would add audiologists to the list of limited-license physicians recognized by Medicare (HJ October 2014 issue, pp. 8-12http://journals.lww.com/thehearingjournal/Fulltext/2014/10000/New_Legislation_Would_Grant_Limited_License.2.aspx; HJ January 2015 issue, p. 34http://journals.lww.com/thehearingjournal/Fulltext/2015/01000/AAA_Supports_Bill_for_Autonomous_Audiology.8.aspx). “We will get ‘boots on the ground’ to oppose this legislation at every turn.”