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Economic Interplay of Medicare and Audiology

Windmill, Ian M., PhD; Freeman, Barry A., PhD

doi: 10.1097/01.HJ.0000558444.06539.45

Dr. Windmill, left, is a past-president of the American Academy of Audiology (AAA) and the clinical director of the Division of Audiology at Cincinnati Children's Hospital Medical Center. Dr. Freeman is the president of Audiology Consultants, Inc, and a past-president of AAA.

Over the past 10 years, numerous efforts have been undertaken to change the standing of audiology within the Medicare program. These efforts have focused on several key factors, including (1) allowing Medicare beneficiaries to access audiology services without a physician referral and (2) having Medicare pay for audiology treatment services such as audiologic rehabilitation or cerumen removal. These proposed changes are often tied to the political perspective of reducing costs to Medicare or more importantly, increasing patient access while reducing co-pays for Medicare beneficiaries and improving patient outcomes.

To understand the financial impact of these efforts on clinical practices at the provider and patient levels, we looked into Medicare payments for audiologic procedures (current and previous years’ payments are available on the Medicare website). This information led us to access the Medicare databases that listed each individual audiologist and the specific characteristics of the beneficiaries they served. We discovered that Medicare tracks details such as how many Medicare beneficiaries are served by an audiologist, how many procedure codes are billed, the amount billed per provider, and the amount allowed by Medicare. These same databases include the demographic characteristics of patients served by each provider and, perhaps most interestingly, the percentage of patients with various comorbidities for each provider. For example, on average, nearly 65 percent of patients seen by audiologists in 2017 had hypertension, 55 percent had hyperlipidemia, 29 percent had diabetes, and 25 percent had chronic kidney disease.

These data led us to question the relation of these comorbidities to hearing status, as well as the role of audiologists with respect to these comorbidities. The relationship between kidney disease and hearing loss has long been appreciated, and evidence of a more significant relationship between cardiovascular disease and hearing and between cognitive status and hearing loss is emerging. It certainly wouldn't be the role of audiologists to manage diabetes or hypertension, but might audiologists have a role in assessing the general health status of patients even if that assessment is asking the right questions? Or might the audiologist have a role in the early identification of comorbid conditions that helps reduce costs to patients and to payers? By extension, it is time to revisit the current audiology test battery to ensure that processes are sensitive and robust enough in identifying markers not only of hearing loss but also of other medical conditions.

The Centers for Medicare and Medicaid Services (CMS) grant audiologists the right to provide reimbursable clinical services that are medically necessary to Medicare beneficiaries and, in return, expect outcomes and recommendations to help manage and treat these patients. By considering patients in the context of their overall health, audiologists may be able to provide further economic benefit to patients and payers, particularly if they can get beyond the pure tone audiogram and the idea that hearing loss exists in isolation from other health conditions.

As we undertake this project to examine the financial impact of Medicare on audiology practices, we've come to realize that audiology practices can have a significant financial impact on Medicare and their beneficiaries. One of our key takeaways was that audiologists have the knowledge and skills necessary to identify, manage, and treat Medicare beneficiaries who have a confluence of health-related issues that may be identified early by the audiologist or mitigated by audiology services. Audiologists must proactively offer their full scope of hearing and balance services to these patients and secure our role in the evaluation and management of individuals with hearing and balance disorders.

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