While improving patient access to care has long been a major objective of the audiology field, bills seeking to accomplish that have taken different tacks. The latest piece of legislation, the Audiology Patient Choice Act (H.R. 5304), would add audiologists to the list of physicians recognized by Medicare.
The bill, which was introduced July 31 by U.S. Reps. Lynn Jenkins (R-KS) and Matt Cartwright (D-PA), came out of the Academy of Doctors of Audiology (ADA)’s 18x18 initiative, which calls for the amendment of Title XVIII of the Social Security Act by 2018 to allow for the changes included in the legislation ( HJ April 2013 issue, p. 2http://journals.lww.com/thehearingjournal/Fulltext/2013/04000/Editorial___ADA__18x18__Initiative___Change,_but.2.aspx; HJ May 2013 issue, p 14http://journals.lww.com/thehearingjournal/Fulltext/2013/05000/Cover_Story___Unlocking_Direct_Audiology_Access.1.aspx).
“Medicare really has not kept pace with best practices for the delivery of hearing and balance care,” said Eric Hagberg, AuD, ADA advocacy chair, in a phone interview.
“The healthcare delivery models of the future are being designed to ensure that every practitioner is working to his or her full scope of practice. It's so important that we do this so we achieve patient-centered care that is also cost-effective.”
The Audiology Patient Choice Act would allow seniors with a suspected hearing or balance disorder to seek treatment directly from an audiologist, eliminating the need for a referral from a medical doctor, and authorize Medicare to reimburse audiologists for the Medicare-covered services they are licensed to provide.
“This legislation aligns with best practices and with what audiologists are already doing under their state-defined scope of care,” said ADA President Brian Urban, AuD, in a phone interview.
“The legislation would not expand or create new services for audiologists to be reimbursed under Medicare. It also would not impact the state requirements for the practice of audiology or add prescription rights.”
ROOTS OF LEGISLATION
The Audiology Patient Choice Act reinforces elements of previous bills, Dr. Urban said, such as the Medicare Hearing Health Care Enhancement Act of 2011 (H.R. 2140) and the Medicare Audiology Services Enhancement Act of 2013 (H.R. 2330), which would recognize audiologists as diagnostic and treatment providers for Medicare reimbursement and would not eliminate the current Medicare referral requirements.
“We were looking at the ideas that were out there to try to pull them into one framework that really gives a more complete solution to the issues that face our patients,” Dr. Urban said.
As far as the statuses of the older pieces of legislation, H.R. 2140 died in a previous session of Congress, and H.R. 2330 was referred to the Subcommittee on Health in June 2013.
Although the American Academy of Otolaryngology–Head & Neck Surgery (AAO–HNS) supported H.R. 2330, it opposes the Audiology Patient Choice Act.
“The way the language of the bill is crafted doesn't address patient safety concerns and our concerns for resource use,” said David Nielsen, MD, executive vice president and CEO of AAO–HNS, in a phone interview.
“We would like to be consulted before the fact rather than to hear about it after the fact and then have to do our own assessment, come up with our own conclusions, and inevitably, it seems, come up with concerns that are deal breakers for us.”
AAO–HNS was consulted by the American Speech–Language–Hearing Association (ASHA) about the Medicare Audiology Services Enhancement Act, ultimately leading to the Academy's support of the bill.
“ASHA has put their efforts toward comprehensive benefits and rehabilitation in an effort to be able to document outcome measures relative to the benefits of the patients we treat,” said Neil DiSarno, PhD, ASHA's chief staff officer for audiology, in a phone interview. He declined to comment on the Audiology Patient Choice Act.
The American Academy of Audiology (AAA) posted a statement about the new bill on its website:
“The Academy fully supports efforts toward physician status for audiologists,” said AAA President Erin L. Miller, AuD, in the statement.
“However, based on the current congressional conditions and the extensive counsel provided to the Academy regarding achievability and overall strategy inherent to this initiative, the Academy will place its current efforts in the pursuit of direct access as the most achievable first step in this long-range plan.”
EFFECTS ON PATIENTS, AUDIOLOGISTS
Barry Freeman, PhD, president and CEO of Audiology Consultants and a past president of AAA, said now is the right time to introduce this new legislation.
“I personally think that ADA is probably taking the correct approach,” he said in a phone interview. “I think it's very positive to have our profession recognized as equivalent to other healthcare professions.
“If we look at a big picture for the profession—if we look at recruiting students to come into our profession, etc.—it's a very positive feature of the profession to have this kind of status and recognition.”
If this legislation passes, audiologists will be able to provide services that are within their scope of practice but are not currently allowed without physician “supervision,” such as aural and vestibular rehabilitation, and cerumen management, said Kenneth E. Smith, PhD, operations manager for the Hearing Center of Castro Valley, a member of The Hearing Journal Editorial Advisory Board, and a past president of the ADA, in a phone interview.
“It would make a big change for patient expense and convenience; it would make a big change in the efficiency of care; it would make no change to the cost engendered by Medicare.”
Robert M. DiSogra, AuD, owner and director of Audiology Associates of Freehold in Freehold, NJ, agreed that the current referral requirement is cumbersome for patients and their caregivers.
“For our older patients who don't drive, that requires having someone drive them to a physician's appointment to have a physician look in their ears and ask them a few questions, and, if there's nothing obvious, then they're going to refer for a hearing test, which means that they've got to set up a second appointment,” he said in a phone interview.
“My concern here really has to do with the extra burden on patients to have two appointments when they can get it done in one appointment.
“If there's any pathology or red flags, audiologists are trained to identify the red flags, and we're going to refer.”
LOOKING TO THE FUTURE
The potential implications of the Audiology Patient Choice Act have much to do with the changing healthcare system in general.
“We're training a generation of healthcare providers, and that includes audiologists and physicians and everybody else, for a system of healthcare delivery in evolution,” Dr. Nielsen said. “It hasn't even been invented yet.
“If we move forward within the next few years, as healthcare reform is doing, to alternative healthcare models and global accountability for outcomes, many of these questions that come up about access to care are going to melt away.”
Dr. Freeman raised the question of whether direct access to audiologists is inevitable given the establishment of accountable care organizations (ACOs) and the rising popularity of salary-based compensation for physicians.
“So, will the legislation pass?” Dr. Freeman asked. “I don't see anything passing, especially in the area of healthcare right now, but I do see possibilities of this happening internally in facilities.
“These major medical centers are going to say, ‘Well, this is just not cost-effective. Why do we have all of these doctors of audiology and we're not letting them perform their scope of practice?’”
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PODCAST INTERVIEW EXTRA: EXPERTS ANALYZE AUDIOLOGY PATIENT CHOICE ACT
Only in the October iPad issue, listen in as Eric Hagberg, AuD, advocacy chair for the Academy of Doctors of Audiology (ADA); Kenneth E. Smith, PhD, a member of The Hearing Journal Editorial Advisory Board and an ADA past president; and current ADA President Brian Urban, AuD, describe how the Audiology Patient Choice Act came to be, what it would and would not do, and why they're optimistic about its potential.
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