The Field of Audiology Audiology: A Profession in Transition Wayne A. Foster, PhD, CCC-SLP/A Chair, Audiology Advisory Council ASHA Board of Directors Heritage of Audiology What Makes Audiologists Unique? Expansion of Scope of Practice Doctor of Audiology A Bit on ASHA The Future of Audiology Heritage of Audiology: Evolution Heritage of Audiology: Foundational Figures Harvey Fletcher Hallowell Davis Pre WWII Physicians, Otologists & Commercial Dealers Raymond Carhart Norton Canfield The Ewings (Alexander & Ethel) Post WWII Military Aural Rehab Centers André Djourno Georg von Békésy Peter Dallos James Jerger Heritage of Audiology: Technology Can you remember? 1st cochlear implant ABR technology OAEs were identified 1st BTE introduced Middle ear function was measured
Heritage of Audiology: Breakthroughs These three advances were critical: What Makes Audiologists Unique? Scope of practice Assess Middle Ear Function (Tympanometry) Evidence-based research Assess Cochlear Function Doctoral degree required (Otoacoustic Emissions - OAE) Clinical care Assess Retro Cochlear Function (Auditory Brainstem Response - ABR) Scope of Practice Life-changing profession Audiology Doctoral Career Expanded curriculum to cover Human Communication Practice areas that overlap other disciplines Intraoperative Monitoring Vestibular Assessment/Rehab Cerumen Management increased scope of clinical practice Incorporated clinical work throughout Audiology SpeechLanguage Pathology the course of study Value of doctoral education is learning how to problem solve(must be adaptive) Must evaluate program of study and clinical experience related to long-term career path. A Bit on ASHA A Bit on ASHA: Advocacy More than 150,000 members World s largest association of audiologists (Over 14,000) Dedicated to advancing audiology as a profession The audiology/slp seat at the table with the Center for Medicare and Medicaid Services (CMS). Since 2003, 11 codes approved for audiology Medicare Audiologic Rehabilitation Act (2003) Medicare Hearing Health Care Enhancement Act (2007) Funding for industry research and policy initiatives Spearheading collaborative efforts Advocating for the professional Public education Credentialing Audiology Resources
A Bit on ASHA: Public Awareness Better Hearing and Speech Month Listen to Your Buds Americans with Disabilities Act (ADA) Individuals with Disabilities Education Act (IDEA) Universal Newborn Hearing Screening (UNHS), and Early Hearing Detection and Intervention (EHDI) Classroom Acoustics Healthy People 2020 Consumer Helpline Audiology Resources Technical Assistance Publications and Web Site (www.asha.org): 4 scholarly journals, including American Journal of Audiology Audiology Connects and Access Audiology The ASHA Leader Articles and practice policy documents Special Interest Divisions Career & Business Development: EdFind Career Mover CD Online Career Center ProSearch ASHA Offers Governance: Audiologists have equal voice Same number of profession-specific positions on the Board of Directors Audiology Advisory Council Professional Development Research Annual Convention & Conferences Continuing Education ASHA Foundation, Travel Award Program & Scholarships Member Discounts The Future of Audiology What if Hair cell replacement supplanted hearing aids? Medicare benefits expanded to include diagnostic services? Genetic breakthroughs prevented hearing loss or restored hearing? Telepractice by audiologists became widespread? Medicare paid for hearing aids? What would this mean for the field? National Office President Vice Presidents Advisory Council NSSLHA CEO President Science & Research Chair: Audiology National Advisor National Office Board of Directors Past President Planning Chair: SLP President Elect Standards & Practice: Aud Standards & Practice: SLP Academic Affairs: Aud Advisory Council Chairs Vice Presidents Academic Affairs: SLP SLP Practice Aud Practice CBC CBC CBC CBC CBC Finance Basic Board Structure Government Relations & Public Policy Committee/Boards/Councils
Advisory Councils Governance Restructure in 2008 Eliminated the Legislative Council (LC) Voting body State representatives Number of representatives determined by number of ASHA members in the state Advisory Councils One SLP and one Audiology member per state Not representing the state Reflection of broad array of work sites and areas of expertise (Note: 25% are private practice/dispensing audiologists) Provides advice to the Board of Directors SLPAC and AAC: 2012 Specific Issues Facing Audiologists March AC Meeting: Face-to-Face ASHA Collaboration Site: Monthly Interactions Provides input to BOD and responds to targeted questions. What is Direct Access? The ability to see a patient without a referral from a physician or other health care provider. Current Status for Audiology Services Impact on Clients and Clinicians Client Physician Audiologist Limits beneficiary choice of providers Increases costs to Medicare program Increases wait time to see an Audiologist Inefficient use of physician resources Administrative burden on audiologists to track down referral if patient comes in without one Direct Access to Audiologist
Current Medicare Policies Audiometric Testing Current Medicare Coverage Audiology Services Audiology services are recognized for Medicare purposes as a diagnostic test under the Social Security Act (Sec. 1861 (s)(3)) Regulations require that diagnostic tests be ordered by a treating physician for the purpose of using the results of the test in the management of the beneficiaries specific medical problem. (42 CFR 410.32) What is an audiologist in the current CMS service provider paradigm? EVERYONE recognizes this as a problem! Testing must be for: obtaining additional information necessary to make a diagnosis evaluation of the need for the appropriate type of medical or surgical treatment of a hearing deficit or other medical problem. Audiology services are not covered when the diagnostic services are furnished only to determine the need for a hearing aid. Rehabilitative services are NOT covered. Medicare Direct Access What it would mean for Audiologists Beneficiaries could go directly to an audiologist. Audiology will remain a diagnostic benefit. Medicare will not pay for services deemed not medically necessary or can be perceived as a screen. Need to develop additional education of patients on Medicare coverage policies and exclusion of audiology services related to hearing aids. Direct Access to Audiologists Legislation H.R. 3024 Medicare Hearing Health Care Enhancement Act of 2009 Section 3: Allows Medicare beneficiaries direct access to an audiologist Section 4: Defines audiology services as a diagnostic benefit Section 5: Nothing in the act will expand scope of audiology services for which payment can be made under Medicare Prior to 2009 ASHA backed the Direct Access approach. (Members of the GRPP Board presented at the ASHA Convention on this issue.) Direct Access CMS Report Comprehensive Audiology Benefit Cost/Fiscal Impact on the Medicare Trust Fund In the 2010 Medicare Physician Fee Schedule final rule, CMS stated that it will not reimburse any audiology service that can be construed to have an evaluation and management or therapeutic component. Impacts tinnitus code, auditory rehabilitation and cochlear implant codes. CMS had indicated concerns with increased cost Historically Congressional Budget Office (CBO) factors in woodworking effect*. No concrete data on cost of direct access or comprehensive benefit High cost requires an offset in the Medicare program CMS made this ruling based on the fact that audiology services are covered as part of the diagnostic benefit. * Woodworking Effect: If benefit is available more providers will enroll and beneficiaries will access.
Direct Access Potential Solution to CMS Concerns Comprehensive Audiology Benefit Work with Congress to define in statute a comprehensive audiology benefit that would include both diagnostic and therapeutic intervention. Comprehensive benefit would include direct access to audiology services. Not include coverage of hearing aids. ADA s 18 X 18 Initiative Title XVIII of the Social Security Act amend to provide for the treatment of audiologists as physicians for the purposes of furnishing services under Medicare. It would also broaden the scope of audiology services. (Limited practice physicians) 2018 The date by which this initiative would become law 18 X 18 Allow for Medicare coverage of medically necessary, covered treatment services such as vestibular rehabilitation, cerumen removal, and aural rehabilitation provided by an audiologist practicing within their state defined scope of practice. Eliminate the need for the physician order required for a Medicare beneficiary to receive coverage of medically necessary, covered audiology and vestibular services Allow audiologists the autonomy to make clinical recommendations and practice the full scope of audiology and vestibular care as allowed by their state license and as dictated by their educational requirements and competencies. ASHA Approach Medicare coverage of comprehensive audiology services in coordination with current billing and reimbursement standards Be consistent with other non-physician services covered by Medicare. Allow audiologists to bill for: hearing and balance assessment services auditory treatment services (including auditory processing and auditory rehabilitation treatment) vestibular treatment Intra-operative neurophysiologic monitoring In addition, audiologists will have the option to opt-out of Medicare. Issue: Service Provision System of Care A goal for the MAJORITY of the people in the U.S. with significant hearing loss -estimated >31 million: with ~24% currently being helped (Kochkin, 2005) Service Provision Clinic/Practice Un-rehabilitated hearing loss affects individual self actualization/quality of life as well as productivity Audiology Technician/ Telehealth Follow-up Audiologist Hearing loss is a personal problem, a family problem, a vocational/avocational problem, a societal problem reducing the capacity of our volunteer/wage earning work force Basic Intermediate Atypical
What we need now.. Alternative service delivery models National outcome database that drives.. Standards of practice (e.g., use of real ear) Reimbursement systems that match real costs. Healthcare Summit: 2012 Service delivery systems are being evaluated: The national healthcare debate is driving changes that audiologist must be in front of. Questions or Comments Telehealth Reimbursement Bundling or Unbundling Technological Changes Use of Technicians Online Purchases Biomedical Advances Outcomes Based Service Practice Models Training of Audiologists