The lowest level of “working together” with other disciplines in the practice of your profession is when professionals make their own decisions, effectively operating in silos.  A middle level of “working together” occurs when individual practitioners make independent decisions about a patient and then consult/communicate with the primary caregiver. 

A higher model of interprofessional healthcare refers to a form of practice wherein healthcare professionals from different disciplines and professions make up a health care team which makes informed and unified decisions about a patient’s care facilitated by intentional and  regular communication..  This week, Hearing International features guest author, Dr. Bettie Borton, former president of the American Academy of Audiology, who shares insights on an organization that promotes interdisciplinary discussion and collegial interaction, the National Academies of Practice (NAP)

 

Origins of the National Academies of Practice

 

The National Academies of Practice (NAP) is patterned after the historic National Academy of Sciences (NAS), a private, nonprofit organization of leading researchers in the U.S., dating back to 1863, that recognizes and promotes outstanding science through election to membership.  Now known as the National Academies of Sciences, Engineering, and Medicine, the NAS provides objective, science-based advice on critical issues affecting the nation. 

The NAP,  a practice counterpart to the NAS, is a non-profit organization that was founded in 1981 to advise governmental bodies on the healthcare system in the U.S. The National Academies of Practice differ from the National Academy of Sciences in that NAP’s members are practitioners who have been nationally recognized primarily for their contributions to professional practice rather than achievements in science, although many are renowned scientists as well. The NAP is the only interdisciplinary group of practitioners dedicated to addressing the problems of healthcare practice in the U .S.

It is the goal and the objective of this self-supported organization to constitute itself as the nation’s interdisciplinary health policy forum. When Distinguished Practitioners, Scholars, and Public Policy Fellows representing fourteen different health professions are elected by their peers, they join a select group of healthcare professionals who are dedicated to supporting affordable, accessible, coordinated quality healthcare for all through interprofessional practice. 

The original idea for the National Academies of Practice surfaced in 1976 when Nicholas A. Cummings, PhD, was testifying before the Subcommittee on Health of the U.S. Senate Finance Committee. The issue was Medicare reform and Dr. Cummings was representing the American Psychological Association.

During the proceedings, he became disturbed at the apparent lack of cooperation among the various health care professional societies. During dinner that same evening, Dr. Cummings suggested to his colleagues that what the Congress needed was an interdisciplinary body of health care practitioners that would set aside turf battles and advise Congress as to what was best for the American people. The concept for NAP was born. 

In ensuing years, the idea of limiting membership to the most distinguished practitioners from each profession surfaced. The prevailing sentiment was that practitioners who had already earned various honors, awards and recognition would be more willing to set aside parochial turf interests and forthrightly address the issues of national health.

Thus, the National Academies of Practice was incorporated in Washington, DC, on January 20, 1981. In 1982, NAP was awarded 501(c)(3) non-profit status. The first Academy formed was the NAP Psychology Academy.  At a historic ‘black tie’ gala event held at the National Press Club in Washington, DC, on August 23, 1982, the first Distinguished Practitioners were inducted into NAP by Founding President, Dr. Nicholas Cummings, and Ron Fox, NAP Psychology Chair. The establishment of more Academies soon followed, and NAP grew to represent 10 interdisciplinary Academies:

  • Dentistry
  • Medicine
  • Nursing
  • Optometry
  • Osteopathic Medicine
  • Pharmacy
  • Podiatric Medicine
  • Psychology
  • Social Work
  • Veterinary Medicine 

In 2014, NAP added four new Academies:

  • Audiology
  • Occupational Therapy
  • Physical Therapy
  • Speech-Language Pathology

In terms of organizational relevancy, NAP represents a great example of an organization whose time as has come, and the NAP-Audiology Academy has an important, new-found role within its ranks, that of interdisciplinary practice. Audiology is a relative “newcomer” to NAP – but with increasing awareness of the importance of hearing health and associated co-morbidities, its presence within this multidisciplinary organization could not materialize at a more critical juncture in the history of American healthcare.  

Audiology Academy members include professionals who identify themselves as members of the American Academy of Audiology (AAA), Academy of Doctors of Audiology (ADA), and / or the American Speech – Language- Hearing Association (ASHA). Many NAP-Audiology members are also members of more than one of these professional organizations.

Current members of NAP Audiology Academy are :

Class of 2014

  • Lucille B. Beck, PhD
  • Victor Hugo Bray, PhD
  • Linda J. Hood, PhD
  • Diantha Morse, MA

Class of 2015

  • Bettie Borton, AuD
  • Kimberly Cavitt, AuD
  • Rita R. Chaiken, AuD
  • Neil John DiSarno, PhD
  • Erin J. Miller, PhD

Class of 2016

  • Debra Joan Abel, AuD
  • Robert Fifer, PhD
  • Gregory James Frazer, PhD, AuD
  • Richard E. Gans, PhD
  • Eric N. Hagberg, AuD
  • Richard A. Roberts, PhD
  • Helena Stern Solodar, AuD
  • Lora Maureen Valente, PhD
  • Gail M. Whitelaw, PhD
  • Kadyn Williams, AuD
  • Christine Yoshinaga-Itano, PhD
  • David A. Zapala, PhD

The Class of 2017

  • Amyn M. Amlani, PhD
  • Margot Lynne Beckerman, AuD
  • Gail B. Brenner, AuD
  • Laurel Christensen, PhD
  • Jackie L. Clark, PhD
  • Allan O. Diefendorf, PhD
  • Kathryn R. Dowd, AuD
  • Larry Engelmann, AuD
  • Erica Friedland, AuD
  • Nancy Green, AuD
  • Scott K. Griffiths, PhD
  • Jaynee A. Handelsman, PhD
  • Veronica Heide, AuD
  • Cheryl DeConde Johnson, EdD
  • Antony Joseph, AuD, PhD
  • Victoria Keetay, PhD
  • Francis Kuk, PhD
  • Devin McCaslin, PhD
  • Joseph J. Montano, EdD
  • Jonette B. Owen, AuD
  • Tabitha Parent-Buck, AuD
  • Thomas Powers, PhD
  • Virginia Ramachandran, AuD, PhD
  • Paula L. Schwartz, AuD
  • Brad A. Stach, PhD
  • Juliette Sterkens, AuD
  • Linda Thibodeau, PhD
  • Brian Taylor, AuD
  • Susan E. Terry, AuD
  • Robert M. Traynor, EdD, MBA

 

Governance of NAP

 

NAP is governed by an interprofessional council representing each of its fourteen Academies. The function of the NAP Council is to make decisions affecting the strategic direction, programs and services of the organization. It is made up of all fourteen Academy Chairs and Vice Chairs as well as an elected Executive Committee and is staffed by an Executive Director.

The Council meets face-to-face twice a year, usually during the Annual Meeting each spring and again in the fall, with periodic conference calls.  Academy Chairs and Vice Chairs serve a two-year term and are elected by their respective Academies. The Executive Committee consists of NAP’s Officers: the President, President-Elect, Immediate Past President, Treasurer, and various Vice Presidents, including: VPs for Public Policy, Communications, and Membership as well as the Co-Editors of the Journal of Interprofessional Education & Practice (JIEP. The Officers are elected by the Council and serve two-year terms. 

 

Membership in the National Academies of Practice

 

Membership in the National Academies of Practice is contingent upon election as a Distinguished Practitioner, Scholar, or Public Policy Fellow within one of the 14 Academies. NAP has two additional membership categories: Associate Members and Members Emeriti. Chosen by their peers as persons who have made a significant and enduring contribution to practice, these Distinguished Practitioners, Scholars, and Public Policy Fellows have spent an important part of their lives in the practice of their profession. By their very stature, the hope is that they have transcended the turf interests of their respective professions and are prepared to address the issue of national health with greater objectivity and independence.

 

NAP – A Sleeping Giant?

 

Audiology is beginning to buzz with conversation and interest regarding its inclusion as a newer Academy in the NAP. With membership caps in place for Fellows, nominations for induction into this organization are by invitation, but the Audiology Academy ranks are beginning to swell. And with increasing emphasis on interprofessional education and practice coupled with Audiology’s quest for increased awareness of hearing healthcare and our role as providers in a complex patient care system, this development could not be more timely.

NAP is dedicated to affordable, accessible, coordinated quality healthcare for all – a concept whose time has definitely come. Members of the NAP Audiology Academy enjoy an opportunity to work collaboratively with thirteen other healthcare professions represented within NAP throughout the year, as well as at the annual Conference and Forum, usually held in March.

NAP Fellows believe that it is critical that healthcare practice incorporate a sound interprofessional foundation, and that addressing the whole person provides better healthcare, treatment outcomes, and preventive care, and can help address the Triple Aim, and the proposed Quadruple Aim, of healthcare. The deliberate inclusion of Audiology as a necessary part of such an interprofessional approach by our colleagues in other healthcare disciplines is a critical step towards appropriate recognition and relevance for our profession.

Click here to check out the Audiology Academy within the National Academies of Practice 

 

 

 

 

 

Guest Author: Bettie Borton, Au.D.

Dr. Bettie Borton is a licensed audiologist in Alabama and North Carolina, and has served hearing impaired children and adults and their families in a variety of professional settings for more than 35 years. She also served as a Visiting Professor, Teaching Associate and Supervising Clinical Audiologist at Auburn University and Auburn Montgomery. Founder and CEO of a multi-location independent private practice, Dr. Borton was a charter member of the Alabama Academy of Audiology (ALAA), serving as Board member and first President of this organization. She holds Board Certification by the American Board of Audiology (ABA) and was elected to their Board of Governors and, subsequently, as National Chair of ABA. In April of 2010, Dr. Borton was elected to the Board of Directors of the American Academy of Audiology, and served as President of the Academy in 2013-14. She is employed by Audigy Group, LLC, as their national Director of University and Student Outreach. In 2015, Dr. Borton was inducted into the Audiology Academy of the National Academies of Practice (NAP) and is currently serving as Chair of  the Audiology Academy.

 

Dr. Borton would like thank Dr. Victoria Keetay, Vice Chair of the Audiology Academy, for her input and edits to this posting.

 

 

 

 

 

 

 

 

 

 

This week’s Hearing International feeds upon a topic that we discussed a couple of weeks ago, the move to over-the-counter (OTC) hearing aids.  For some reason those that don’t know the real story, such as Senators Elizabeth Warren and Chuck Grassley and others always feel that the price of hearing aids is too expensive and that is what keeps patients from seeking treatment for their hearing impairment.  They look at eyewear being purchased in pharmacies and grocery stores and think that a visual impairment is the same as a hearing impairment, differences which were explained in the previous article.  Another issue is that, in the consumer’s mind, hearing aids cost so much more than commercial electronic products, such as iPads, and they should cost relatively the same. 

Hearing Aids are Just Commercial Electronics…Why do they Cost so Much?

Politicians, consumers, insurance companies, and others always have a tough time grasping the difference between a highly commercial product that most everyone can use, such as an iPad and a highly customized limited market product such as a hearing aid.  Drawing a contrast between an iPad and a hearing aid is like looking at differences between apples and bananas, but let’s take a look. 

Belcher (2014) discusses why a hearing costs 6 times more than an iPad.   Belcher’s argument is that while an iPad and a hearing aid have about the same research and development costs, production costs of the iPad are higher but costs to the consumer in the selling of the product are much lower. On the other hand, he feels that hearing aids have about the same research and development costs and a lower production cost but a huge cost to sell them bundled up in the retail sales costs. 

Here is where Belcher’s argument fades.  It fades in that Apple sold 16.2 million iPads in the first quarter of 2016 and hearing aid manufacturers collectively will co not sell that many hearing aids worldwide in a year.  There are research and development costs for only one iPad product while hearing aid manufacturers must have an array of products available for various types of hearing losses, so the research and development costs are a greater portion of the overall costs than he estimates.  

Another of Belcher’s arguments is that most of the costs of hearing aids are bundled up in the retail costs.  While there are a lot of retail sales costs in hearing aids relative to hearing aids, iPads do not need to be fitted to a specific individuals.  Here the comparison breaks down again in that selling an iPad to surf the net, email, or other activities is just not nearly the same as working with a patient and new hearing aids to achieve better hearing. 

Thus, Belcher’s and other cost comparisons to consumer electronics are totally unrealistic.  Manufacturers have very high research and development costs as they must have an innovative device for each hearing loss, lifestyle budget category and to obtain the most benefit from each of these devices they must be fit by a hearing professional that knows the variables of hearing loss and the various hearing aid products. So these comparisons to retail consumer electronics are false.

 

But……..Are the Cost of Hearing Aids REALLY the Issue??

 

Consistently, the audiology and hearing literature suggests that it is an average of 5-7 years after those with hearing loss know there is problem and seek hearing care.  In the minds of the under informed, this might seem to be caused by the cost of the products.  Those of us that have worked with the hearing impaired for decades feel that most of this hesitation to seek treatment is psychological.  Trychin (2003), a psychologist that has worked for decades with the hearing impaired,  presented a classic organization of why people do not seek or put off treatment for hearing loss. Cost was only one of the 20 reasons.  While costs were of some concern in his listing, this was before manufacturers and audiologists had various cost levels of products from which to choose and insurance programs that are now available. 

 Trychin’s list includes the following:

  • Don’t Realize They Have a Hearing Loss
  • Denial 1:  Do not admit they have a hearing loss
  • Denial 2:  Know they have a hearing loss but don’t think it is a problem for them or others.
  • Denial 3:  Know they have a hearing loss but do not think there is anything that can be done for it.
  • Higher Priorities
  • Costs
  • Lack of Transportation
  • Lack of Motivation to Hear
  • Family Resistance
  • Fear of being Seen as Failing or Incompetent
  • Afraid of Doctors & Professionals
  • Motor Coordination Problems
  • Bad Prior Experience with Hearing Aids or Vendors
  • Friends or Relative Bad Experiences with hearing Aids or Vendors
  • Overstimulation
  • Emotional Status
  • Ear Pain and Allergies
  • Vanity
  • Fear of Ridicule

Dr. Trychin’s list of reasons why patients do not seek treatment is similar to research results and experience of seasoned professionals.   While costs are often used an excuse,  the younger mild to moderate hearing impaired individuals and many baby boomers are still working and may have some insurance support for the acquisition of hearing aid products.  So, likely, the issue is not the cost of hearing instruments that keeps patients from seeking treatment.  Consider European countries where hearing aids are given out for free as part of National Health Insurance programs.  Hear-it.org (2017) indicates that in the European Union, where most countries hand out hearing aids for free to their citizens,  there are about 55 million individuals with hearing loss.  In these countries only 1 in every 6 hearing impaired individuals wear amplification.  So the real problem is not costs, it gets back to Trychin’s psychological issues. The age old issue of the stigma of hearing aids.

 

So….What Will Get More People to use Hearing Aids?

 

Many of the barriers to hearing aids are being challenged.  These challenges are being met by audiology researchers, clinicians, hearing aid manufacturers and others.  The methods that are used for hearing aid fitting and verification have progressed substantially in the past 10 years.  Better hearing aid technology, research into psycho-acoustical needs of patients, better fitting practices have all contributed to better success in fitting hearing aid products that deliver great benefit. 

Manufacturers have taken the some of the stigma that was present 40 years ago and significantly reduced it so that hearing instrument are much more acceptable in 2017 than in past decades.  Recall that prior to about 2003 most hearing aids were ear plugs, creating as many problems as they helped.  The devices were unsightly and advertised the fact that the patient was old and useless or had diminished capabilities.  Engineers and hearing aid manufacturers have made a big dent in the stigma factor by reducing the size, shape, modifying styles of hearing aids. In addition, the culture of having “things in your ears” has become cool in some age groups as well. 

Even with these modifications that manufacturers have created, better performance, better fitting techniques by hearing professionals and now the reduction of costs by the use of Personal Sound Amplification Product Systems (PSAPS) and the eventual OTC hearing aids, market penetration will still be the same if there is not much change in the looks of the products.  If over the counter hearing aids are presented to the market, there should be on the shelf right next door to them a kit that makes them invisible, such as Vanish which will reduce the sigma substantially. 

While hearing devices will cost less,  be available at the push of a button on a computer or at the corner drug store, the real market growth will be created by the cosmetics of the products.  Hearing aid cosmetics have taken leaps and bounds over the past few years but the products are still visible and a substantial psychological deficit to most personal egos.  The going attitude seems to still be, “I can get by, I just do not want to look like I have a hearing loss”.  I fear that with reduced costs of hearing aids that we are getting ready for huge pandemic of “Dresser Drawer Syndrome”  as the goal is not simply the purchase of these devices, it is wearing of the instruments that is important to better hearing health.

Disclaimer:

Robert Traynor has a financial interest in Vanish.

References:

Belcher, E. (2014). Why does a hearing aid cost 6 X more than an iPad. Audicus. Retrieved March 20, 2017.

Bouton, K., (2013). Why we don’t wear hearing aids.  Psychology Today.  Retrieve March 20, 2017.

Traynor, RM (2017).  Hearing Professionals do it better!  Hearing Health and Technology Matters, LLC, Hearing International.  March 7, 2017.  Retrieved March 21, 2017.

Trychin, S. (2003).  Why don’t people that need them get hearing aids. Sam Trychin, Erie, PA.  Retrieved March 20, 2017.

Vanish (2017).  http://www.hearingaidsvanish.com/ retrieved March 21, 2017.

Images:

Bill the Butcher (2017). Tea Party Tribune.  Retrieved March 21, 2017.