Editor’s note: In light of the coming audiology storm, this short piece by Professor Roeser has as much relevance today as it did when it appeared at HearingHealthMatters on August 22, 2012.  One should consider this position in reference to “big box” practices as well as the rehabilitative tasks that audiology has been favorably arguing for at least the past five years.

 

By Ross Roeser

A growing trend in audiology practice, at least in Texas, is for audiologists to sponsor office staff for hearing aid licensure. The notion seems to be that by holding a hearing aid dispensing license the staff member will be able to carry out office duties that include a broad array of basic audiological procedures, and will be able to fit and dispense hearing aids.

When asked about the wisdom of sponsoring someone with minimal educational requirements for such licensure, audiologists invariably give the rationale that the individual will function under the “close supervision” of the licensed audiologist.

This practice is counterproductive to the desire to raise the audiology profession in the healthcare arena. It is antithetical to bringing quality audiological services to patients. And it is shirking the issue of defining and implementing programs for audiology assistants.

Hearing aid licensure laws in many states set minimal requirements. In Texas, being 18 years of age, having a high school education or its equivalent (GED), serving a 9-month apprenticeship, and passing a written and oral exam (given by other licensed dispensers) will allow an individual to become “independently” licensed to fit and dispense hearing aids. This means the individual is licensed to carry out all the audiological procedures needed to fit and dispense any and all types of hearing instruments on the market– bar none.

Most important is that, once licensed, these assistants do not have to be supervised by anyone; they can function as independent practitioners. The sponsoring audiologist might one day find his/her apprentice across the street in a competing practice vying for the same patient population!

 

NOT THE TIME TO LOWER PRACTICE STANDARDS

Audiologists who sponsor hearing aid dispensers for licensure trivialize the training and skills needed for adequate hearing instrument competency. With today’s advanced technology and fitting strategies, more training and clinical experience are needed, not less.

Even more important is that once licensed the dispenser may (and will) become an independent practitioner, even if the audiologist who trained the assistant had every good intention of supervising him or her. But what happens when the audiologist is on vacation, is out sick, or when there is a satellite office that needs staffing?

What other profession promotes substandard academic requirements and limited requirements for individuals who have the potential to become independent competitors? There were only about 250 licensed Texas dispensers just a few years ago. Now the number is approaching 500 because of audiology sponsorship.

It is time to define and implement audiology assistant programs so that support staff are available—true support staff who will require mandatory supervision. Isn’t that the model virtually every other profession follows?

 

Ross Roeser, PhD, is Professor and Head of the Doctor of Audiology Program at the University of Texas at Dallas/Callier Center for Communication Disorders, and Executive Director Emeritus of the Callier Center. He is also Editor-in-Chief of the International Journal of Audiology, and was the founding Editor of Ear & Hearing.

feature image from Shout Awards

I heard a story the other day about an audiologist who bills in a threatening manner. Without going into specifics, this audiologist reportedly over-bills, submitting for tests that appear unnecessary (billed for almost every patient) or redundant (fails to add clinical value). Obviously, this is a case of attempting to make investigational testing cost-effective. Is this action illegal or unethical? Does it affect other clinicians?

On occasion, insurers have asked for evaluation of the audiologist’s billing submissions that payers thought were questionable. My first thoughts were:

  1. How many audiologists would agree to criticize the actions of a colleague?
  2. These types of submissions can’t happen often, can they?
  3. Will criticisms result in this payer holding the field in lower respect?
  4. What might be other downstream results of these investigations into billing?

Every audiology code of ethics requires that all audiologists adhere to the code and participate in its enforcement. Nobody likes the“snitch” article of the code (Principle 8, Rules 8b and 8c of the AAA Code), but with a little thought, most everyone should see why it is necessary. Other professional providers who refuse to evaluate and help discipline (if necessary) their colleagues are likely acting in a manner that violates their own professional code. Their refusal to “rat out” their colleagues cannot be supported by a legitimate argument. If you don’t believe this, ask the courts. In other words, if you know this audiologist is billing like this, it’s your ethical duty to report it to your professional and/or licensing organization. (It’s also your legal duty.)

Regarding the above over-billing matter, arguments that investigational testing is not profitable have usually been made by those who choose not to do such tests—a self-fulfilling argument, many times used in order to jump to a sales pitch for hearing aids, which will increase profits. My experience would indicate that many audiologists in “sales positions” appear to do little testing beyond the basics. Not providing “best practices” to all patients is an ethical violation, and perhaps should be reported as per Rules 8b/c. It’s interesting to consider how many “professional” providers in a number of other fields make similar profit-based arguments.

There is a difference between over-billing (illegal) and failure to provide procedures that have value—tests that provide a baseline for future comparisons, contribute in a clinical manner to the patient’s complaints, or support prior test results. It would be helpful if each test were reimbursed at a reasonable rate, but that is not the essential determiner.

When asked to criticize or report colleagues, some audiologists have reluctantly done so. Many times direct communication with those involved solves the problem before it reaches “critical mass”. While we all hope these few audiologists are not typical of the whole, observation and my experience have not provided a great deal of hope for the level of understanding held by what seems to be too many making unsound audiology decisions or ignoring professional responsibilities.

 

feature image from close-up films