By George Lyons Jr.
Upheld by the U.S. Supreme Court last year and the centerpiece of the Obama Administration’s first term, the Patient Protection and Affordable Care Act (ACA) is on track to trigger change in the U.S. health care system that will have an impact on how audiologists practice.
It is important, therefore, for audiologists to understand how the ACA–often referred to as Obamacare by critics and supporters alike–affects their profession. Specifically, this comprehensive health care reform:
- Expands quality reporting measures and focuses on patient outcomes
- Includes state insurance exchanges where plans may be available for patient access to audiology services and devices
- Expands potential beneficiaries and patients through expansion of Medicaid
- Offers shared savings models for physicians and, potentially, audiologists, through accountable care organizations (ACOs).
The ACA calls for improved patient quality of care. As Congress and the Centers for Medicare and Medicaid Services (CMS) focus more on the quality versus quantity of patient outcomes, audiologists will be required to participate and report data on quality measures. This system, known as the Physician Quality Reporting System (PQRS), will require audiologists to report on quality measures or ultimately pay a penalty for non-compliance. For details, see the Step-by-Step Guide on the American Speech-Language-Hearing Association (ASHA) web site.
ACA also emphasizes efficiency and effectiveness, and audiologists will need to demonstrate that their services meet these requirements. The use of patient self-reported questionnaires or patient-clinician tools like those that measure the effectiveness of hearing aids, aural rehabilitation, quality of life, and functional areas of improvement are some ways to document the quality and value of audiology services.
Under the ACA, audiologists will also practice in a new world of health insurance exchanges. These are organized state and/or regional level marketplaces where an additional 24 million Americans who have been uninsured and underinsured can partake. ASHA has a fuller explanation of Health Insurance Exchanges on its web site.
The law calls for exchanges to be created and for insurance plans to provide certain benefits as determined by the states. Among the benefits offered are rehabilitative and habilitative services and devices provided by audiologists, as discussed in The ASHA Leader. This customized approach could mean that the offerings of exchanges will largely reflect market forces within their states’ borders. Audiologists should advocate that participating insurance plans cover rehabilitative and habilitative services in their home state exchanges.
The ACA also expands Medicaid by providing coverage for an additional 17 million Americans who until now have not qualified for that program. While it is not known how many states will comply, starting next year, states electing expansion must cover all individuals under age 65 with incomes of less than 133% of the federal poverty line. An update on the position of individual states regarding Medicaid Expansion is available online. Audiologists will need to weigh the advantages and disadvantages of accepting beneficiaries as patients. The choice may become clearer if states require participation in Medicaid as a condition of state licensure for specific providers or facility types.
ACA expands the emerging role of ACOs (accountable care organizations) in the marketplace and provides opportunities for health care professionals, including audiologists, to participate. An integrated system of health care delivery, ACOs are designed to be patient-centered and to connect physicians, hospitals, and other health care professionals, such as audiologists, with patients and each other for making mutual decisions about care. Along with Medicare, ACO models are also being used in the private sector and some state Medicaid programs. Further information on ACOs is available at several web sites.
In all of these areas, the American Speech-Language-Hearing Association has urged consideration of:
- Clinically relevant codes for PQRS participation
- The inclusion of aural habilitation/rehabilitation, devices, and cochlear implants in Medicaid programs and in the health insurance exchanges
- Accessible audiology services for all patients, including those in ACO models. (CMS [Centers for Medicare and Medicaid Services] responded that market forces will determine the need for the range of services offered).
- Allocation of an equitable portion of shared savings to audiologists, when models present with those options. (CMS stated that it does not have legal authority to dictate how shared savings are distributed).
As a rule, developments stemming from Washington involve taxes and paperwork, and the ACA is no exception to that rule. One provision imposes a medical device tax; however, hearing aids are exempt. The tax is levied upon the manufacturer of the equipment, and is only for devices that patients cannot purchase independently or over-the-counter, such as cochlear and osseointegrated implants.
Meanwhile, new paperwork will be required, whether for complying with quality reporting measures or working with ACOs. In the big picture, it is conceivable that documentation could be used to demonstrate to policymakers the important role that audiologists play in health care. If that happens, the changes brought on by the ACA may come with a considerable silver lining.
George Lyons Jr. is Director, Government Relations, the American Speech-Language-Hearing Association.