Why are Vestibular Specialists so Hard to Find? Part V


Last week, we reviewed some of the drastic reductions in reimbursement for the most sensitive vestibular tests, and pointed out an example of the medical community deciding it could no longer afford to invest in expensive diagnostic equipment, such as a rotational chair. There has to be a breaking point somewhere. Some physicians will simply stop seeing “dizzy” patients. We have already seen evidence of this locally. This has lead to a longer than usual wait time to get a new patient appointment in my office, making neither the patient nor the referring physician happy. As a practitioner, I am devoted to helping patients with both simple and complex vestibular pathologies. This takes time, training, equipment and staff. In other words, “It ain’t cheap to provide, and it ain’t getting no cheaper.” As a business owner, getting paid approximately 60% less per patient and procedure than I was just five years ago, that breaking point can’t be too far away.

The solution?

One well known private vestibular clinic has decided to “opt out” of Medicare. In other words, they are a “cash only” clinic. Here is an excerpt from their website “Philosophically, we feel strongly that medical care is a process between a patient and physician and third parties should not intrude on this relationship. Increasingly, health plans have not only reimbursed care but have tried to oversee and direct care. We are not subject to the coercion, restrictions, rationing and meddling in your medical care by bureaucrats – for the purpose of improving their profits or limiting care to meet cost-containment objectives (often at the expense of the individual patient).”


I suspect that in time this will become the model for top quality health care. Medicare will cover “basic” healthcare, but if you want to see a first rate practitioner who has the proper equipment and can take all the time you need, you probably need to be willing to pay them over and above what Medicare allows.


About Alan Desmond

Dr. Alan Desmond is the director of the Balance Disorders Program at Wake Forest Baptist Health Center, and holds an adjunct assistant professor faculty position at the Wake Forest School of Medicine. In 2015, he received the Presidents Award from the American Academy of Audiology.


  1. The real solution for when you have an expensive piece of machinery, whether it be a rotational chair, an MRI (or an automated milling machine in an engine factory!) is to keep it running over multiple shifts, with technicians operating it, while specialists remotely monitor and interpret the results during the weekdays… In other words, proper management.

    Using your example of $85 reimbursement for a 55 minute ride, you can be reimbursed $1275 for 15 tests in a 16 hour two-shift day (7am to midnight with two 30 minute breaks for meals): Hire/train two operators, and keep that machine in production.

    1. Dan:
      In an unregulated environment, this strategy may make sense. Medicare requires that the independent Audiologist personally perform the test. Even in an environment where a physician supervises a less trained/lower paid technician, the physician must be present in the office when the test is performed. Low reimbursement is only half the problem. Medicare restrictions do not allow for efficient practice. Another good idea for a post.
      Thanks, Alan

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