Direct access to audiologists would save Medicare megabucks, AAA study finds

David Kirkwood
November 21, 2012

RESTON, VA—A study commissioned by the American Academy of Audiology (AAA) has found that giving Medicare beneficiaries direct access to audiologists would save Medicare about $240 million over 10 years.

In a message e-mailed to AAA members on November 7, Deborah L. Carlson, PhD, president of the academy said, “This compelling and comprehensive study shows what the academy has purported for many years: Direct access to audiologists by Medicare beneficiaries is cost-effective and safe.”

AAA has been working with Dobson DaVanzo & Associates, LLC, an independent health care economics consulting firm, for the past 18 months to determine the impact on Medicare spending of providing beneficiaries direct access to audiologists.

The report drew upon data from the Centers for Medicare and Medicaid Services (CMS), a comprehensive literature review, interviews with stakeholder, and the assistance of a clinical advisory committee.

The study identified two primary areas where direct access would yield savings: (1) the reduction of duplicative and unnecessary services associated with obtaining a physician referral, and (2) increased vestibular intervention for Medicare beneficiaries that would prevent falls, which result in costly and debilitating patient care.

According to AAA, the study also “established that patient safety is in no way compromised by eliminating the current ‘gatekeeper’ model” of delivering audiologic care to older Americans.

President Carlson stated, “The solid methodology and analytical approach used to evaluate the immense amount of data available are indisputable and the impact of this study cannot be overstated. This development is critical in our efforts toward a legislative victory.”



Armed with the results that it was looking for, AAA told members that it is “aggressively and effectively using these data to advance direct access on Capitol Hill.”

Specifically, the academy will be lobbying for passage of the Medicare Hearing Health Care Enhancement Act (H.R. 2140/S. 3242), which would eliminate the requirement that Medicare beneficiaries obtain a physician’s referral before seeing an audiologist. The academy urged members to visit its Legislative Action Center to contact their members of Congress and encourage them to support this initiative.



Attempts by Hearing News Watch to learn more about the study from AAA or to obtain a copy of the report were unsuccessful. Amy Miedema, the organization’s senior director of communication, wrote in reply to our blog’s inquiry that “the Academy will ultimately publish more details for our members in the near future.”

  1. Let’s hope the medical community (AMA, AAONS, etc) comes to their senses and stops the hand-wringing over Audiologists being allowed Direct Access to Medicare patients. Audiologists already see almost everyone else in this manner, including Veterans, so why should people on Medicare be any different?

    Audiologists are now required to have 8 years of education–they are trained to know when a referral to an MD or ENT is required–this should be a non-issue!

  2. Looking forward to the release of the study from the Academy. The data we published (Freeman and Lichtman) was based on actuarial data provided by CMS. We just looked at the savings to Medicare for pure tone testing (92557, air thresholds, and a/b thresholds). We found savings approaching $80m/year if audiologists were permitted direct access without compromising quality of hearing care. Putting this data together with the new data should provide some strong arguments for cost-savings.

    1. David Kirkwood Author


      Thank you for the additional information.

      As for when the Academy will see fit to make the study it commissioned available to the public, perhaps you as a former president can accelerate the process.

  3. This is great but lets also be realistic. When you look at those dollar amounts and the oveall amount spent. We are talking about a drop in the bucket. Don’t get me wrong it is great news and should help us but its not that big of deal in their eyes as we seem tobe purporting it is. We need to rememeber to look at it from their prespective as well. What precentage of their expenditures is it really? Just something to remember as we go forward with this. We have known for some time we saved them dollars and nice to have some actual dollar figures.

    1. I agree with Rick, this is a half a drop in the bucket for Medicare expenditures…I think it was 540 billion in 2011…24 million per year is chump change

  4. I also think that direct access will likely increase utilization, which will reduce, possibly eliminate, any cost savings for Medicare…not to be the nay-sayer of the group…..

  5. And there is little to no empirical evidence that care will not be compromised…the only study I’ve seen is Zapala et al from 2010, which looked at Mayo clinic audiologists…hardly generalizable to the general public of audiologists…. Please let me know if I am missing the empirical data in the literature…

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