By David H. Kirkwood
WASHINGTON, DC–Contending that the increasing number of U.S. veterans with hearing problems has outstripped the ability of the Department of Veterans Affairs (VA) to meet their needs effectively, the International Hearing society (IHS) has launched a campaign to make hearing aid specialists eligible to provide to veterans with hearing evaluations and hearing aid services.
Under current VA regulations, the free hearing aids and audiologic services to which qualified veterans are entitled must be provided—with only rare exceptions–by audiologists. These audiologists are either VA employees or independent audiologists working under contract with the VA.
IHS, whose members are predominantly hearing aid specialists, points out that these non-audiologist practitioners are licensed in every state to provide hearing care to adults and have been designated by the Federal Office of Policy and Management government as approved providers for people insured under the Federal Employees Health Benefits (FEHB) Program. Surely, IHS argues, hearing aid specialists are also “fit to serve” America’s veterans and to do their part to ensure that those who defended their country in uniform get the care they deserve.
LAUNCHED ON CAPITOL HILL
Rep. Scott Garrett (R, NJ), center, met with Alissa Parady and Tom Higgins, who were part of the delegation lobbying in Washington for the IHS Fit to Serve Campaign.
The Fit to Serve Campaign was officially launched on February 28 when 14 IHS members and staff visited the Washington offices of 18 members of Congress. Their goal was to raise awareness of the need for veterans to have improved access to hearing care services and to explain how hearing aid specialists can help provide that.
Among the participants was Tom Higgins, BC-HIS, president of the organization. As a U.S. Navy veteran, he has often expressed his frustration at having to turn away veterans coming into his practice in Ramsey, NJ, because the VA program does not allow hearing aid specialists to serve “our nation’s heroes.”
In a March 14 e-mail message to the membership, Higgins reported on the visits by IHS members to their representatives in Congress and their staff. Higgins wrote:
“We shared your stories of long waits [by veterans] for appointments, inadequate programming, limited follow-up services, and veterans being turned away for simple repairs because they had no appointment. We told them how hearing aid specialists are uniquely qualified to help the VA meet the need for high-quality, local, and timely hearing evaluations and hearing aid services.”
As IHS’s manager of government affairs, Alissa Parady is playing a key role in Fit to Serve. Parady, who is based in Washington, told Hearing News Watch that the members of Congress and their staffs who met with the IHS delegates responded positively to the initiative and were very interested in what the visiting hearing aid specialists told them about their experiences with veterans and the VA.
For example, at one meeting on February 28, Richard Giles, BC-HIS, the Pacific governor for IHS, informed Rep. Jaime Herrera Beutler (R-WA), who represents his district, about a veteran who had recently come to his office in Vancouver, WA. The man was distraught because neither the new hearing aids he had received from the VA nor his backup instrument was working and he had been unable to get them fixed in a timely manner. (According to the VA’s hearing aid handbook, hearing aids brought by a veteran to an audiology clinic for repair usually take two to three weeks to be returned; those shipped to the VA’s Denver Distribution Center take four to six weeks.)
The veteran, who was terminally ill, told Giles that he had come to him after being turned away from his local VA clinic because he didn’t have an appointment for that day. He had previously scheduled an appointment for April to have his new instruments looked at, but when his backup failed he was desperate to get help sooner.
Although Giles found that the new hearing aids needed to be returned to the manufacturer, he was quickly able to fix the back-up instrument, which allowed the veteran and his family to communicate during his final weeks.
After hearing this account, Herrera Beutler was shocked, Giles said. “Her jaw dropped, and she told a staff member ‘Take care of this!’”
A LONG TIME IN THE PLANNING
Although Fit to Serve was officially launched only three weeks ago, IHS leaders have been laying the groundwork for more than a year.
Parady said that with the aging of Vietnam War veterans and the high percentage of veterans of Iraq and Afghanistan who suffer from hearing loss and tinnitus, the VA has been unable to keep up with the growing demand for audiologic services.
“We aren’t finding fault with the VA,” said Parady. “It’s a wonderful institution.” But, she added, “The audiologists are so overwhelmed they may not have time to do as much counseling and follow-up.”
As a result, she said, IHS members report seeing more and more veterans coming to their offices either to buy hearing aids out of their own pocket because they don’t want to wait to get them free from the VA or to get help with the hearing aids provided by the VA. These developments convinced IHS that the time had come for hearing aid specialists to be allowed to help serve veterans’ hearing needs in the same way that non-VA audiologists have done for many years.
To this end, Parady, Higgins, and Kathleen Mennillo, the executive director of IHS, met in February 2012 with Lucille Beck, PhD, who is director of the VA’s Audiology and Speech Pathology Program and also chief consultant of the VA’s Rehabilitation Services.
According to Parady, Beck said that the VA was taking steps to increase its ability to serve veterans. These included making greater use of audiology assistants and developing tele-audiology programs to serve patients who don’t have easy access to a VA clinic. Parady said that Beck expressed confidence that the VA would be able to handle its caseload through these programs.
(Editor’s note: My attempts to reach Beck and the VA’s media relations office have not yet been successful, but I welcome their comments on the Fit to Serve campaign and this post.)
PETITIONING FOR A NEW POLICY
The society stepped up its campaign last December when Mennillo sent a seven-page letter to the VA’s director of regulation, policy and management. The letter, submitted in response to requests for public comment on a proposed new rule regarding non-VA medical services in general, explained in detail why IHS believes current VA policy “does not adequately serve the hearing healthcare needs of veterans” and why it “recommends hearing aid specialists be permitted to provide hearing evaluations and hearing aid services for veterans as non-VA providers.”
Mennillo wrote, “Hearing aid specialists can and are ready and willing to help the VA meet their goals stated in a 2012 VA presentation (“Meeting the Challenges of VA Audiology Care in the 21st Century”) to the Association of VA Audiologists: “Improve access to care in rural and highly rural areas; improve access to specialty care; reduce time spent in travel and time off work; reduce costs.”
She contended that because of rising demand for services, “VA clinics are increasingly unable to meet the hearing healthcare needs of veterans. As a result, veterans are experiencing long wait times to get appointments, limited follow-up services, and extensive time spent traveling to their nearest VA clinic (which may be several hours away).”
Mennillo added that hearing aid specialists, who number about 9000 in the U.S., are fully qualified to serve veterans. “Contrary to outdated and inaccurate perceptions,” she stated, “hearing aid specialists do not simply fit and ‘sell’ hearing aids,” but are full-fledged hearing care providers. In fact, she argued, “As they move into independent practice, hearing aid specialists typically have as much, if not more experience performing hearing evaluations and fitting and dispensing hearing aids than an average new AuD (doctor of audiology) program graduate.”
Mennillo’s letter received no response.
LOBBYIST HIRED
The Fit to Serve campaign is IHS’s most ambitious lobbying initiative in many years. To improve its chances for success, the organization has hired Brownstein Hyatt Farber Schreck, a leading Washington lobbying firm, and has retained a public relations firm.
The campaign is expected to cost IHS $115,000 in 2013, which will be paid for entirely through member donations.
“As they move into independent practice, hearing aid specialists typically have as much, if not more experience performing hearing evaluations and fitting and dispensing hearing aids than an average new AuD (doctor of audiology) program graduate.”
Where do they come up with information to back up this absurd statement? If I’m not mistaken, I thought they already had hearing aid technicians as part of the VA system…
I sense a turf battle on the horizon.
The VA does employ some audiologist assistants who perform simple tasks under the supervision of an audiologist. None of the audiologist assistants are performing hearing evaluations, to the best of my knowledge.
A diagnostic VA audiological evaluation and interpretation is often much more in-depth than what even most average audiologists are doing on a regular basis in their clinics. It is beyond the scope of a HAD–sorry!
I don’t think there’s a problem with HAD’s dispensing hearing aids recommended by the audiologists after a VA examination, but they should not be allowed to perform diagnostic evaluations and interpretations for Veterans, this is outside their scope of practice.
The VA could easily meet the needs of Veterans locally by allowing more private audiology clinics to service Veteran’s hearing needs. There has been inconsistent implimentation of private contracting across the country, but it’s way more efficient and cost effective for the VA to contract with private clinics to do this work for them. The audiologists contracted with the VA have to meet certain education and training requirments to be allowed to see these patients.
Locally, they pay mileage for vets to travel 75 miles to the closest VA hearing clinic. Many of these vets had previously been seen at private audiology clinics on VA contract a few years ago (local contracting has since stopped after they hired 2 more audiologists at the VA, but the need didn’t stop and the wait time is still substantial, not to mention the travel requirements). It would literally save tens of thousands of dollars in mileage reimbursement alone if they allowed more vets to be seen locally by audiologists at a private clinic. Plus, not to mention satisfaction rates will likely be much higher when people can be served closer to home.
There are better solutions available than having dispensers take over the role of audiologists. Dispensers can have a role to play in the VA system, but not with diagnostic examinations and interpretations: this should be left to the experts.
I agree completely. A good example is the State of Montana, in which a variety of audiologist-owned private practices and non-VA hospitals have VA contracts. We provide our veterans excellent hearing health care, and as audiologists are qualified to perform comprehensive audiologic evaluations, referring with evidence to a VA ENT, or the local VA physician depending on the patient’s need.
MT also has is right when it comes to processing VA claims. We are the only state of which I am aware providing state employees who intervene on behalf of the veterans. This State intervention works wonders and greatly increases the number of veterans who receive assistance.
For our audiology friends who are now learning about Fit to Serve for the first time, know that we have one straightforward goal: improving the hearing healthcare system for the Veterans who have served our nation. This is not a turf battle between hearing aid specialists and audiologists. Audiologists are a highly-respected member of the hearing healthcare team, providing a variety of important functions, including those beyond the provision of hearing aids, for the hearing healthcare population. Nor is this a fight between outside healthcare providers and the VA. IHS members and non-VA audiologists alike stand ready to work with the hard working men and women of the VA to advance the shared goal of better care for our Veterans.
Hearing aid specialists’ sole focus is hearing evaluations and providing a wide array of hearing aid services, and we are very good at it. You need only ask any of the thousands of Veterans who come to our members for help each and every year. We know there is a place within the VA for hearing aid specialists. We are committed to working with our fellow hearing healthcare professionals, including audiologists and our colleagues at the VA to find a long overdue solution to the problem of hearing healthcare for America’s Veterans.
Kathleen Mennillo, MBA
Executive Director
IHS
Licensed Hearing Aid Specialists are indeed competent to interpret audiometric test results for the purpose of fitting hearing aids. They also look for and report any “red flags” found during testing and during the case/patient history. Referrals for “red flags” are required by the FDA and the various licensing bodies. Additionally, HAD’s are available in more rural areas than clinical or dispensing audiogists who mainly practice in doctors’ offices, medical centers and hospital complexes. It is short-sighted to believe there will be enough audiologists to serve the hearing impaired, including this important population. All reports on the number of audiologists in practice and coming into the profession show the shortfall of professionals vs. the tremendous influx of hearing impairment into the general population.
“Hearing Aid Specialists are indeed competent to interpret audiometric test results for the purpose of fitting hearing aids.”
Yes, I wouldn’t dispute this fact, this is what they are trained for. But, having experience working at the VA on-site and contract work with the VA, audiological evaluations go far beyond what an HIS would normally do and is beyond the interpretation scope of an HIS. Most dispensers aren’t trained to interpret ipsilateral and contralateral acoustic reflexes, pure tone decay, rollover function, etc. I bring this up soley because there is a lot of interpretation involved in VA examinations that is far beyond what many non-VA audiologists are doing. Could dispensers competently fit vets with hearing aids: no question.
Should dispensers be allowed to serve in the VA system as part of the ‘hearing team’, absolutely. I wouldn’t argue with that.
This is amusing, as we all know that the audiological evaluations that are performed in VA’s nationwide, for the most part, do not go far beyond what a H.I.S. is qualified to do-and within our scope to do- to include interpretation of acoustic reflex results. The majority of the tasks performed by audiologists within the VA mirrors what we are qualified to do for the MOST part, not the other way around, lol. Why couldn’t you have picked vestibular/balance/dizziness or tinnitus to try to down play our capabilities instead of acoustic reflexes. Quite comical.
I suggest you learn the difference between “hearing evaluation” and “testing” that a hearing aid dealer is allowed to perform by state law.
Please provide the name of any state which requires sufficient training for a hearing aid dealer (HAD) to provide a hearing evaluation or uses the term “diagnostic evaluation” to describe the type of testing a HAD is allowed to perform.
NY–“testing of hearing, solely for the purpose of fitting, selecting, selling, distribution, renting, adapting or servicing hearing aids ”
https://www.dos.ny.gov/licensing/lawbooks/HearDispatch.pdf
Iowa –“When a physician or audiologist makes a general hearing aid recommendation, a
hearing aid dispenser may perform tests to determine the specific brand or model
appropriate to the recipient’s condition. ”
https://www.dhs.state.ia.us/policyanalysis/PolicyManualPages/Manual_Documents/Provman/audio.pdf
Better take that white coat off…and learn to use “The Google.”
Type “name of state” then “Board of Hearing Aid Dispenser” in the white rectangular box.
Well, I can see that you feel threatened, as most audiologists do, however, don’t you think it would be best to take the gloves off and put your energy into helping resolve the issue that really matters? (yes, the Veterans) Why not bring H.I.S.’s into the practice for the sole purpose of hearing aid related tasks? Maybe even perform annual retests for existing patients, working under the supervision of an audiologist to report any red flags, changes in hearing, abnormal results or concerns, etc. Meanwhile, the audiologists could concentrate on the diagnostic end of things. Just a suggestion. I have worked with audiologists most of my career and prefer to do so, we maintained a high respect for each other’s roles and always knew each other’s scope of practice. This is a no brainer as there are not enough audiolgists to meet the growing demands, would you rather have an H.I.S. performing ear impressions and cerumen removal, fitting and programming hearing aids? Or an audiology assistant that is not qualified to perform any of the above?
Typical requirements of state licensure for a HAD:
1. Free from communicable diseases
2. No felonies
3. High school education or G.E.D.
4. Pass a very simple written test at 70%
5. Six month or so apprenticeship
6. Demonstrate the ability to perform an earmold impression (EMI) in front of a board member.
Hmmm….don’t see Diagnostics I, II, III, or IV in that description.
Here’s CA’s requirements. Wow, you can still have communicable diseases and dispense HAs in CA. Oh no. the cat is out of the bag.
https://www.asha.org/Advocacy/state/info/CA/California-Hearing-Aid-Dispensing-Requirements/
My state only requires that in #6 above that you “demonstrate the ability to operate an audiometer.” That literally means you can turn the knobs on a portable audiometer and put headphones on someone.
In what state does the practical test only consist of making an earmold? That sure isn’t the case where I live. I think we have another audiologist who does a lousy job of fitting hearing aids. Probably because they never did it whle in school. A dirty secret they try to keep from the public.
PLEASE SENT THE ABOVE PAGES AND INFORMATION TO MY FATHER WHO IS
A WWII VET IN NEED OF THIS ASSISTANCE. PLEASE SEND TO [email protected]
Thank you for your help.
I to would like to see privete business be able to test and set up hearing devices for the militairy, seeing how long it takes to get an appointment.These business are qualified and take a load of the VA people. When repair time comes around we can’t be without for weeks or months. I am all for the idea of privete business helping out. thanks D Dill
Myself a veteran with tinnitus, a former hearing instrument specialist/hearing aid dealer, and current doctor of audiology, this subject leads me to make a point about quality of care and services for veterans–something I care very much about and just so happen to have experience with from multiple viewpoints. Hearing instrument specialists a have scope of practice which is limited to basic (non-diagnostic) hearing screenings for the sole purpose of selling and fitting hearing aids. Comprehensive diagnostic procedures along with many treatment services (including for tinnitus as well as balance disorders) are not within the scope of practice for a hearing instrument specialist (H.I.S.). Licensure for an H.I.S/hearing aid dealer in most states requires no formal education beyond a high school diploma or equivalent. Licensure to sell hearing aids does not, by itself, encompass the best healthcare practices that veterans deserve. The VA is not a perfect system and there is always room for improvement, but quality and comprehensive care should never be sacrificed.
Further, contrary to the press releases being put out by the IHS, the VA and many audiologists actually staff and utilize support personnel such as technicians, assistants, aids, and even hearing instrument specialists. When diagnosis and treatment is provided under the guidance of the audiologist, these support personnel are a great asset and allow for increased availability of services while ensuring the highest level of care are delivered and underlying medical conditions are not missed. This model is already an option for use by the VA so that individuals do not have to travel great distances or have long wait times, but rather can obtain services including diagnostic, treatment, and rehabilitation from contracted local audiology practices (which may also employ support personnel including hearing instrument specialists). In addition, the increased availability and utilization of tele-health practices will also afford better access to quality health care for veterans.
I am highly aware of the hearing healthcare industry and obviously have my own personal biases. These biases are formed by my collective experiences and my opinion is that this legislation does NOT serve the best interests of veterans, but rather jeopardizes the quality of care and puts the veteran at risk for missed diagnoses and untreated or inappropriately managed problems.
We all know we can be convinced of things “that are for our own good” only to find out that it caused another problem and really did not solve the first one. In fact, some might argue that this is too often the case in politics where a particular group may try to take advantage of an opportunity to further their own interests and agenda to expand scope of practice and healthcare leverage without the necessary and requisite education and training to do so. There is a reason that I did not remain as a hearing instrument specialist and went on to attain 8 years of education and clinical training to become an audiologist.
Sincerely,
Clint
I am a state licensed Hearing Instrument Specialist. I am more than qualified (and it is within my scope of practice) to perform comprehensive hearing evaluations. I am highly trained and very accustomed to ruling out any medical red flags that would warrant follow up with a physician/ENT. I am more than qualified (and it is within my scope of practice) to handle anything under the sun as it relates to dispensing/fitting hearing aids. I understand the age old battle of how threatened audiologists are of hearing instrument specialists, but I think it’s time for them to realize that the marriage between the two hearing care professionals could only benefit the field of audiology. There are simply not enough audiologists to meet the growing demands of our nation’s veterans and they are the ones suffering. I worked with the VA as an assistant and found it quite interesting that even though I couldn’t touch a hearing aid fitting appointment, the VA allowed me to perform the two most invasive procedures that can actually hurt a patient- ear impressions and cerumen removal. There are audiology assistants that are not even licensed that perform these procedures and the audiologists and the VA support this. I am not qualified to address balance/dizziness/ vestibular issues. Tinnitus is also another area that may seperate audiologists from hearing instrument specialists. So here is an idea (lightbulb-duh), instead of the audiologists declaring a turf war, why don’t they be confident about what they can do that differs from us, welcome us for the purpose of performing hearing evaluations, making necessary referrals to them as needed and help with the hearing aid related tasks alone? One thing that I can say, VA systems are allowing technicians that have no training whatsoever to not only do impressions and cerumen removal, but they also allow them to program and adjust hearing aids. The VA SOP states that audiology assistants are not to perform these tasks, however, audiologists are so overwhelmed that they sneak and let them do it anyway. Hmmmm
doesn’t make much sense to me, but I am not an audiologist, so I guess I wouldn’t understand. Obviously, audiologists are so threatened about the idea because they know we can perform 99% of what goes on everyday in clinics at the VA across this nation and we would be willing to be hired at less pay. Guess they feel that we would take alot of their jobs away. WAKE UP AND SMELL THE COFFEE PEOPLE, there are plenty of hearing impaired patients that need and deserve our services in a timely manner, we can all work together as a team, THERE IS NO I IN TEAM, remember?