Report spells out case for giving Medicare patients direct access to audiologists

David Kirkwood
May 15, 2013

• AAA report by Dobson DeVanzo E



By David H. Kirkwood

WASHINGTON, DC—Consultants commissioned by the American Academy of Audiology (AAA) calculate that allowing Medicare beneficiaries direct access to care from an audiologist would reduce costs by $173.3 million over the next ten years by eliminating duplicative audiological services and unnecessary evaluation and management services.

In its report, “Determining Potential Medicare Savings by Streamlining Beneficiary Access to Audiology Services,” Dobson DaVanzo & Associates, LLC, also projects an additional $82.7 million in savings to Medicare from making it easier for patients to get vestibular care from audiologists. Direct access, the study says, would result in more Medicare beneficiaries getting needed help with balance problems. That, in turn, would lead to fewer falls and thereby reduce the cost to Medicare of paying for the treatment of injuries suffered in falls.

Although the consultants’ report has not yet been made public or shared with most AAA members, Hearing News Watch was able to obtain a copy of the executive summary. Last November, Deborah Carlson, PhD, president of the academy, sent an e-mail to members telling them about some of the consultants’ findings, as was reported by this blog. However, the four-page executive summary, which is not yet final, provides considerably more detail than were revealed last fall.



Currently, Medicare does not cover audiological services unless a physician has referred the patient to the audiologist. Commenting on that, the consultants say:

“The requirement for the physician referral can result in complicated patient pathways, as well as additional spending for both the Medicare program and beneficiaries through co-payments. Furthermore, the burden of the referral process causes some patients to become discouraged and then not receive the needed diagnostic services, leaving their conditions untreated.”

This statement offers support to audiology’s long-held contention that present Medicare rules do not serve patients well when it comes to hearing and balance problems.

The study goes on to look at two basic questions about the effects of giving Medicare patients direct access to audiologists:

(1) How would it affect the quality of care they received?

(2) How would it affect the cost of that care?

In addressing question 1, the study authors—Allen Dobson, PhD; Audrey El-Gamil; Matt Shimer, PhD; Anne Pick, MPH; and Joan Davanzo, PhD, MSW—write:

“Separately for acute and chronic hearing loss and vestibular conditions, this analysis concludes that patient care would not be compromised and patient safety would be maintained.”

They say also: “…if direct access to audiologists were to be implemented by Medicare, patient outcomes would not be jeopardized.”

Having concluded that direct access would not reduce the quality of care provided to Medicare patients, the authors turn to calculating how direct access would affect the cost of that care.

As noted above, the study estimates that direct access to audiologic care would result in major savings to the Medicare program. By getting rid of the current requirement of medical referrals, the study finds, direct access to audiologists would save $155.9 over ten years in the cost of evaluation and management services that would no longer be needed. It calculates that another $17.3 million in duplicative audiological services in the current referral system would be eliminated.

As mentioned, the consultants project that by making it easier for patients to get vestibular care from audiologists, direct care would increase the number of older Americans receiving such help and thereby reduce the number of falls and ensuing medical costs that Medicare would have to pay for. According to the report, this would result in approximately $82.7 million in additional savings, for a total of $256 million over ten years.



On the other hand, the report says, direct access to audiological care would cause some modest increases in Medicare costs because it would encourage more people age 65 and over to get help for hearing and balance problems. The study estimates that if direct access were available 63,667 more Medicare beneficiaries would receive care from audiologists than do so now.

The study projects that the additional treatment of hearing loss would add $11.8 million in Medicare costs over ten years. While treating more beneficiaries for hearing loss would presumably improve their quality of life, the consultants do not anticipate that it would reduce their medical costs, as it would in the case of patients treated for vestibular disorders. The study also estimates that treatment of more patients with dizziness would add $3.8 million to Medicare costs over 10 years.

After adding up all the savings and extra costs to Medicare that they anticipate would result from adopting direct access to audiological care, the consultants reach a bottom line—one that seems certain to please their client. Direct access, they estimate, would reduce Medicare’s costs by $240.4 million over 10 years.



The executive summary of the consultants’ report to AAA ends with the following, rather understated, conclusion:

“Given the economic pressures to reduce Medicare spending and to provide beneficiaries with the most cost-effective care, study results indicate that patients could be receiving diagnostic services related to acute and chronic hearing loss and vestibular conditions directly from audiologists without a negative impact on patient safety or increased Medicare expenditures.” 

  1. Interesting strategy on the part of AAA. Slippery slope leading to ultimate adoption of web-based and self-care options. This is the direction healthcare is moving as advances in technology close the gap between the web and ‘brick and mortar’ options.

    1. Probably more than you might think and more in the future as practices seek to diversify their services. We are not a major metro area, yet we have 3 different private practices that do vestibular evaluations, including our practice. Our vestibular services are usually booked out for 3-4 weeks.

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