By David H. Kirkwood
WASHINGTON, DC—Citing “significant differences in the education and training of audiologists and hearing aid specialists,” the Association of VA Audiologists (AVAA) issued a statement on December 16 opposing proposed federal legislation that would allow the Department of Veterans Affairs (VA) to hire hearing aid specialists internally and to update its contracting policies to allow hearing aid specialists to perform work that currently is performed by licensed audiologists.
As reported on this blog, the bill in question, H.R. 3508, was introduced in the House of Representatives on November 15 by Rep. Sean Duffy, a Wisconsin Republican, and Timothy Walz, a Democrat from Minnesota. The measure is a centerpiece of the International Hearing Society’s Fit to Serve campaign, which seeks to make hearing aid specialists eligible to assist the VA in pursuit of the goal of “improving the hearing healthcare system for America’s veterans” and to “ensure timely access to high quality hearing health care for all veterans.” Most IHS members are hearing aid specialists, although the national organization has audiologist members as well.
WHY AVAA OPPOSES THE LAW
In its statement, AVAA said that it “appreciates the intent of this bill’s sponsors to ensure that the nation’s veterans are given access to quality hearing healthcare.” However, said the organization, which consists of audiologists employed by the VA but is independent of that federal agency, it opposes passage of H.R. 3508 “as we believe it will fail to achieve the sponsors’ stated goal of improving access to the highest quality hearing healthcare.”
Basically, the AVAA’s position is that the work that VA audiologists do requires education and training beyond what hearing aid specialists typically possess.
The association states, “Audiologists earn doctoral level degrees through the completion of eight years of academic and clinical training from accredited universities. Upon completion of this rigorous, formal training, audiologists assume their roles as licensed independent healthcare professionals. Audiologists engage in clinical decision making in order to evaluate, diagnose, treat and manage auditory and vestibular disorders. This level of independent clinical practice is essential to provide the type of multifaceted, comprehensive care needed by many veterans.”
In contrast, the statement continues, “H.R. 3508 specifies that hearing aid specialists would be required only to have earned an associate degree or to have completed a basic apprenticeship program.” It adds, “A primary result of the vast differences in academic and clinical training between audiologists and hearing aid specialists is a dramatically reduced scope of practice for the latter. Hearing aid specialists will not be equipped to assume the roles and responsibilities currently being assumed by audiologists in the VA healthcare environment.”
A TECHNICIAN’S ROLE
H.R. 3508 is intended to enable the VA to make greater use of hearing aid specialists in helping it keep pace with the fast-growing needs of veterans with hearing loss and related conditions. However, AVAA maintains that no law is required to permit the VA to use specialists. Under current VA regulations, the association says, non-audiologist practitioners can already be hired as audiology health technicians. In fact, many of the over 300 audiology health technicians working in VA audiology clinics are hearing aid specialists.
As for contracting for services from hearing aid specialists, AVAA says that the VA can already do this. Its handbook provides for the use of hearing aid specialists “where timely referral to private audiologists and or other Veterans Health Administration facilities is not feasible or when the medical status of the veteran prevents travel to a VHA facility or a private audiologist.”
COMPLEX CASES
The AVAA statement goes on to discuss the special demands that caring for veterans places on audiologists:
“VA audiologists occupy critical roles as members of interdisciplinary health care teams specifically designed and equipped to meet the unique needs of their veteran patients. These patients often present with very complex conditions resulting from the synergistic effects of auditory and vestibular disorders occurring with co–morbidities such as traumatic brain injury, poly-pharmacy, and post-traumatic stress disorder. The diagnostic work performed by a VA audiologist becomes the foundation for rehabilitative care, which may, or may not, include the use of hearing aids.”
CLOSING COMMENTS
In concluding its statement, AVAA noted that its opinions do not represent the views of the Department of Veterans Affairs. Thus far, the Department of Veteran Affairs has made no public statement on H.R. 3508 or on the International Hearing Society’s Fit to Serve campaign. However, it seems highly probable that the VA shares the view of the audiologists it employs.
IHS welcomes the opportunity to comment on AVAA’s position, and believes that many of the points AVAA made in its statement underscore the exact reasons why hearing aid specialists should be better integrated into the VA system.
Yes, audiologists have more education in their field of expertise and provide many services that are well beyond the legal and desired scope of hearing aid specialists. We believe that allowing hearing aid specialists to work on the VA team providing hearing aid dispensing services would better enable VA audiologists to focus on those services for which they are uniquely qualified to provide, including disability evaluations and dealing with complex medical and audiological cases. To that end, in drafting the bill we specifically chose to retain the VA’s authority to make hiring decisions and define hearing aid specialist job duties. We would expect these to be similar to the contracting policies which allow for hearing aid specialists to perform hearing aid evaluations, and fitting and dispensing services. We are not seeking to have hearing aid specialists fill the role of audiologists, and feel hearing aid specialists can provide much greater value in a hearing aid specialist role rather than working as an audiology assistant. In terms of the hiring requirements, ultimately it is up to the VA/clinic to determine who it chooses to employ based on a candidate’s education, training and experience; and the statutory requirements simply set a benchmark for minimum qualifications.
On the contracting side, Veterans would still start with the VA for intake and diagnosis, then the VA audiology clinic would determine the appropriateness of referring an individual Veteran to a hearing aid specialist. And while the VA clinics currently have the ability to utilize hearing aid specialists, they rarely do so because VA policies require these clinics to seek out audiologists first. For hearing aid services specifically, the VA clinic should be able to tap into all available providers – especially given the increasing number of Veterans who are in need of care.
We invite questions or feedback. You can contact us at [email protected] or you can learn more at http://www.fittoserve.us.