By Melissa Sinden
The American Academy of Audiology (the “Academy”) is the world’s largest professional organization of, by, and for audiologists. The Academy has in place a team of experts who constantly review contemporary healthcare delivery models, analyze the climate for change, and make recommendations to the Academy’s elected board of directors for opportunities to act. As part of this ongoing analysis, evidence suggests within the current Medicare system that access to hearing healthcare could be improved. Under the current Part B model, Medicare patients must obtain a physician order prior to seeing an audiologist as a necessary step for Medicare to reimburse for those services. To address this burdensome model, the Academy has conceived and shepherded legislation that would eliminate the physician order requirement and allow for the increased access to care that our senior population desperately needs.
Approximately 36 million Americans experience some degree of hearing loss and that number is expected to reach 78 million by 2030{{1}}[[1]] National Institute on Deafness and Other Communication Disorders (NIDCD)[[1]]. Furthermore, hearing impairment is one of the most common conditions affecting older adults, with approximately 33% of Americans aged 60 and over and 40%-50% of those aged 75 and older with hearing loss{{2}}[[2]] National Institute on Deafness and Other Communication Disorders (NIDCD)[[2]]. It seems logical that the community that reflects the greatest need for diagnosis and treatment should have the same access to care enjoyed by most other populations within the United States healthcare system.
In the aging population, hearing loss can present a major barrier to participating in society, both economically and socially. If left untreated, hearing loss can result in isolation and depression.
Among those nearing retirement age, loss of hearing can lead them to withdraw from the workforce earlier than planned, which, in some cases, results in loss of independence and decreased quality of life. Recent studies show an increased likelihood of developing dementia when hearing loss is present, and a positive correlation between degree of hearing loss and risk of dementia{{3}}[[3]]Lin, F. R., Metter, E. J., O’Brien, R. J., Resnick, S. M., Zonderman, A. B., & Ferrucci, L. (2011). Hearing loss and incident dementia. Archives of Neurology, 68, 214–220.[[3]].
Congressman McDermott (D-WA) first introduced HR 4035 in the House of Representatives
On average, people wait seven years from the time they think they might have a hearing loss to the time they seek treatment. Unnecessary referral requirements, particularly for Medicare patients who experience concurrent mobility or transportation challenges, may further delay access to quality hearing healthcare.
Audiologists are qualified to identify, diagnose and treat hearing loss. The Academy’s objective is to remove any unnecessary barriers to the delivery of quality hearing healthcare so that our nation’s seniors can easily receive appropriate services. In February 2014, Congressman Jim McDermott (D-WA) and Senator Sherrod Brown (D-OH) introduced legislation in the U.S. House and Senate, respectively, that would address these access issues currently faced under the Medicare system.
The Access to Hearing Healthcare Act of 2014 (H.R. 4035/S. 2046) would eliminate the need for Medicare beneficiaries to obtain a physician referral prior to seeing an audiologist in order to have those services reimbursed by Medicare. Veterans, who have completed the necessary requirements to establish eligibility for healthcare services through the Department of Veterans Affairs (VA), have been afforded direct access to audiology services since 1992 and the administration has reported this policy allows the VA to provide “high quality, efficient and cost effective hearing care” to veterans. The Office of Personnel Management allows federal employees to directly access audiologists through the Federal Employees Health Benefit Plan, and many private insurance companies also employ this model. H.R. 4035/S. 2046 would afford Medicare patients the same option of going directly to a qualified audiologist for hearing and balance diagnostic services.
Although audiologists are required to refer to a physician if a medical condition is present, the overwhelming majority of hearing loss, approximately 90%-95%, may be treated through amplification alone (audiology services), while only 5%-10% of hearing loss requires intervention by a physician.
Several studies show that patient safety and patient outcomes are not compromised in any way under the direct-access model{{4}}[[4]]Zapala, D., et. al., Safety of Audiology Direct Access for Medicare Patients Complaining of Impaired Hearing. Journal of The American Academy of Audiology, 2010:21(6), 365-379; Freeman BA, Lichtman BS. (2005). Audiology direct access: a cost savings analysis. Audiology Today 17(5): 13‐4[[4]]. It is also important to note that, should this legislation be enacted, Medicare patients would retain the option of seeing their physician first if that is their preference. H.R. 4035/S. 2046 would simply afford Medicare beneficiaries the discretion to go directly to an audiologist for hearing healthcare. This legislation is endorsed by the Hearing Loss Association of America (HLAA), the nation’s leading organization representing individuals with hearing loss.
Hearing loss among the Medicare population is currently under-diagnosed and under-treated. If Medicare beneficiaries had direct access to an audiologist, more seniors with hearing loss might obtain the requisite tests and necessary treatments to allow them to continue their independent lifestyles and maintain their quality of life. Eliminating the referral requirement would improve Medicare beneficiaries’ access to hearing care and, studies show, result in a cost-savings to the system{{5}}[[5]]Dobson, A., et. al., Determining Potential Medicare Savings by Streamlining Beneficiary Access to Audiology Services, Projected Impact of Direct Access for Audiologists (2013).[[5]]. Medicare currently allows beneficiaries direct access to a range of providers including podiatrists, optometrists, chiropractors, nurse practitioners and physician assistants.
Those who would like to urge their elected officials to support H.R. 4035/S. 2046, the Access to Hearing Healthcare Act of 2014, which would improve access to quality hearing healthcare for seniors, are urged to visit the American Academy of Audiology’s Legislative Action Center. This site allows you to quickly identify your representatives and access an editable letter that you can email directly to their offices to voice your support for this important initiative. This legislation is the first step toward ensuring better care for Medicare beneficiaries with hearing loss.
Melissa Sinden is the Senior Director of Government Relations for the American Academy of Audiology. She can be reached at [email protected].
The public being what they are, may have more difficulty with this than we would initially expect. For example, will this law clarify or further blur the difference between audiologist and non-audiologist dispenser? Can the public go to either? If one goes to a non-audiologist dispenser without seeing a physician, can the non-audiologist simply “no charge” the patient and proceed? Is there any clarification of who’s who involved? How will the non-audiologists-both physicians and dispensers–react?
Does anyone see that there may be more complications/problems to this legislation than initially anticipated?
Interesting questions that we don’t have answers to Mike. I think if it doesn’t get any serious traction this session, it may be time to abandon this whole piece-meal concept and fight for 18×18 instead.
We’ve had more than 10 years of attempting this legislation without much success to date. Maybe it’s time for a new strategy?
The purpose of this legislation is to afford Medicare coverage for services provided by an audiologist without requiring patients to first obtain a physician order. Medicare does not pay for services provided by hearing instrument specialists. This legislation would not effect that policy. Since the same direct access policy is one component of the 18×18 proposal (legislation has yet to be introduced for this initiative), as outlined, that proposal would also not change Medicare policy with regard to non-audiologist dispensers. Finally, Medicare providers, unless they have opted out of Medicare, are required to file claims and reimbursement and fees are set by the Medicare Physician Fee Schedule. This direct access legislation would not alter that arrangement for physicians who dispense.