Ethics versus Reimbursements – Part 2

Gael Hannan
July 5, 2016


by Mike Metz


During the early years of the American Academy of Audiology, many people took a great deal of time to compile a list of what audiology can include in its scope.  Many hours of volunteer work went into what skills define the profession.  Similarly, many hours went into the organization of the Code of Ethics.  While most of the code was derived from the ASHA code, the AAA spent time and money in an attempt to set and promote the principles of practice.

Ethical practice reflects not only best practices, but it also must incorporate other elements like the makeup and abilities of the professional members, the changing demands and regulations of business and government, as well as educational growth and financial health of members of the group.  The trick is to keep all elements in balance.  In at least some opinions, audiology is out of balance.

How many of the public view various “professionals” and judge them “ethically challenged”?  Professions that purport to function for the public good should strive to do just that.  If they do, it should be obvious.  If they don’t, they deserve questioning.

Consider “Big Pharma”, politics, or the law.  While many of these public-interest companies and people are commendable, one only has to look at methods and profits—and the nightly news—to rate their commitment to the public good.

Would you rather consider medical care?  How about outrageous hospital charges, or the many hospitals and clinicians that have learned to “game” Medicare?  Surely, we don’t want to hold up those responsible for these actions as examples of ethical behavior and commitment to the public.  While none of us have any right to criticize the ethics of other professions, it should be obvious that something is whacky as there are many who are behaving in a manner that seems to ignore the public good.

I have written and spoken about audiology ethics for many years.  For many of these years, I have had a friend who was a national spokesperson on the topics of legal and ethical matters in medicine.  I received this comment a couple of weeks ago from this friend:

“[I gave up on] “…healthcare a while back now, it’s too calcified with too many self-interested actors all vying to protect their mediocrity and income. The insurers who set up the reimbursement deals create the monster as well; if we only paid for services OR goods from the same practitioner, or gave a CHEAP bundled [insurance] payment and that’s it, (you could) watch the practitioner shift his/her ‘ethics’ to accommodate more means to rip the insurer off. Then the insurer will react to limit reimbursement again or change its terms to maximize its profits and C-suite bonuses; which will garner additional changes and gaming. It’s a never ending battle for those who want more pay than they’re entitled to and those who want to pay less than services are reasonably worth.” (I added the italics.)

Where does audiology find balance?  For those of you who would use the behavior of others in health care fields as arguments or examples, both my friend and I have warnings.

  • If we compare ourselves to another profession, we should be sure that the other is a good example. To be compared to the “usual suspects” may place us in pretty poor company.
  • What other field do we want (or need) to look like? Are there reasons we should look the same or different?  Scope must not exceed abilities and training and when the training and ability of the majority does not match the scope, something needs to change.
  • If our original code is not reflective of what we think we want to be, we first have to admit the problem and then take steps to fix things.
  • Do we (re)build the audiology scope of practice to reflect what we should be, what we wish to be, or what we are?

This takes us back to the discussion of ethics and reimbursements in Part 1 of this posting.  If audiology desires true professional standing, perhaps we should begin by proving what we offer is valuable.  Many tests in the hearing and balance clinics yield interesting intrinsic information but the everyday tests used by most audiologists have little value other than that which was proven 30-40 years ago.  Audiology research moves forward yet little application reaches the public through the many practicing audiologists.

As an audiologist, you can fight for the reimbursement of procedures that match your training, time, equipment, and skills, or you can succumb to the regulations limiting your effectiveness.  Freeman’s “Position of Strength or Weakness”: you get to choose.


Michael Metz, PhD

Michael Metz, PhD

Dr. Metz has been a practicing audiologist for over 45 years, having taught in several university settings and,  in partnership with Bob Sandlin, providing continuing education for audiology and dispensing in California for over 3 decades.  Mike owned and operated a private practice in Southern California for over 30 years.  He has been professionally active in such areas as electric response testing, hearing conservation, hearing aid dispensing, and legal/ethical issues.  He continues to practice in a limited manner in Irvine, California.


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