A Case for the Enhanced Audiology Assistant: Part 2

Today’s post concludes last week’s discussion on audiology assistants:

 

When we think about how audiology assistants can be utilized in the clinic, one of the first places to look for comparison is how they are being used in the Veteran’s Administration (VA).

The VA has been successfully using assistants for many years. While the general job description for assistants in the VA may have parallels to those working outside the VA system, they do perform a broader range of duties than is generally acceptable (or even legal in certain states) in the private audiology clinic.

Here’s a job description I came across for Health Technician at a VA clinic in Texas:

“As a Health Technician for the Audiology Clinic, you will primarily perform hearing aid maintenance and repairs, manage the technical aspects of cerumen removal, and provide clinical support to the staff Audiologists. You will independently complete the Audiology Assessment of patients needing ear-mold impressions or hearing aid/assistive device repairs; make impressions of the ear canal for ear-molds or custom in-the-ear hearing aids. You will schedule hearing aid evaluation appointments at the request of the Audiology Staff; receive and appropriately route consults to clinic providers in consultation with the staff; screen calls from veterans, walk-in patients, or incoming devices from Veterans having complaints about their hearing aids or assistive listening devices. You will perform routine and advanced electro acoustical analysis of hearing aids on hearing aid test equipment for audiologist review; dispense repaired items to veterans.”

Aside from maybe taking ear impressions and cerumen removal, which might make some a little queasy, I think many audiologists would love to have (if they don’t currently) an assistant that could perform the type of duties outlined in the VA’s job description for a [Hearing] Health Technician.

Image courtesy Sungard
Image courtesy Sungard

If assistants performed half the duties outlined in the VA job description, that would be a major enhancement to how they are being utilized presently by most clinics.

If it has shown to be successful and more efficient with this model at the VA, should we then take into consideration expanding the typical duties of  assistants in the audiology clinic?

 

Let’s take a look at what a 2010 AAA task force had to say about how assistants can and can’t be used in some states:{{1}}[[1]]Task force report, AudiologyNow 2010. Click here to read more about this and other issues pertaining to Audiology Assistants[[1]]

AA hjduties

The “allowed” duties may surprise some of you reading this, while the “prohibited” items likely come as no surprise.

While a few of the procedures may seem surprising, or even “risky”, consider that nearly all of those procedures are performed by non-audiologists in some capacity everyday (by nurses, techs, dispensers, etc)–meaning those without a Master’s or Doctoral degree and years of clinical training (like audiologists have).

With a lack of training programs and no widely accepted certification standards, getting qualified people as assistants will continue to be a significant challenge.

Support Personnel in Audiology

Aside from the VA, there are many other professions where we could take our cues as to making the clinic more streamlined and more efficient in utilizing the audiologist’s time effectively.

Take the example of the optometry clinic:

The assistant greets the patient and takes them back to the exam room. The assistant reviews history and determines if there is any issues that the optometrist needs to discuss with the patient prior to the exam. The examination by the optometrist is performed, the prescription is dispensed and the patient is sent down the hall to see the optician who helps them pick out glasses, discuss payment options, etc.

While it sounds less personable, this is the model we’ve all become accustomed to when attending other medical or dental appointments. It’s the model my optometrist uses and I have no complaints about my care. Many dentists and other health professionals use a similar model.

If an audiology clinic adopted this model–how many more patients could they see in a given day? How much could efficiency be improved in the audiology clinic if it operated in a similar fashion?

A 40-50% increase in efficiency could increase the number of patients seen in a day and potentially have a very positive impact on the bottom line, making the cost to employ support personnel well worth the investment.

Incorporating Techs in the Clinic

At our practice, we have (with much success) utilized hearing aid technicians in all of our offices. They see a lot of the appointments that are just routine checks/maintenance that really don’t require an audiologist’s time. Aside from saving the audiologists time for other tasks, some of the maintenance appointments our techs see are billable appointments.

Hierarchy of personnel in the audiology clinic.
Hierarchy of personnel in the audiology clinic.

With our techs, individuals with minor problems can often get in sooner and maybe have their problems resolved easily without having to schedule an appointment with an audiologist. Often, as we know, hearing aid problems can be something as basic as wax plugging the receiver or the ear canal itself. Our techs also perform otoscopy and basic hearing screenings to help determine if someone should return for a diagnostic hearing evaluation. In addition to the daily clinic duties, they also are involved in our outreach services to senior centers and assisted living facilities.

While we haven’t yet, some clinics have gotten their technicians CAOHC certified{{2}}[[2]]To become a Certified Occupational Hearing Conservationist (COHC), a candidate completes a Council for Accreditation of Occupational Hearing Conservation (CAOHC)-approved, 20-hour certification course and earns a passing score on the exam.[[2]], so they are able to bill for hearing conservation services at a much lower cost than having their audiologists perform the basic screenings as part of a hearing conservation program for individual businesses.

Techs vs. Assistants…Where Do We Go From Here?

Audiology Assistants (AA’s), as I view it, should have a broader base of skills and be able to take on a larger role in the clinic than a hearing aid technician, for example. With a greater foundational knowledge, allowing them to take on more of the duties outlined earlier in this post would prove to be less “scary” to practicing audiologists.

Lets face it, many of the issues involved with having an assistant take on extra clinical duties is often due to lack of knowledge on the part of the assistant and lack of time on the audiologist’s part to train someone from scratch.

State prohibitions, Medicare and other issues do in fact prevent audiologists from allowing AA’s (even those who are highly trained) to take on a greater level of responsibility than we have outlined above. Yet, in a physician’s office, technicians (of various stripes and abilities) can perform close to 80% of the same procedures an audiologist does and can bill for them under the physician. While it may seem strange to those unfamiliar with these types of occurrences, or even unfair or inappropriate, for audiologists to be in a similar position as a physician in this instance may take an act of congress or even the creation of a completely new kind of licensed assisting professional.

Dreams of any significant revenue generation in the clinic by an assistant (like a dental hygienist equivalent for example) may need to be replaced with dreams of revenue savings, at least at the present time; however, this shouldn’t diminish the value a technician or assistant can bring to the audiology clinic.

Maybe it’s time to really give some thought as to how we are (or how we aren’t) training assistants to help out in the clinic and consider better ways in which we can incorporate them to help us become more effective with our patients. Enhancing the skills of many of the current support personnel being used in audiology today could pay dividends and allow audiologists to see more patients.

Without stepping outside of our comfort zone, we could potentially be missing out on reaching a greater number of patients that would benefit from our services and instead continue to watch as more people seek help from the One-Size-Fits outlets that promote and sell products rather than seeking personalized solutions.

Have an audiology assistant job opening at your clinic? Post it at the HHTM Career Center.


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