Best Practices, PSAPs and the VA Hearing Aid Bill

By Michael J. Metz, Ph.D.

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Micheal J. Metz, Ph.D.

It is interesting, if not illustrative, to note two blogs in the posting of Hearing Health & Technology Matters dated September 16, 2015.  Specifically, the article from Angela Loavenbruck titled “You Do Your Thing and I’ll Do Mine: Ethical Considerations In Audiologic Treatment of Hearing Impairment”, speaking to the ethical considerations of best practices, contrasted with the news blog of Brian Taylor concerning “US Senate VA Committee to Hold Hearing on ‘Fit to Serve’ Legislation”.

If an unaware member of the public (or perhaps an insurance carrier or government official) attempted to differentiate between the people who fit hearing aids, it would appear that those not specifically trained in an academic setting would fare quite well in comparison to many members of the dispensing community who have completed a degree in Audiology.

Loavenbruck’s article would seem to imply that only about 30% of Audiologists used best practices with their hearing impaired patients when fitting hearing aids. She further notes that this figure likely has not changed from published data that may be 6-9 years old.

It may be unwise to hope that those folks in the US Senate VA Committee don’t also have access to the same data that the Audiology profession has known since at least 2006 (the published date of the AAA guidelines).  It may be even harder to argue that audiologists do a “different” job than lesser trained dispensers do if Angela’s responses from the audiology practices she contacted are an indicator of the extent to which “best practices” are utilized.

To the unpracticed eye—public, government, insurance, etc.—there would seem to be very little difference in the care many public receive when compared to what many veterans would receive if the Veteran’s Access to Hearing Health Act of 2015 passes.

This movement has counterparts in many states.  If I am not mistaken, California non-audiologist dispensers commonly use bone conduction (BC) in evaluating their customers.  Any of us who have used bone conduction methods know that BC almost always works with sensory hearing losses.  As conductive loss grows, BC results become less reliable until they finally constitute “a dilemma”.

Maybe it was just me, but I often had difficulties explaining BC methods and problems to ENT residents. In California, non-audiologist dispensers have attempted to get reimbursed from MediCal/Medicaid patients when they do this test.

Putting Things in Perspective

Movement for increased clinical visibility, responsibility, and etc. by non-audiologist dispensers is not new.  Nor should it be unexpected, especially when one reads the well documented and logical testimonies of highly respected people writing about PSAPs.  Additionally, much of the MarkeTrak information would seem to give the impression that there is little difference in the abilities of anyone fitting these devices. While there may be arguments about many parameters, there is little data to suggest that any one group is “better” than any other in fitting hearing aids and judging “success”, whatever that is.

But, before taking a position on either side of the VA access bill, one ought to recall that when one door closes, another opens.

Perhaps, if the majority of audiologists do not use best practices, we can assume that neither do VA audiologists use these rules for fitting hearing aids.  If that is the case (and the number of VA hearing aids dispensed, the number of VA patients on the waiting list, and the average time spent with VA patients in the hearing aid process would certainly support this assumption), then passage of the VA access bill will have little to no impact on the care received by veterans.

Indeed, perhaps the VA could limit the “scope” of non-audiologist fittings to only those involving PSAPs.  And VA Audiologists, their patient load reduced significantly, could spend more time and testing with certain to-be-determined patients.

If nothing else, a long term study of these two groups might go some distance in showing the value of “best practices”.

*title image courtesy realteachingblog

Michael Metz, Ph.D., has been a practicing audiologist for over 45 years, having taught in several university settings and, in partnership with Dr. Bob Sandlin, providing continuing education for audiology and dispensing in California for over two 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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