by Michael Metz, PhD
Harvey Abrams comes through again in a recent posting on this site entitled “Noise in the Quiet”. Dr. Abrams discusses the value that audiology can add to the patient with the clinical methods we should possess. He states:
Note that I purposely avoided the word “bundling” here because bundling is often associated with a false choice – either you charge one fee for everything or you charge a separate fee for everything. There are many ways to separate the product from our services -we are limited only by our imagination.
However, in a recent post to the American Academy of Audiology’s General Audiology Digest, Dr. Roy Sullivan warns us:
“Value-added in not an assertion, it is a perception!” The “unbundlers” in our field sorely ignore this harsh truth. One cannot justify costs of services detached from cost of product by simply invoking a litany of what you, as dispensing audiologist, promise to provide beyond product. It is the patient’s perception of your intrinsic value-added that drives success or failure of the ensuing clinical encounter and enterprise.
Dr. Abrams provides a list of clinical activities that provide value to the patient. And he concludes that
The perceived value of these procedures seems to have been lost on the PCAST, the press, and the public…. But it’s not going to be enough to simply list the professional services we provide in answer to the question, “why do hearing aids cost so much.”
How is Value Added to Audiology?
How is value added to audiologic procedures? Let’s take a closer look, as there is a need to add to Dr. Abrams’ comments.
- Patients should realize that services are associated with a cost. Bundled or unbundled, time, skills and expertise come at a price. And, in our haste to “get into the profit game” in the late seventies and early eighties, and because we used a model in which sellers and sales offices did not (could not) list clinical services, we didn’t either. It seems that we did not think far enough ahead to itemize.
- Third party payers must have a way to code the procedure prior to their paying for it. And, that procedure has to be demonstrably valuable to patient care. If what we do has value, we have to be able to prove it undeniably. Can’t we do that for most of what is done in out clinics? Don’t any of our associations have a list of rehabilitative services with justifying information available to their members? If not, shouldn’t they?
- While Medicare does not pay for hearing aids, if they passed a law that incorporated such payment into their schedules, wouldn’t it be a little too late to argue that we do it better than anyone else when there was no code history, no payment history, and no other evidence that we used any of these clinical tools? This lack would not be a “good duck” in our row.
- Third party billing history would seem to indicate that, when we had a new or better test, we billed under a generic code and added procedural notes (justifications) to that billing. After a while and enough submissions, payers put a new code into the manuals. This is how most procedures get into the system—insurers get tired to reading all that “proof” after a while, and then denying payment in the face of that justification.
- Insurers are more willing—not happy but more willing—to pay for diagnostic procedures if there are investigative procedures that help define the hearing loss more completely (demonstrated in peer-reviewed research). If these tests will facilitate treatment, these procedures should be used and billed to third parties with the “universal” code (justification will be required).
After you read Abram’s article, you will need to carefully review the recent study from Indiana University from Larry Humes and colleagues.
All audiologists need to incorporate these ideas and practices in their services. And then they can wage a reasonable and justifiable fight for reimbursement. Not in the manner they have been doing, but in the way it has worked in the past. Fee for service may be the salvation of the field.
Humes, L., Rogers, L., Quigley, T., Main, A., Kinney, D. & Herring, C. (2017). The Effects of Service-Delivery Model and Purchase Price on Hearing-Aid Outcomes in Older Adults: A Randomized Double-Blind Placebo-Controlled Clinical Trial. American Journal of Audiology, Retrieved March 7, 2017.
*image courtesy docsvault