This Week in Hearing, Episode 2: Dr. Alicia Spoor Discusses MAASA Legislation

– Welcome to “This Week in Hearing” where listeners get the latest information on all things happening in the hearing care space from device technology to pharma-therapeutics to practice management. My name is Amyn Amlani and today we are discussing the topic of patient access to receiving audiology services as it relates to Medicare in the United States. To facilitate this conversation, please welcome Dr. Alicia Spoor. Alicia thank you so much for being here.

– My pleasure, thanks for having me.

– Would you tell us little bit about yourself before we get into this discussion?

– I would love to. My name’s Alicia Spoor as you so kindly mentioned, I am a doctor of audiology, so I hold a clinical doctorate degree in the profession of audiology and I have a private practice in the Baltimore Washington D.C. area where I see patients as my daytime job. In addition to my daytime practice of seeing patients, I also do a lot of advocacy work, which is what I think we’re gonna talk about today a little bit, both on the state and national level. But, going back to my original roots of me and Dr. Amlani and how we met, I grew up in Michigan and I’m honored to be with you as you’re one of my favorite TA in my undergraduate program at Michigan State, so thanks for having me.

– Absolutely, go green, go white right?

– That’s right.

– all right, so we’re gonna talk about the Medicare Audiologists Access and Services Act. Now, whether you call it MAASA or MAASA I will leave that to you you can tell me which one is right, but it’s an important legislation piece that’s been handed over to the government to hopefully pass and what we really wanna share with the audience today is one, what’s its importance, number two, what are some potential things that we could see down the road? But before we do that, I think it’s really critical that the masses understand current patient journey as it relates to Medicare and if you would share that with us, that would be really helpful.

– Perfect, happy to do it. So, what I see as a provider is when patients call my office and whether I answer the phone or whether my front desk manager or somebody answers the phone, if the patient’s coming to me and they’re 65 years or younger or they’re 65 and older and have a Medicare Advantage Plan and that’s Medicare Part C, but those are plans that are typically administered through United Healthcare at NUS signal a lot of these common third party insurance payers, they’re coming in and they’re calling and they’re saying, hey, I have a hearing concern, a balance or vestibular concern, ringing in my ear, maybe wax in my ear canals, whatever it might be and we’re that patient into our practice, getting their information and scheduling them right then and there, and hopefully getting them in as quickly as possible so that we can start to figure out what type of issue may be causing their difficulties and get them treatment if that’s warranted. So that’s true, again, from birth through 65 and on many Medicare Advantage Plan. When you look at Medicare Part B, which is often, B as in bravo, which is often referred to as the traditional Medicare system that’s been around since the 1960s, these patients are typically 65 and older, and they have that traditional hospital’s Part A, medical as Part B and Part D as your prescription drugs. When you have that Medicare Part B system, or that traditional Medicare, if you call the audiologist with any again, any type of concern that I just listed off, it’s very difficult for me as a provider to bring you in initially. And the reason being is that the antiquated Medicare system hasn’t changed for the profession of audiology since it was written in the 1960s. And so there’s an old statute in place that says that in order for a Medicare patient to come see an audiologist, they first need to go to their family or general practitioner or primary care provider and obtain an order. That order is literally a piece of paper that says that they can come see me as a specialist to complete their evaluation. I’m still ordering the testing, I’m still figuring out what’s needed, but they have to have that piece of paper. After I’m done with my system, you then go back to whoever ordered that test in order to go over those results which again, most of the time the audiologists are doing, because we’re providing the testing, we’re going through that diagnostic finding, and then talking about that treatment system. So, where that birth through 65 a Medicare Advantage-patient has one visit, those traditional Medicare patients have three visit and if you don’t bring me that order or your primary care physician is not enrolled in the Medicare system which some of them are not, very few but still occasionally there’s no Medicare coverage for you to come and see an audiologist. And again, it’s just an outdated system within the Medicare policy as a whole.

– And as you’re talking, and you’re talking about the journey here. It’s not a linear line anymore, it’s not, come in and be seen it’s kind of a runaround. So accessibility is affected and then of course there’s a liability from a taxpayer standpoint and also from a personal standpoint, ’cause you’ve gotta take time off at work and transportation or whatever the case may be. It’s, how do we fix that?

– Well, I’m so glad you asked. There have been quite a few organizations that have been working on this issue for decades now, but the current iteration that is in Congress in this congressional session is called MASSA or MASSA or whatever you’re, however you’d like to say it, as long as it gets passed I guess it doesn’t matter how we say it, but it is the Medicare Audiologists Access and Services Act and that’s a fancy name of saying, in order to change traditional Medicare, you have to have an Act of Congress because it is a congressional government-run system and therefore Congress sets those statutes, limitations and regulations. So, MAASA or MAASA is currently H.R… let’s say I wrote my numbers down just to make sure H.R 1587 in the House and Senate bill 1731 in the Senate. So they are identical pieces of legislation and we have some great champions on both sides of the aisle. So this isn’t a political this is really to help those Medicare patients and as you mentioned, all the people that go with the Medicare patients. So we’re talking about maybe people who take them as part of their transportation system, maybe the caregivers that come with them because they live with their daughter or maybe they live in a facility or somewhere along the line and anybody now or in the future that might ever be on this traditional Medicare plan. So there are really three different turnout to the Medicare Audiologists Access and Services Act. The first thing that the legislation will do when it’s passed is it will eliminate that need for that physician order that we just talked about before seeing an audiologist. So this is something where we talked about how you have to go to primary care, then the audiologist then back to your primary care referring provider again. This would eliminate those two extra steps and you could just go to the audiologist for any medically necessary assistance. So, most people are banging down my doors because they just love to see their audiologists, they wanna come hang out with me for a year. There’s still has to be a reason why you’re coming in before insurance is gonna cover something, but it would eliminate those extra steps. And as you alluded to, that saves money not only and time, energy, time off of work, provider, patient care system whatever it might be, but it also saves those tax payer dollars and insurance dollars, so that’s number one. Number two, it would reimburse or provide coverage which is the fancy term for payments. It would provide coverage for Medicare Part B beneficiaries to receive treatment services from audiologists, for services that they can provide under their state-defined scope of practice. That’s a really long way of saying if Medicare covers a service and it’s considered a treatment service not diagnostics, but treatment and an audiologist like myself can provide that service within my state scope of practice, then Medicare should also cover it for those patients. And again, going back to what we talked about just a second ago, that eliminates a lot of the you have to go to A to go to B to go to C to go to D this can be a one-stop shop. You come to me, I diagnose wax in your ears, I can take it out under my state-defined scope of practice, I take it out, Medicare provides coverage for it and then we move on to whatever that next thing is. So it makes it more of a holistic care because again, we just mentioned from birth through 65 Medicare Advantage and a lot of the VA TRICARE systems they’re already working in this way it’s just Medicare Part B that’s their outlier. So, this allows those treatment services to have coverage. It’s also important to note that this national legislation doesn’t change scope of practice, so it doesn’t do anything related to what I can or cannot do that’s all defined at the state level and it doesn’t change anything Medicare is already covering. So what we’re seeing is, if Medicare covers a treatment service and the audiologist can do it, let the audiologist do it if the patient chooses to come to the audiologist. But it’s not gonna introduce anything new or expand anything that’s already there, we’re just working in the confines of what is already covered. And then the third turnout is it would reclassify audiologists from the diagnostic supplier or diagnostic other category that we’re currently sitting in with radiology into the practitioner category. That’s really important for a couple of different reasons. Number one, we’re currently in a COVID pandemic states although many states are lifting some of their restrictions, but right now a lot of our patients can receive services through tele-health. When those tele-health emergency transactions go away as the COVID pandemic becomes under control or restrictions are lifted, the ability for the audiologist to provide tele-health is also gonna go away because we’re in the wrong category. So those are the three big turnouts and just little examples along that of what this MAASA legislation would do.

– So, having said all that and that’s fabulous, what can the audiologists that’s practicing today do to help advocate for this?

– There’s a lot of things that audiologists and everybody else can do. Everything that has to be done is really local, but age-old saying of . And because it’s an Act of Congress that needs to be done, or that needs to be completed, everything goes through congressional members. So we’re very fortunate in the United States, we have our House members and we have our Senate members and we have legislation in both chambers and so you can reach out and talk to at least two people, if not three about what’s going on in your state and what needs to be changed. There’s a great website in my little partial called chooseaudiology.org and under that there’s a system called congressional connect and they have free form template that you can go in and doctor often change to give your experiences and then you can fax them out. All of the Audiology National Associations also have some type of legislative center, advocacy center, PAC donation system that audiologists themselves can donate to. But the nice thing about chooseaudiology.org is that they have templates for Medicare Part B beneficiaries currently who may or may not be audiologists. They have individuals who may be a Medicare patient in the future. They have all these different things that you can do, but you can call somebody, you can write somebody at the House or the Senate side whoever your representatives are, so if you’re not sure you can look them up congress.gov is a great place to look that up, but everything goes through that system. So, the more they hear stories about what’s going on, why it’s antiquated, why it’s outdated, why it needs to be changed, the more likely they are and just like anything else, the squeaky wheel gets the oil, so we have to tell them why this system needs to be changed.

– That’s great information and we’ll be sure that we have those links up so that folks can access that information and subscribe and partner with us in getting this bill moved. This is absolutely fantastic. So let me ask you this while I have you here. Do we have any idea, and I know this is a loaded question do we have any idea what’s the likelihood of this thing passing? I know it’s pretty strong, but do we have any idea at this point or not yet?

– That’s a great question. Sometimes I get really excited and I think, oh my gosh we’re moving forward and then a COVID pandemic hit and then there are other times where we think like, oh my gosh, this is the lame duck session and nothing’s gonna happen and all of a sudden it takes off. A couple of things we know kind of for sure, which nothing is for sure in politics is that this is a very small piece of legislation that’s not gonna pass on its own. So it needs to be attached to something that’s much larger that’s moving through the system and part of that is bandwidth. Congressional members you’ve heard my numbers 1587 and 1731. Those are the number of bills when we actually got MAASA I say we as if I authored it, where we actually got MAASA into the system. So there are literally house in the pieces of legislation that are voted, representatives are looking at on a regular basis and they’re not gonna go through every single little one and pass this and not this and pass this and so that’s where things are getting attached into bigger packages because if it’s an easy Act or if it’s something that needs to be done and kind of put all those things together and move them forward. Right now, our congressional session is pretty democratic on both chambers as well as in the executive branch in the White House. And Democrats have always been looking at the possibility of expanded healthcare coverage, they’ve been looking at Medicare for all, whether you agree with that or not is not to be debated, but they’re also looking at ways to help benefit the Americans and this could be one way of making that change. So it’s a very strong session that we’re in and the session runs from January 2021 until December 31st of 2022 so we’ve got a window that we’re working in. So we’re looking at any avenue that we can do, but the more congressional members hear from us, the more likely they are to say, hey, there’s an opportunity to put this MAASA legislation and we better put it in here so that it moves forward. I wish I had a crystal ball and could say, it’ll pass on X day at X time but sometimes I don’t even think our congressional members know when something’s gonna pass. So me as an advocacy person, you as a interested audiologist, that’s my best guess although it is an adjudicated guess.

– You know what? I’ve got my fingers and toes crossed and I’ve got my lucky rabbit’s foot out and God willing this will move forward because I think it’s critical for the profession and really for our patients.

– Definitely for our patients.

– So last question that I’m gonna ask you and it’s a little bit loaded. So as we look further down the line and as we look internationally, you’ve probably heard that the National Health System in the UK they stopped providing traditional hearing aids for people with mild to moderate hearing loss and they went with a piece of it, went with the new hearing product. And I understand that products are not part of this whole MAASA piece ’cause we’re not adding anything new into it as you indicated. But my question is, down the road, is it possible that either the government could potentially partner with a lower-end piece app or OTC company and or, I’ll use the word or is it possible with the MAASA’s services component that you talked about, a patient could buy the product and come in and get the services that they need?

– If that’s not a loaded question I don’t know what one it is. as long as there’s not a test at the end I think we’ll, we can probably be good. I have a couple of thoughts on that and they are my personal opinion from having looked at these and neither nor anything on behalf of any other organization first and foremost. The MAASA legislation does not include devices as you talked about. But, if devices were ever covered separate or in conjunction with MAASA, the audiologist would be the one that could be helpful on that case. Regardless of whether a question of audiologists and of service members coming back with hearing loss and tinnitus coming from the world wars aren’t covered when it comes to audiologist under Medicare Part B services, because they’re treatments services already. So that’s part of the issue that we went back to on the MAASA’s side. And right now, audiologists, if you talked to any audiologists or the majority of audiologists, most of us will say, when asked why did you go into this profession? Most of us will say something like, oh, I wanna help people hear or oh, I love working with whatever and the quality of life just got so much better for our patients and that feeling was very caring and heartwarming and people wanna be helpful and that’s oftentimes why they go into audiology. My thought is that if you really wanna be helpful and the best course of action comes to a personal sound amplifier or what will soon hopefully be on the market as an over-the-counter hearing aid that’s just another avenue of helping people regardless of if it’s for hidden hearing loss so it isn’t that’s not important, ’cause that’s the audiologist’s role is to help people walk through that but I don’t see any reason why the place of procurement of a device should make any difference. I mean, you’re wearing glasses at the moment your optometrist probably doesn’t turn you away if you got your glasses when you lived in Arkansas versus when you lived in Texas. Or if you decide you wanna go the option of Warby Parker because it’s more convenient, whatever it might be and you find a provider if or when you need something, why would there be any change for that? When you come in for services the audiologist should be helping you for whatever services you need for the types of services that you do need. So I think this is a great opportunity for our audiologists, as we’re looking five years out, which I don’t have a crystal ball because if I did I would tell you when MAASA was gonna pass. I think this is a great opportunity for audiologists to look at their scope of practice and decide what they’re doing and what else they could be doing. We talk about how we wanna help people hear but are we helping people with their balance? Are we helping people prevent falls? Are we helping people keep their ears clean? Are we helping people with hearing protection? Are we helping people with tinnitus? Are we helping with auditory processing? There’s so many things that audiologists can do and there are so many patients at any age with any insurance coverage that could benefit from those services. So if we look back at our roots, we were never the hearing aid person, initially we were that kind of therapeutic side which is ironic since we’re diagnostic only within the Medicare system. But there are so many things that could make us into a more well-rounded profession and could also bring in more patients who actually need those different types of services. So as somebody who loves doing cerumen removal at this moment in my lifetime, I think it’s fantastic for people to look at those other avenues as well.

– Yeah, now I’ve been in this field for 25 years or 26 years now, and the star is shining brighter than it ever has in my career. It was always about hearing aids and I think we’re starting to transcend into what we should have been from the very get go and I’ve always said, it’s not how you start, it’s how you finish and hopefully we’ll be able to take these things that you’re talking about, improve the educational system and be able to provide these services to each and every individual who has these types of issues whether it’s tinnitus or balance or hearing, or they need intervention through hearing aids and be able to service those and improve the quality of life of those individuals. And that’s a conversation that we’re gonna have to have down the line ’cause we’re almost out of time here. Having said that, Alicia thank so much for your insights, your input, for sharing this information with our podcast, our viewers and also enlightening me and it’s always good to see you

– It’s my pleasure. Thanks so much for having me and thank you to everybody who’s working to promote audiology, to promote audiologists and more importantly to promote the access and affordability of audiologic care for our patients. So, thank you very much.

– We also wanna make our readership and followers aware that there is an ADA 2021 Virtual Fly-in for the MAASA Senate and it is going to occur on August 3rd, 4th and 5th, where AUD advocates from around the nation will be able to virtually connect with the hundred U.S. senators in every state and make a case for MAASA or MAASA. We have that link located below, and we hope that you’ll exercise the opportunity to engage with the Senate leadership in making sure that the audiology voice is heard.