The Audiology 2050 Initiative: Elevating the Profession to Tackle Future Challenges

All right everybody, and welcome to another episode of This Week in Hearing. I am excited to be joined today by two great doctors, Doctors Amyn Amlani and Jason Leyendecker. Thanks guys for coming on. How are we doing today? Oh, I’m doing great. How about yourself? Doing fantastic. You can’t complain on a nice beautiful Thursday like this. Sun shining. What do I have to complain about? What about you, Dr. Amlani? I’m doing well, man. And it’s interesting being on the other side of the equation this time around. So I’m looking forward to it. David. Should be should be an interesting conversation for sure. Well, thank you guys so much for coming on. Really wanted to just dive right into Audiology 2050. We’re sort of, you know, right off the heels of ADA, which was a great conference. Kudos to both of you guys in the big roles that you played at it and will be playing into the future. But I know that this was sort of one of the byproducts of this year’s ADA and probably some years prior leading up to that. So the floor is yours, gentlemen. If you want to explain and kind of go through what this what this all is. Sure. I’d happy to take the reins at first and kind of explain. The reason why we wanted to hop right into a big change or a vision was I think that the AuD now is, it’s 25 years old and the things that were part of the original design have not completed 100% yet. There’s, there’s part of the original vision that we just, we need to get to, to be able to establish ourselves in the healthcare space that we really wanted to be part of. So that whole process started by you know, doing the research on what happened when they designed it. So we did a lot of looking back at communications between kind of our stakeholders of our audiology profession back in the 70s, 80s and 90s and how created the AuD movement. And then from there we decided, well, what have we not accomplished? What does the future look like and what we need to address as we get into that space and how do we get there. So that’s where the vision came from. So our board worked pretty hard to put that all together, did a lot of research and spent time in our two in person board meetings really dedicated to designing this process. So it’s been a lot of work, but a lot of fun in the same instance, not very often do you get to really dive into how you get to be part of the future? And it was, it was great. So that’s my side of it. Yeah. And Dave, I’ll just add it’s kind of a perfect storm. And I think Jason will agree with me. You know, when, when you start looking at the history of ADA, you know, it’s a, it’s a continuous engine that’s always seeking the betterment of the profession. And you know, they’ve been looking at ways to improve reimbursement through legislation, through these other factors. You know, you tie that in with what Jason said and looking at other professions and trying to figure out what we can do from a historical standpoint of what the AuD was supposed to be and where we’re at, look at the, some of the work on the workforce and how that’s playing out. And as all of these things kind of converged on one another, we came to the point of, you know, now’s the perfect time to think about what we want to be and reverse engineer that. And as Jason said you know, the board worked hard on getting the pieces together. Some of the, some of the pieces were there. We had to refine them. We’ve added a few new pieces at this board meeting. And the goal now is, and we’ll talk about this, I would assume throughout the rest of this conversation is how can folks get involved? Because at the end of the day, this is not just ADA’s profession, it’s all of audiology’s profession. And you know the folks that are putting in the time should reap the benefits and those folks that are complaining need to step up to the plate. Yeah. So I think let’s zoom out a little bit and frame it, I think with what has happened from what you just described over the last 25 years. Right. I always use the conversation I had with Dr. Victor Bray on This Week in Hearing as a reference point of this whole thing. And it was, as I understand it so correct me if I’m wrong, but I think it was George Osborne and some of those founding fathers of the, of the profession. They were really looking at optometry as sort of an analogous comparison, I guess, in terms of how they reached what he had outlined was the seven step process of ultimately becoming a limited practitioner. Is that right? Were originally looking for physician. Not just a practitioner. Yeah. So can you, I think if you could maybe talk about that in terms of what hasn’t been achieved and ultimately what this will do. Because as I understand it, we’re almost stuck in the quagmire of step four and five or something like that, you know. And I know like what was really interesting as I was having that conversation I was learning about that was to understand that, you know, there was legislation back in 1992 that was talking about that was essentially the same premise more or less as what we now have with MAAIA. So it’s like this ongoing sort of never ending cycle of just being, you know, in neutral. And I’m trying to understand why that’s been the case is like what’s happened from, from then till now and, and what can we do to change things into the future to kind of achieve this and then what will that achieve? Yeah, yeah, that’s a, that’s an interesting comment. So I I’ll actually go back a little bit further. I was a David Goldstein student. I was a master’s level student when the AuD was still being formulated. And I remember David and Carl Binney and others in the building you know, putting the curriculum together. They would go out on a speaking tour and convey the message and try to get support and all these other things. So I’ll go back that far. George Osborne. I first met George Osborne when I was a master’s level student. I think I was a second year student. He actually came to Purdue. We had a small conference on what the AuD was going to be. We had invited several folks. He was one of those individuals. And you’re right, the idea was, is to find something that we could mimic rather than recreating the wheel. And as Jason pointed out, we needed to move forward from just being dispensers. We needed to be able to provide services. And in order to provide services and get reimbursement, we can’t do that in the way that we’re set up right now. Today we are classified under CMS as Diagnostic Suppliers Only, which is why we don’t get reimbursement on the Medicare side for the services related to devices and cerumen management and some of these other things. And so having MAAIA pass is really, really critical. I think for the last four or five years we’ve been really, really close. Jason. And remind me, I think last year we were like two or three or maybe five votes short of actually getting this bill through Congress. So we were really, really close. We are in a little bit of a we’re in a little bit of a quagmire, as you put it, given the fact that this is an election year and, you know, most of the folks are, most of the, the supporters and things are concentrating on who’s going to be our next leader and you know, so the hope is, is that we’ll be able to attach this bill onto something else because it can’t stand by itself. It’s not big enough. There’s lots of benefits, not only in terms of saving money to the system, but also to the beneficiaries. And ADA has all that and we’re happy to certainly share that. So, as you pointed out, the biggest thing right now is to get MAAIA passed, improve our services, which would put us in a practitioner level. And there’s lots and lots of benefits to that. So, number one, telehealth automatically becomes available to us. Number two, we are now classified similarly to other healthcare professionals that are within our allied health space. So nurse practitioners, chiropractors and so forth and so on. Right. Eventually, we’d like to get into the physician standpoint where we can actually prescribe medications, but we’re not quite there yet. But this would be the launching point for that. And then the other attributes to this. And Jason, remind me, as I’m starting to draw a blank here the other aspect of this is the abilities also now to have direct access to our patients. So rather than for somebody with cerumen, for example, coming in as a Medicare beneficiary, we then have to punt them back to their physician and then get them back. We lose them here. We now have the option to continue that treatment. And so there’s lots of benefits. And I think we get this passed that will open up the door to allow us to improve our service delivery, which will then hopefully improve our reimbursement. And then the next stepping stone is how do we change the profession? And I’m using that word kind of globally here in order to move forward. And that then is at a state level where we have to change licensure laws and at the educational level, where we have to actually change the way we train folks. And so I’ll stop there and let Jason chime in, in case I missed something. I think you did a great job of explaining, you know, the three pillars of the Maya bill and how that plays a role in this 2050 approach. I think on top of that, you know, to what Amyn puts together daily is the information on our workforce issues and how that is going to be a much bigger deal. Our profession is still very young, and what we’ve accomplished already is amazing, but we have to keep it moving, and we have to keep moving things along. So the professions that we do parallel with, well, they’re much older professions than us. They have a lot more established, and it will continue to be that way unless we start learning. From them and moving things forward. A perfect example would be using extenders and how we can use those and you know, policy changes, legislation changes that allow for us to be able to extend using technicians and assistants in our space more effectively and being able to bill under the purview of an audiologist that establishes us a much better level of hearing health care and it fits better in the process. So if we have 50 million people needing our help and there are what, 15,000 audiologists, we’re going to need to be able to adapt and use those extenders to help us with that kind of support. So I think that’s the big ticket items that we’re really focusing on top of just really establishing ourselves as better practitioners, you know, so the education piece is a big part of it, but also setting expectations of what an audiologist needs to be when they graduate. You know, one of the pillars is activism. It should be standardized that people come out of school knowing that they’re going to donate to their PAC funds for their state, national organizations. It’s just part of it. Because the only way for us to grow is to have that, that resource to be able to keep working on the legislative side of things. So really kind of moving the profession forward, it needs all of us working in the same direction. Yeah. And I’ll add one more thing. As Jason is talking about activism, we also came up with something called professional socialization. And basically that’s acting like a doctor. And you know, we have a contingency of our peers who don’t do that. And so in order for us to gain the respect and to live up to these higher expectations, we got to walk the walk and talk the talk. And in order to do that we all have to align with what is our professional etiquette and we need to set that standard. Yeah So I mean, I got a couple thoughts here. I want to actually go back while it’s still kind of in my mind, this telehealth piece, because I actually think it’s extremely timely as I just recently learned about the expiration of the ability for audiologists to perform telehealth diagnostics and be reimbursed by CMS, as I understand it that is due to expire, I believe in November. So going off of what you had said there, Amyn it seems to me as if, you know, when we’re thinking about how can this get passed that’s going to affect a lot of other medical professionals outside of Audiologists, if that happens. And so I think that would be, I think hugely positive for this to It seems as if this is going to have to come to some type of resolution where it’s going to get extended, but that should help to at least put focus on this. And my point is, is that I think it’s you know, it’s a timely, I guess, thing that this is happening and it’s you know, sort of happening at a much more macro level. But I feel like this is going to kind of bring a lot of this to, to a head. Yeah, no, and you bring up a good point. Yeah, it’s going to expire here in several weeks. You know, the first thing that I would tell the audience is that this is a federal bill. So you reach out to your representatives in your state, your senators and ask them to support MAAIA. We can provide a link to where you can ask for that assistance. The more sponsors we get, the more likely this bill is to be attached to something. Right? And so, you know, get on now and start pinging those individuals. If they can also get patient reports or patients to contribute their needs for these services, that will also help those sponsors move the needle along. So you know, we’re at a point where we really need this thing to pass in order not only for us to grow, but in order for us to continue providing services to these individuals. Because as we found out in the workforce model there’s an encroachment of scope and that’s coming from other professions, mainly the hearing instrument specialists. And when audiologists are either unable or unwilling to provide those services, someone else is stepping up to that plate. We need to be able to own our space. And so in order to do that, passing MAAIA would be one huge step in that right direction. And then as it elevates us, it would then allow us, as Jason pointed out, to add on these other individuals as extenders to help us provide those services. So it’s a win, win for everybody. So if I had a plea, that’s what it would be to the, to the audience. And I’ll add in there that the likelihood of MAAIA passing this year, the best chance is some type of telehealth omnibus bill in the lame duck session. MAAIA is probably as close as it’s ever been to passing. And we just need that last little giddy up to get over the, the hump here. So for sure it might be our best opportunity. Yeah, that’s what I’m, that’s where my head went was when I learned about that, I thought, well, this actually could be the, the thing that it gets attached to. Since that I have to imagine there’s a lot of medical professionals that their entire you know, patient care model, it very much included telehealth. I think that there are certain fields of medicine that it’s actually quite far along. If you’re a patient of those models, you’ll know what I’m talking about, where you’re actually kind of blown away. Which brings to a point that I wanted to talk about, which is this whole workforce dynamic and what I perceive to be a looming supply shortage, more or less. I mean, I think that the supply and demand of this market is crazy when you really think about it. I mean, we’re talking about, especially now that I think you have tinnitus treatments that appear to be on the horizon. These you know, neuromodulation techniques and who, who knows what else is on the horizon. But I think that the market for audiological services was already very large. Hundreds of millions of people in the US for hearing loss alone. But, but now you add in tinnitus treatment as well. So how do you possibly accommodate for hundreds of millions of potential patients when you are limited to 15,000 ish audiologists? I mean, in one way, isn’t this kind of a bull argument for audiology is that, you know, hopefully there is these broader resolutions of your profession and the way in which you can practice your medicine. But at the end of the day, who is going to possibly see all these people and provide them with treatment? And for me, that the kind of only answer to that is some means of technology that is augmenting the professional to where they can basically serve the masses. So just broad thoughts about that. tinnitus is definitely near and dear to my heart. I see a lot of patience for tinnitus, and I see them from virtually all over the world. So it is, it is very challenging to be able to create the right model when our laws are a little bit more restrictive as they are right now. That said, I think a hybrid model is probably going to be the best option. Im currently reading a book called Future Care. And that book definitely explains how there are limitations to what telehealth can achieve. But it is a need that fits a niche and if you can find the right way of using it appropriately, it’s going to be very effective. But that case, we’re very limited in what we can do based off of our current laws. So I do think one area that we’ve seen already trending in the right area is the compact bill that has. Was it Alaska? Alaska that just joined? Its possible. I know Alaska, I want to say I just saw in HHTM or somewhere that I correct me if I’m wrong, we’ll put the actual statistic. But I think it was the 34th state was Alaska. Right. And I know Minnesota passed just earlier this spring and that was the 31st, I think. So we’re moving along in that area. So really quick. Can we just. Can you just explain the. The compact real quick? So the compact law allows for audiologists to be able to travel and move into a new city. Let’s say you’re part of a or your family is military and moving often. It allows for them to be able to start working right away under the license of somebody within the compact. It also allows for us to see patients virtually from one state to the other if the state is in the compact. So what it does does is it just frees things up. You still have to be licensed in the state that you live in, but it allows for us to be able to see patients. Like your license is more like a driver’s license where it allows you to go over, cross borders and be able to see them in other states. And you still have to follow the rules of the state that you’re seeing the patient in. But it does allow more access to care. For sure. Yeah. And David, I’ll just add this in, is as we’re talking about workforce and taking care of the patients through the supply and demand mismatch that we’re seeing, you know, that the workforce is not only affecting audiology, it’s affecting healthcare in general. The next huge shift that we’re going to see or the next big healthcare reform that we’re going to see, and we’re starting to see that now, is to do it yourself. Patients are going to have to start taking care of themselves and because there’s just not enough providers. And then also if you look at the medical triangle, right, you have the ancillary folks taking care of what’s at the bottom, which is that downward push. And then the folks that have the physician’s status are kind of working at the top and that’s where all the money is. So as we’re thinking about this workforce piece. The comment that I’ll make is this. We want to be practicing at the top, not only because that’s where the revenue is, that’s where our skill set is probably best. We want the extenders to kind of work in the middle, and then we need to let go of some of the things. That we do and allow automation to take place. And if we do that, we create a pipeline where we can see more individuals. And by allowing us to see more individuals, we have less strain on the healthcare system as it relates to social isolation, depression and all those other factors that we keep talking about. Yeah, I mean this is kind of the, the reoccurring, you know, type narrative, I guess, or, you know, theme in my mind is how. How does this all play out? Because I, again I think that it’s, it’s kind of a exciting sort of, you know, setup here for the audiologist. Because again I, I do think that the you gotta square this math equation that you know, there, there’s gonna be just all this demand. And so to your point, you know, if they rise up in the sort of medical food chain and there’s a, you know, sort of, you have these additional layers of workforce that fall adjacent or underneath. You know, I think that it allows for the audiologist to really focus on that, on the area of expertise. Right. And so I think that you know, you can, you can kind of see how this, you know, is already shaking out where you know, if your value is more or less your your knowledge you’re a knowledge worker. Right. And we can see how the knowledge, the knowledge worker economy is shaping out, you know, outside of healthcare. It just seems like that seems like a realistic possibility that in 10 years maybe, or you know, maybe less, where you can literally work from home as an audiologist that and a lot of people will do this, that they can. A big appeal to this will be that you’re really just serving as that oversight into those lower levels of work. You know, so it’s different than you know, a patient facing audiologist. It’s more like you’re you know, overseeing this, this workforce more or less. So I just kind of see how this can evolve in different ways where again you’ll still have the ability to be the type of doctor where you just are interacting with patients all day every day. But I think that there can be tiers of this once you start to enable and open up the ability for extenders or additional like layers to help augment your ability to really provide this like top of the triangle expertise. But make sure that you’re able to like facilitate it in a really big way. Absolutely. I’m, I’m impact driven and this is the way to provide a bigger impact. And so pushing that forward, we have to be working at the top of our scope and educating along the way, getting the right people in the right spot on the bus. Yeah. And Dave, there’s a We have a, we have quite a ways to go in order to do that. It’s, again, as I said earlier, we’ve got to change the educational model. And that educational model has to change as a function of a licensure. It can’t be the other way around. The licensure has to drive what the educational model is teaching. And the educational model that we are under right now has not changed, but neither has our scope really over the last couple of decades. And so, you know, as the Maryland bill, for example, just passed, where imaging is now a part of the scope of practice you know, how is the institution now going to manage that? So Victor and I, Victor Bray, who I have the great pleasure of collaborating with on this workforce initiative. We had a conversation with the cap, CSD folks who run the programs. And as we were having these discussions you know, we don’t have any solutions at this point. It’s just a dialogue to get them to think about this and say, hey, we actually need to move. And I think we did that. But how do we get those things to change and then what’s on the horizon? You know, you talked about gene therapy and some of these other things that are starting to come out. Where’s the audiologist role in this? And the better educated we are, the more of a role we’ll have, the better the role we have, the better the profession is going to be down the road. Yeah, I think all of this is, you know, very much it’s exciting to think about and I think it will be, you know, interesting to see what happens at the end of the year. But I wanted to go back to the whole Because I think this kind of does tie into the Maryland piece, which is the activism and the, you know, really having a concerted, consistent message and being able to affect change in. On Capitol Hill. Jason I know you’ve had quite a bit of experience doing this. I mean, can you speak to what that process is like? You know, and maybe some examples of how, you know, again, as even a small workforce like audiology, how they’ve been able to They’ve been successful? I think you know, at our conference we had our advocacy committee up on a panel as well as a Maryland audiologist who helped pass that and the key takeaway I got from that was opportunity. Always giving ourselves an opportunity. So the more we are independently working in our states and communicating, you know, going to Capitol Hill and continuing to just be there the more opportunity we have to make change. So a lot of it doesn’t necessarily have to be a huge movement. It’s just little pieces coming together and working together when they are just in the right opportunities. So always saying yes to an opportunity to go to the Capitol Hill and communicate with people. When you get a chance to talk to a staffer or to the actual legislator congressman or woman, you get 15 minutes. And that 15 minutes is really hard to make a long lasting effect. But the more times you do it, the more the opportunity will arise where they remember who you are, they remember why you were there. And the more you can tie it back to how it’s going to improve patient care for their constituents, the more they’re motivated to make change. So I think the Telehealth bill right now is a or Telehealth portion is going to be a very big factor in how people will address this. I know we did just, just get Senator Klobuchar on yesterday onto the bill. So they’re still signing on regularly. And the more we just give ourselves the opportunity, the more we’re going to make this change. Yeah, agreed, agreed. Yeah And again it’s getting involved not only at the professional level, which is where most people want these changes to happen. You got to do it at the state level because the Maryland belt is a Maryland thing. It’s not a AAA thing or an ADA thing or an ASHA. It was, it was at the state level. So you have to participate at both levels in order for, for this to be successful. And as Jason pointed out, going and talk to these folks, get them to know you, get them to know what your cause is and how it benefits them and get your patients to also write them. It’s a huge, huge deal. So 100% Very cool. Awesome guys. Well, I very much enjoyed getting a sense of, you know, what Audiology 2050 sort of you know, is designed to communicate and you know, I just think it’s, I think we’re at a really interesting time in this industry. I think the profession is there’s you know, kind of things could change. And I think there’s a lot of potential upside for this profession. And it seems like, you know, there’s just gotta be some some of this like collective, you know, People getting on the same page and being aligned, more or less. There’s no doubt our world is kind of polarized and the more we bring each other together the more we can make this change. We’re a small organization, we’re small industry. And to make change it’s going to require all of us working together. I can tell you we’ve already made some headway in that, that area communicating with our colleagues at other organizations and trying to start creating those relationships so that way long term that we can have those key conversations when it’s necessary. Yep. Yeah. And the advice that I would give is advocate for the profession, become an activist. Dave, we’ll send you a link for folks who want to volunteer and participate in this 2050 wheel that’s been created. We’re looking for professionals to join the cause. Theres several assets and things that we’ll, we’ll try to create next year. Hopefully present them as part of the ongoing work that’s been done through leadership over time. At the AAA meeting. So you. At the ADA meeting which is in the Washington D.C. i believe it’s at the end of September. September next year. Yep, yep, next year. And you know, we’d love to have some assets and things and then when the next, when I come off and the next President elect comes in as president, we’ll keep that ball rolling because again this thing just keeps churning and so we appreciate the opportunity and again the more people that can join us along with this fight, the the easier the battle. Awesome. Very cool. We will link all that make this something that people can, can participate in. Because I agree, I think you know, just a shout out to you know, getting involved. I think might be one of the most universal things that is positive and beneficial in life. You know, I can’t think of how many different examples of people around me that you know, they, they go and they do something that’s a little bit out of the ordinary. You go to a state, you go to your state conference, you go to the, you know, you, you just go and you kind of get to know some of the other people and you’ll be amazed at where that takes you in life and where those paths cross. And I just think that the more involved you get, the more opportunities you give yourself. And these things are truly like the best way I think for, for people in general to build a network. And then those networks always kind of create and open interesting doors. Absolutely. Absolutely. Very cool, guys. Well, thanks so much for coming on. Thanks for everybody who tuned in here to the end, and we will chat with you next time.