Hearing Aids and Health Policy: Medicare, Ally’s Act, and More with Bridget Dobyan of HIA

Hello, everyone,

and welcome to This

Week in Hearing.

It’s my pleasure to have on the

program Bridget Dobyan,

executive director of the

Hearing Industries Association,

or HIA. Previously,

she was HIA’s director of public

policy and advocacy.

It’s the topic of public policy

that brings Bridget

to the show today.

But before we get into that,

Bridget please tell everyone a

bit more about your background

and both your roles at HIA.

Sure. Andy.

Its great to be here with

you today. As you noted,

I’m the new executive

director of HIA.

I’ve been serving in this

position since January of this

year. Prior to that,

I was HIA’s director of public

policy and advocacy for

nearly four years.

My path to HIA was kind

of a winding one.

I’m actually a lawyer

by training.

I briefly flirted with the

idea of corporate law,

but made the right decision

after law school to

stick with policy.

I worked as a policy advisor for

the Michigan senate for

a couple of years.

I made the jump from

there to DC,

where I served as legislative

director for Michigan

Congressman Dave Trott.

Following his retirement,

I made the decision to

leave Capitol Hill.

It was a difficult one to go,

but I think the right one,

because I went on to serve in

government affairs for an energy

efficiency nonprofit before

ultimately coming to HIA.

So that winding path has given

me a background in law,

state and federal policy, and,

of course, nonprofit advocacy.

So,

what’s really funny is that in

my initial conversations

before joining HIA,

no one actually knew that

I had hearing loss.

I lost hearing on one side

when I was eleven.

I am a very satisfied user of

a bone anchored hearing aid.

I think that personal connection

is really incredibly valuable

when advocating for the

importance of hearing health

when working to combat the

stigma around hearing loss.

And so I’m just so thrilled that

my professional pathway

has brought me here,

and I’m really honored

to lead HIA.

Which is a really interesting

background in multiple respects.

I mean,

in terms of hearing loss,

you came at it in a way that

I’ve seen other times before

where a person has hearing loss

and they managed to work their

way into the industry,

whereas I was the.

I was in the industry for six or

seven years before I finally

addressed my hearing loss.

A result of a youth going to too

many rock bars and otherwise

abusing their ears,

and it finally caught up

with me. But also,

all your experience on the hill

must really benefit HIA

in multiple ways.

So it seems like a great

place to land.

I would say so.

And I wish that the cause of my

hearing loss was something as

fun as going to too many

rock concerts, but,

you know,

I’m sure at some point maybe

that’ll catch up with me too.

But that’s another discussion,

right?

That’s a totally different

discussion.

At least you don’t look yourself

in the mirror and

blame yourself.

So but anyway since, you know,

we came to talk about

public policy,

let’s get into the conversation.

And actually,

I think the policy initiative

with the highest potential

impact right now is the Medicare

Audiology Access Improvement

Act, or MAAIA

I should probably explain for a

global audience that Medicare is

the US government program that

provides healthcare benefits and

services for people

aged 65 and older.

Would you explain how hearing

care services are provided by

Medicare today and what changes

are proposed in MAAIA?

Sure So hearing care services

are somewhat limited under what

I’ll call original or

traditional Medicare.

You have original or traditional

Medicare and then you have

Medicare advantage,

which is part c.

So original Medicare has parts

a and b. So your hospital,

your inpatient services,

your diagnostic.

There is a statutory exclusion

within the Medicare program.

Currently the original

Medicare program,

that hearing aids cannot be

covered under original Medicare.

However,

certain diagnostic services

relating to hearing health

are covered,

as well as things like

osseointegrated devices and

cochlear implants for

beneficiaries who fit certain

selection criteria.

Again,

nothing for what we would call

traditional hearing aids or

prescription hearing aids,

but Osseo and CI and certain

diagnostic and vestibular

services.

The MAAIA bill,

which DC is a town of acronyms

and thank goodness,

because that’s a mouthful.

So happy to refer to

that one as MAAIA.

Hia is very pleased to endorse

this legislation.

It’s been introduced in multiple

sessions of Congress so far,

and it’s a priority for the

audiology professional groups.

So, just a brief overview.

The MAAIA bill would provide

Medicare coverage for diagnostic

and treatment services that are

provided by audiologists.

It would remove the physician

order requirement to improve

access to audiologists and also

reclassify audiologists as

practitioners under the

Medicare program.

The bill does not expand the

scope of services that are

currently covered under

original Medicare.

It just kind of smooths that

pathway to covered audiology

services.

Nor does it expand the scope

of services provided

by audiologists.

And I will give ADA a shout out

on that summary because I did

pull that one from

their website.

It’s very eloquently put.

So this bill has been introduced

in both the House and the

Senate, it’s a bipartisan,

bicameral bill.

It’s S23 77 in the Senate,

which is led by senators

Elizabeth Warren, Rand Paul,

and Chuck Grassley.

And then in the House, HR 6445,

it’s led by Gus Belarakis

and Matt Cartwright.

And I seen various groups going

to Congress to lobby

for this Bill.

What can ordinary people,

or people in the hearing

industry, as individuals,

do to help move this across

the finish line?

Well,

I think for your ordinary

individuals,

the best thing that you can do

is reach out to your members

of Congress,

reach out to your senators.

You can, of course,

reach out in writing,

but I have always said that the

best way for a legislator to

take specific interest in an

issue is to see how impactful

that issue is.

So invite your congressional

member,

invite their district staff,

if you’re a professional,

invite them to your office,

have them come in,

see what you do.

Check their ears,

discuss what your day

usually looks like,

the population that you serve.

I think that the firsthand

experience in witnessing what

professionals do is the most

important. And then,

as your ordinary person who

might have hearing loss or

hearing difficulty, again,

call your congressional member,

call your senator.

They work for you and voice the

importance of access to hearing

health services,

particularly for Medicare

beneficiaries.

Okay, thanks.

Now, one thing that’s not MAAIA,

and you mentioned this,

too is that hearing aids

themselves are not covered

by Medicare.

And it’s not in a MAAIA

bill either.

But it has shown up several

other times in proposed

legislation.

Share where that’s at and how

HIA views those proposals,

please.

So, in this particular congress,

actually,

let me back up a little bit.

In the last several congresses,

there are always a handful of

bills that are introduced and

then reintroduced that deal with

the statutory exclusion of

hearing aids in the Medicare

program a bit differently.

For example,

Congresswoman Debbie Dingle has

a bill that she’s introduced in

multiple congresses that would

remove that statutory exclusion,

which would then pave the way

for the regulatory authorities

to create the rules to

allow for coverage.

We may recall that in the

previous Congress,

the 117th Congress,

there was the Build

Back Better act,

failed to pass by a very

narrow margin,

a margin of Senator Joe Manchin

that would have expanded

Medicare to include coverage for

hearing aids and related

services.

And then there are a handful of

other bills in between that all

take kind of a different

approach to the coverage issue.

In this particular Congress it’s

a divided Congress where

Democrats control the Senate,

Republicans control the House,

and of course,

we have a Democrat in the

presidency with a divided

Congress,

that makes it difficult to make

any really significant

or seismic changes,

particularly in something that

is as big of an issue as

potential Medicare expansion.

And the Medicare expansion

conversation doesn’t just

pertain to hearing aids.

It typically includes dental

vision. So hearing,

dental, vision,

none of those three are

currently included, again,

within the original Medicare

program. And again,

it’s very important to make

that distinction,

as nearly all Medicare Advantage

plans offer some type of

supplemental benefit within

the hearing health space,

dental space and vision space.

So for purposes of

this congress,

we have not seen a large scale

proposal such as Build Back

Better. And really,

in this Congress at this point,

there’s not a lot of large

legislative packages that are

going to move forward at all.

Not to change topics at all,

but we are in an election

season,

and typically an election season

at the congressional level tends

to create a bit of a vacuum

for legislative activity,

particularly in the second half

of the legislative session.

And we are in not just

an election season,

but a presidential

election season.

So not just a vacuum for

legislative activity,

but kind of a black hole for

legislative activity,

particularly at this,

at this point.

So we do still see members of

Congress taking an interest in

the oversight of these programs

and asking the questions

with Medicare Advantage,

we know that there are questions

about utilization rates and how

to collect the best data on the

success of the Medicare

Advantage program if

beneficiaries are utilizing

their supplemental benefits.

And so while I don’t see a lot

of activity at the legislative

level,

it is an opportunity for a bit

more action in the

regulatory space,

which would really speak to

that data collection,

utilization metrics,

and overall satisfaction and

operation of these programs.

Okay,

so it sounds like that’s almost

the precursor step to

some legislation,

because you then have the

evidence and the data behind it.

And I suppose it’s fair to say

that the Build Back Better bill

was a much larger bill.

And so the reason for it not

passing doesn’t necessarily have

to do with the Medicare hearing,

dental and vision coverage,

but the greater issues that were

around Build Back Better.

I’ll ask how you feel

about this,

because my personal

opinion is what,

roughly half or a little more,

if people are taking advantage

of the Medicare Advantage

programs now,

but that also creates an

accessibility gap,

leaving behind hearing coverage

for those who can’t afford

an advantage program.

And how do you feel about that?

Yeah,

HIA is very supportive of access

and affordability.

And in crafting these

legislative proposals,

it’s really important to make

sure that it’s done the correct

way that does ultimately provide

a benefit to the beneficiary,

making sure that there would be

enough providers that the

benefit is structured in a way

that individuals can access the

devices that are best suited for

their unique hearing loss,

for their lifestyles. And so,

you know, it’s a,

it’s a very detail oriented

conversation that needs to be

had within restructuring

the Medicare program.

Yeah, that makes a lot of sense.

And of course,

Medicare is for people 65 and

older for younger people,

unless I’m missing something,

Congress has generally shied

away from mandating private

insurance coverage of hearing

devices and services,

typically leaving that to the

states if the states choose

to do so individually.

But that’s not true for cochlear

implants and bone

anchor devices.

There’s now the proposed

bill called Ellie’s act.

Share how and why that made it

onto the federal agenda.

Yeah,

so this is really a passion

project that has grown.

This was started by Melissa

Tumblin, who runs Ear Community,

which focuses on hearing loss

related to microtia. And,

and she was spurred on by her

daughter’s experience in trying

to obtain an osseointegrated

device due to her medical

conditions and having

difficulty doing so.

And so Melissa worked with

Representative Joe Neguse out of

Colorado to introduce the House

version of the bill. Again,

this is another one that’s been

introduced in multiple

congresses.

There’s a Senate companion that

is led by Senator Shelley Moore

Capito of West Virginia and

Elizabeth Warren as well.

And so this device again,

or this bill,

it focuses on osseo devices

and on cochlear implants,

and trying to smooth that access

pathway within the private

health insurance space to obtain

these devices for a population

for which these devices are

really the only option.

Another hot topic is the 2021

decision of the US Preventative

Services Task Force to not

recommend hearing screenings as

part of routine examinations

for people 50 and older.

This caused a good deal of

consternation in hearing

care circles,

especially since the deleterious

effects of untreated hearing

loss seem well understood.

But the task force which makes

evidence based recommendations,

stated that,

and I’m quoting here,

whether earlier detection due to

screening and provision of

amplification improves outcomes

is not clear based on existing

evidence. Let’s break that down.

How did they come to that

conclusion and what would be

needed to change that decision?

So I’ll cite specifically to the

comments that HIA submitted

in response before the

recommendation was ultimately

finalized.

And our comments recognize that

need for more specific evidence

and peer reviewed research to

support a recommendation.

And we really focus that down

in three different areas.

Studies on protocols,

studies on procedures,

and studies on efficacy.

And at this point,

we generally rely on

our excellent,

excellent network of

strategic advisors,

including Dr. Tom Powers,

who can speak very eloquently

and thoroughly to the specifics

of each of those three elements.

At the overarching policy level,

anytime that a recommendation is

made or legislation advances or

regulatory measure is adopted,

and it really is founded and

grounded in science,

in research and in review.

And we’ve had follow up

conversations with NIDCD,

had follow up conversations with

congressional members about the

importance of addressing hearing

loss, of screening for it,

and intervening early and the

associated comorbidities,

and then the overall health

and wellbeing outcomes,

the positive health and well

beings from an earlier

intervention.

This is also an ongoing

conversation with our partners

at the audiology groups hearing

aid specialist groups,

consumer advocacy groups,

as well around the importance

of screening.

So the US Preventive Services

Task Force, which, again,

DC being a city of acronyms,

the USPSTF,

as it rolls right off the tongue

that’s one part of the process.

The other part of the process is

now working to supplement that

screening research that

they said is lacking.

This is something that we’ve

been working on.

There is more work to do about

what that research looks like,

where it’s most appropriately

conducted,

and if there’s anything that’s

currently ongoing within the

National Institutes of Health.

And so we’ve worked with

congressional members to have

this issue recognized at the

congressional level,

within appropriations report

language that asks about what’s

currently going on.

And so then the next step is

kind of filling in those

gaps before US

PSTF will and can revisit

the screening issue.

So the best answer is,

it’s an ongoing issue that we

continue to emphasize and

recognize its importance.

Okay. And it strikes me,

you know,

the physician workload

always comes to mind.

And so if you’re going to add

workloads in a medical practice

during a routine exam,

you really have to have clear

evidence that the outcome is

going to be beneficial.

It strikes me that once a

screening protocol is developed

that has good evidence for being

accurate in improving

the outcome,

that this could be highly

automated these days,

with a little AI or

machine learning,

that you could have even a multi

step screening protocol that’s

more or less automated and

reduced the physician workload,

because you could,

could set a person up at intake

time and let that thing run and

then interpret the results,

or have the results interpreted

for you?

Is that the sort of thing you

envision happening in the end?

And what kinds of things would

be built into such a screening

protocol that makes sense?

I think that’s a really

interesting perspective on the

potential for automation,

because you’re right,

there is a significant

physician workload,

particularly if you’re looking

at an annual physical.

How much time is spent

with the patient?

And are those short time

resources allocated to be the

most impactful for the end

outcomes for the patient?

I latch onto this discussion of

artificial intelligence, too,

because that’s an area that we

are seeing significantly greater

focus from Congress and from

regulatory authorities.

For example,

the FDA has created a new

advisory committee,

the digital health advisory

committee

And that’s taking a look at how

FDA can both responsibly,

potentially regulate the

artificial intelligence space,

the digital patient telehealth.

It’s a very broad mandate of

this advisory committee,

but I think a very important

one. And you’re right,

all of these issues kind of loop

back around to each other to,

can we make the system more

efficient and ultimately more

beneficial to the patient?

I don’t have the perfect answer

for how this might work and

how it looks in the end,

but what we are doing in the

meantime is impressing upon the

importance of early intervention

of hearing health.

Okay. And of course,

we’ve been having this

conversation about,

you know making decisions

based on evidence.

And one of the bits of data

that’s often used both in

decision making and framing

policy goals is the market

track reports.

Lets discuss that a

little bit more.

What’s going into the

MarkeTrak?

What are you going to do for the

next one that’s different

than the previous ones?

And what do you think is the

most valuable contribution in

the whole hearing space of

the MarkeTrak reports?

Sure.

So we are so excited that we’ll

have our next MarkeTrak

We’ll be fielding it later this

year with results expected

in 2025.

So this version of MarkeTrak

will be termed MarkeTrak

2025 or MT25.

MarkeTrak 2022, which,

as the number speaks to,

was released in 2022.

It sampled over 15,000

households.

We reached nearly 44,000

individuals with an ultimate

3218 individuals with self

reported hearing difficulty,

with hearing aid owners

representing just under 1200 of

that population. And so it’s,

it’s a big survey.

We found that people in the

hearing health community kind

of excitedly anticipate

the results.

We have been really pleased that

we’ve been able to host issues

of Seminars in Hearing that

discuss some of the findings

in a peer reviewed way.

And we’re excited to do that

again with MarkeTrak 25.

We look forward to extending

a lot of our longitudinal

research.

So some of those top line,

which I think most listening to

this podcast would

be familiar with,

would be the rates of self

reported hearing difficulty,

age and gender breakdowns,

average number of years that it

takes to take each step in

the hearing loss journey,

adoption rates,

of course overall device

satisfaction – satisfaction with

hearing professionals and the

services that they offer

information on coverage.

There is obviously a

lot more in there.

But MarkeTrak 25 will be the

first survey in the OTC space.

And so we’re looking forward

to this potential to obtain

additional insight into OTC and

into consumer behaviors

and perceptions.

And if they’ve shifted in the

last couple of years in

this new reality.

Yeah,

that’ll be really interesting

to see,

because we know the first year

of OTC was a little bit less

lackluster compared

to expectations.

Even at the EUHA last year,

there was some discussion

of that,

a presentation that was done

talking about that,

but now we’ll have enough

time behind us,

and the industry itself

has matured.

So I think that’s going

to be really,

really interesting to see what

the public perception of OTC is,

and if there’s enough people

using OTC devices in the survey,

what their feedback

is in the get go.

I think that’s going to be a

valuable part of the

next MarkeTrak.

I agree.

So as we wrap it up,

I also want to acknowledge that

HIA does a lot of education and

advocacy work, which, of course,

was part of your title

previously for example,

with the Hear Well campaign.

Do you want to add any detail on

that initiative or others that

HIA are taking in the education

and advocacy sector?

I would love to.

And I love wrapping this into

the policy discussion

that we’re having,

because I think it’s really

important that our policy

informs our communications and

our communications informs

our policy. So, you know,

I referenced at the beginning of

our conversation that there’s a

bit of a legislative vacuum

that’s expected for the

rest of this year.

So we certainly don’t sit back

and do nothing during that time.

We take advantage of it as an

opportunity to expand our

education and awareness outreach

efforts with members of

Congress, with their staffs,

and then pursuing opportunities

for them to engage their

constituents on the importance

of hearing health.

And so that’s one piece of

the Hear Well campaign,

because this is an unbranded

campaign.

It was put together with

our partners, again,

the professional organizations,

the consumer organizations,

and it has created social

media graphics tiles.

You can edit these different

resources. We have videos,

and I will give you a shout out,

Andy,

as one of our highest

performing videos,

with the testimonial that you

created for the Hear Well

campaign,

and so to be able to take those

resources to congressional

offices,

for them to share with

constituents,

and then for us to be able to

speak directly to consumers,

to speak to them on Facebook

we’ve expanded into,

HIA has expanded into

Instagram this year.

So we’re working on increasing

our outreach to people who are

scrolling through their phone.

And if they can take a second to

realize maybe I should think

about my hearing health while

they’re scrolling,

that’s ultimately a positive.

And then also working to

engage professionals.

How can these resources

benefit them?

Can they incorporate these

resources into their

office outreach,

into their communications,

into their Facebook groups?

So what I’m most excited

about with hear well,

and it has a great track record

of success, is that you know,

we’re excited for it to

continue to evolve.

We’re undertaking some

new efforts.

So World Hearing Day this year,

we actually created a hearing

health quiz and saw some of our

highest engagement. You know,

there were some fun questions.

There were also some serious

questions about hearing health,

about hearing loss. You know,

did you know that these

celebrities have hearing loss

or wear hearing aids?

And so it’s all part of

combating that stigma around

hearing loss and then making

sure that people have the

information when they make that

choice to see a hearing

professional or to take that

first step to actually address

their hearing health needs.

Oh,

that’s – that’s a really excellent

part of the program.

I love showing successful people

who have hearing loss. It’s not,

you know,

to remove the stigma by showing

people living happy,

successful lives while having

hearing loss, I think,

is fantastic.

So that’s a great part

of the program,

and I was glad to contribute to

it. I appreciate the shout out.

I wasn’t looking for it,

but it’s.

A well deserved shout out.

Well, thanks. I mean,

I was happy to contribute,

and I’d be happy to

contribute again.

Now as we kind of conclude,

are there any other closing

thoughts you have?

And if people would like to

reach out to you as a result

of this conversation,

how would they do it?

People should absolutely

reach out to me.

I am still quite new in the

executive director leadership

role. Not new to the industry,

not new to the community,

but I am open to hearing

from everyone.

So the best way to reach

me is by email.

So my email is [email protected]

You can of course,

find that through our

website as well.

I think that really,

my closing thought is this is

such a collaborative space,

and to make change in

hearing health,

to make change in people’s

perceptions,

and then ultimately to make that

really positive change

in people’s lives,

it takes all of us and some of

our messaging points might be

a little bit different,

but that’s where the hear well

campaign has been so beneficial

and that we’ve been able to come

together to create

this resource.

And so I’m excited

for the future.

I’m excited to bring Hia into

this new space and just really

thrilled to be here and to be

on this podcast with you.

Well, thanks.

And I’m really happy

that you joined.

I thought this was a great

discussion and I think everybody

will appreciate it.

So thanks to everybody for

watching or listening to this

edition of this week in hearing.

And thank you too, Bridget.