History of Hearing Aid Dispensing Systems: Part II

Last week’s blog discussed the United Auto Workers (UAW) as the first major U.S. union benefit program to include hearing aids, thus creating a change in the hearing aid distribution system.  This change introduced third party financial and procedural decisions not directed by those directly involved in the fitting and sales of hearing aids.  To meet the needs of the UAW contract, insurance companies and benefit administrators rapidly became engaged in programs to facilitate the terms of the contract.  But, not everyone was happy in River City.

ACO Outlines Problems With the UAW Hearing Aid Benefit

In a 1978 Newsletter of the American Council of Otolaryngology (ACO), the Executive Director discussed problems that might be encountered in implementing the UAW hearing aid benefit program {{1}}[[1]] ACO executive director outlines problems with UAW hearing aid benefit, Audecibel, Spring, 1978, pp. 58-59[[1]].  The concern was that the contract benefits might establish “interesting” precedents for all of medicine, because of the size (six million eligible workers, plus an estimated family per worker of three, or eighteen million covered).  The ACO’s concerns were as follows:

• Limitation on the freedom of choice of doctors – unless patients want to pay from their own funds, they must use a physician from a pre-selected list.
• The insurance carrier is establishing, and fixing, the physicians’ fees.  Physicians listed on the “panel” must agree to accept whatever the insurer pays as full payment for covered services.
• Insurance carriers agreed to pay for medical services without any prior consultation with those who would be delivering those services.  Service deliverers did not participate in developing the terms of the contract.

The ACO could not agree with the responsibilities assigned to the different participants providing the services, especially those identified with the otolaryngologist and audiologist.  Their concern was with the position of “organized audiology” to foster the notion that in evaluating the hearing impaired, a separation of the diagnostic audiologic tests from anatomical assessment was to be made.  The UAW benefit program required a physician to perform the anatomical assessment and then have the patient referred to an audiologist as the only one trained and capable of performing the audiologic testing.  The ACO was unable to agree with this concept because their position was that the audiologic testing of an impaired ear is inextricably a part of any otolaryngologist’s medical examination, and any effort or precedent that would have it otherwise is “wrong.”  And, to make matters worse, in the contract, anatomical diagnostic evaluation would not be paid for, but four audiometric tests would be.

ACO Was Not Alone

The ACO was not alone in this concern.  Two Michigan otolaryngologists filed a suit in the Federal District Court in Detroit on December 23^rd of 1978 against Blue Cross-Blue Shield of Michigan, General Motors Corp., Ford Motor Company, Chrysler Corp. and the United Auto Workers International over provisions as well.  They alleged that the UAW prepaid hearing care program illegally interfered with and deprived them of their freedom to practice medicine and deprived their patients of their freedom to select their own physician.  The suit was backed by the Michigan State Medical Society, which voted unanimously in October of that year to recommend that all physicians in the state withdraw their participation from Blue Shield and authorized attorneys to file a suit to resolve their dispute.

The otolaryngologists charged further that “….. the discrimination against them and their patients violates the equal protection and due process clauses of the U.S. Constitution as well as federal and state antitrust laws and the Michigan Insurance Code, and that the plan fixes prices in violation of antitrust laws.”

The Winds of Change Were Blowing

Audiologists Expand Their Employment Opportunities

Audiologists began expanding their employment opportunities by departing from their traditional public-funded work environments to the private sector.  Although this practice started in the late 1960s, it found its greatest growth during the 1970s.  Audiologists were increasingly being hired by otolaryngology practices, hospitals, or clinics, where their primary responsibility was to measure hearing for differential diagnostic purposes.  Physicians, who examined the most hearing-impaired patients on a daily basis, were otolaryngologists, who also required hearing measurements to diagnose and treat the hearing problems presented.  As hearing diagnostic methods became more complicated and advanced, an increased number of otolaryngologists and clinics hired audiologists because they had training in such measurement methods.

For some strange reason, working for a hospital or clinic to test hearing was generally accepted.  However, to be employed directly by an otolaryngologist was met with much resistance and condemnation by audiologists in training institutions, reflecting the position of ASHA.  The concern expressed was that such employment designated audiologists as “technicians,” and not as independent “professionals.”  For a number of years, audiologists working for otolaryngologists were considered out of the mainstream of audiology.

Ironically, the exposure of audiologists to otolaryngology clinics and hospitals led to an unforeseen consequence by positioning the audiologist as an alternate entry level for the measurement of hearing.  Audiologists had been trained for this purpose and, with the support of the clinic or otolaryngologist, had the equipment to make such measurements.