Audiology: Heritage of Audiology - NeonCRM...surgical treatment of a hearing deficit or other...
Transcript of Audiology: Heritage of Audiology - NeonCRM...surgical treatment of a hearing deficit or other...
Audiology: Audiology: A Profession in TransitionA Profession in Transition
Wayne A. Foster, PhD, CCC-SLP/AChair, Audiology Advisory Council
ASHA Board of Directors
The Field of Audiology
• Heritage of Audiology
• What Makes Audiologists Unique?
• Expansion of Scope of Practice
• Doctor of Audiology
• A Bit on ASHA
• The Future of Audiology
Pre WWII
Physicians, Otologists & Commercial
Dealers
Post WWIIMilitary Aural
Rehab Centers
Heritage of Audiology: Evolution
� Harvey Fletcher
� Hallowell Davis
� Raymond Carhart
� Norton Canfield
� The Ewings (Alexander & Ethel)
� André Djourno
� Georg von Békésy
� Peter Dallos
� James Jerger
Heritage of Audiology: Foundational Figures
Heritage of Audiology: Technology Can you remember?
1st cochlear implant
ABR technology
OAEs were identified
1st BTE introduced
Middle ear function was measured
Heritage of Audiology: Breakthroughs
• These three advances were critical:
� Assess Middle Ear Function (Tympanometry)
� Assess Cochlear Function (Otoacoustic Emissions - OAE)
� Assess Retro Cochlear Function (Auditory Brainstem Response - ABR)
What Makes Audiologists Unique?
• Scope of practice
� Evidence-based research
� Doctoral degree required
� Clinical care
• Life-changing profession
Practice areas that overlap other disciplines•Intraoperative Monitoring•Vestibular Assessment/Rehab•Cerumen Management
Speech-
LanguagePathology
Audiology
Scope of Practice
Human Communication
• Expanded curriculum to cover increased scope of clinical practice
• Incorporated clinical work throughout the course of study
• Value of doctoral education is learning how to problem solve(must be adaptive)
Must evaluate program of study and clinical experience
related to long-term career path.
Audiology Doctoral Career
• More than 150,000 members
• World’s largest association of audiologists(Over 14,000)
• Dedicated to advancing audiologyas a profession
� Advocating for the professional
� Public education
� Credentialing
� Audiology Resources
A Bit on ASHA A Bit on ASHA: Advocacy
• The audiology/SLP seat at the table with the Center for Medicare and Medicaid Services (CMS).
• Since 2003, 11 codes approved for audiology
• Medicare Audiologic Rehabilitation Act (2003)
• Medicare Hearing Health Care Enhancement Act (2007)
• Funding – for industry research and policy initiatives
• Spearheading collaborative efforts
• “Better Hearing and Speech Month”
• “Listen to Your Buds”
• Americans with Disabilities Act (ADA)
• Individuals with Disabilities Education Act (IDEA)
• Universal Newborn Hearing Screening (UNHS), and Early Hearing Detection and Intervention (EHDI)
• Classroom Acoustics
• Healthy People 2020
• Consumer Helpline
A Bit on ASHA: Public Awareness
• Technical Assistance• Publications and Web Site (www.asha.org):
� 4 scholarly journals, including American Journal of Audiology
� Audiology Connects and Access Audiology
� The ASHA Leader
� Articles and practice policy documents
• Special Interest Divisions• Career & Business Development:
� EdFind
� Career Mover CD
� Online Career Center
� ProSearch
Audiology Resources
• Governance: Audiologists have equal voice� Same number of profession-specific positions on the
Board of Directors
� Audiology Advisory Council
• Professional Development� Research
� Annual Convention & Conferences
� Continuing Education
• ASHA Foundation, Travel AwardProgram & Scholarships
• Member Discounts
ASHA Offers
• What if…� Hair cell replacement supplanted hearing aids?
� Medicare benefits expanded to include diagnostic services?
� Genetic breakthroughs prevented hearing loss or restored hearing?
� Telepractice by audiologists became widespread?
� Medicare paid for hearing aids?
• What would this mean for the field?
The Future of Audiology
Basic Board StructureBasic Board Structure
National Office
President Vice Presidents Advisory Council
NSSLHA
CEO President Science & Research Chair: Audiology National Advisor
Past President Planning Chair: SLP
President Elect Standards & Practice: Aud
Standards & Practice: SLP
Academic Affairs: Aud
Academic Affairs: SLP
SLP Practice
Aud Practice
Finance
Government Relations & Public Policy
Committee/Boards/CouncilsCommittee/Boards/Councils
Board of Directors
National Office
Advisory Council Chairs
Vice Presidents
CBC CBC CBC CBC CBC
Advisory Councils
Governance Restructure in 2008
� Eliminated the Legislative Council (LC)
• Voting body
• State representatives
• Number of representatives determined by number of ASHA members in the state
� Advisory Councils
• One SLP and one Audiology member per state
• Not “representing” the state
• Reflection of broad array of work sites and areas of expertise (Note: 25% are private practice/dispensing audiologists)
• Provides advice to the Board of Directors
SLPAC and AAC: 2012
March AC Meeting: Face-to-Face
ASHA Collaboration Site: Monthly Interactions
Provides input to BOD and responds to targeted questions.
Specific Issues Facing Audiologists
What is Direct Access?The ability to see a patient without a referral from a
physician or other health care provider.
Client Physician Audiologist
Direct Access to Audiologist
Current Status for Audiology ServicesImpact on Clients and Clinicians
� Limits beneficiary choice of providers
� Increases costs to Medicare program
� Increases wait time to see an Audiologist
� Inefficient use of physician resources
� Administrative burden on audiologists to track down referral if patient comes in without one
Current Medicare Policies
Audiometric Testing
� Audiology services are recognized for Medicare purposes as a diagnostic test under the Social Security Act (Sec. 1861 (s)(3))
� Regulations require that diagnostic tests be ordered by a treating physician for the purpose of using the results of the test in the management of the beneficiaries’specific medical problem. (42 CFR 410.32)
� What is an audiologist in the current CMS service provider paradigm?
� EVERYONE recognizes this as a problem!
Current Medicare Coverage
Audiology Services
� Testing must be for:
� obtaining additional information necessary to make a diagnosis
� evaluation of the need for the appropriate type of medical or surgical treatment of a hearing deficit or other medical problem.
� Audiology services are not covered when the diagnostic services are furnished only to determine the need for a hearing aid.
� Rehabilitative services are NOT covered.
Medicare Direct AccessWhat it would mean for Audiologists
� Beneficiaries could go directly to an audiologist.
� Audiology will remain a diagnostic benefit.
� Medicare will not pay for services deemed not medically necessary or can be perceived as a screen.
� Need to develop additional education of patients on Medicare coverage policies and exclusion of audiology
services related to hearing aids.
Direct Access to AudiologistsLegislation
H.R. 3024 “Medicare Hearing Health Care Enhancement Act of
2009”• Section 3: Allows Medicare beneficiaries direct access to an
audiologist• Section 4: Defines audiology services as a diagnostic benefit
• Section 5: Nothing in the act will expand scope of audiology services for which payment can be made under Medicare
Prior to 2009 ASHA backed the Direct Access approach. (Members of the
GRPP Board presented at the ASHA Convention on this issue.)
Direct AccessCMS Report
� In the 2010 Medicare Physician Fee Schedule final rule, CMS stated that it will not reimburse any audiology service that can be construed to have an evaluation and management or therapeutic component.
� Impacts tinnitus code, auditory rehabilitation and cochlear implant codes.
� CMS made this ruling based on the fact that audiology
services are covered as part of the diagnostic benefit.
Comprehensive Audiology BenefitCost/Fiscal Impact on the Medicare Trust Fund
� CMS had indicated concerns with increased cost
� Historically Congressional Budget Office (CBO) factors
in woodworking effect*.
� No concrete data on cost of direct access or comprehensive benefit
� High cost requires an off-set in the Medicare program
* Woodworking Effect: If benefit is available –more
providers will enroll and beneficiaries will access.
Direct AccessPotential Solution to CMS Concerns
Comprehensive Audiology Benefit� Work with Congress to define in statute a
comprehensive audiology benefit that would include both diagnostic and therapeutic intervention.
� Comprehensive benefit would include direct access to audiology services.
� Not include coverage of hearing aids.
ADA’s 18 X 18 Initiative
� Title XVIII of the Social Security Act amend to provide for the treatment of audiologists as
physicians for the purposes of furnishing services under Medicare. It would also broaden the scope of audiology services. (Limited practice physicians)
� 2018The date by which this initiative would become law
18 X 18
� Allow for Medicare coverage of medically necessary, covered treatment services such as vestibular rehabilitation, cerumenremoval, and aural rehabilitation provided by an audiologist practicing within their state defined scope of practice.
� Eliminate the need for the physician order required for a Medicare beneficiary to receive coverage of medically necessary, covered audiology and vestibular services
� Allow audiologists the autonomy to make clinical recommendations and practice the full scope of audiology and vestibular care as allowed by their state license and as
dictated by their educational requirements and competencies.
ASHA Approach
� Medicare coverage of comprehensive audiology services in coordination with current billing and reimbursement standards
� Be consistent with other non-physician services covered by Medicare.
� Allow audiologists to bill for:� hearing and balance assessment services
� auditory treatment services (including auditory processing and auditory rehabilitation treatment)
� vestibular treatment
� Intra-operative neurophysiologic monitoring
� In addition, audiologists will have the option to opt-out of Medicare.
Issue: Service Provision System of Care
� A goal for the MAJORITY of the people in the U.S. with significant hearing loss -estimated >31 million: with ~24% currently being helped (Kochkin, 2005)
� Un-rehabilitated hearing loss affects individual self actualization/quality of life as well as productivity
� Hearing loss is a personal problem, a family problem, a vocational/avocational problem, a societal problem reducing the capacity of our volunteer/wage earning work force…
Service Provision
Basic Intermediate Atypical
Clinic/Practice
Audiology Technician/Telehealth Follow-up
Audiologist
What we need now……..
� Alternative service delivery models
� National outcome database that drives…..
� Standards of practice (e.g., use of real ear)
� Reimbursement systems that match “real” costs.
Healthcare Summit: 2012
Service delivery systems are being evaluated: The
national healthcare debate is driving
changes that audiologist must be in front of.
Questions or Comments
Telehealth
Practice Models
Reimbursement
Online Purchases
Technological Changes
Bio-medical
Advances
Training of AudiologistsUse of Technicians
Outcomes Based Service
Bundling or Unbundling