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Putting Audiology in Its Place

Putting Audiology in its Place
by

Stephanie Czuhajewski

on 8 January 2014

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Transcript of Putting Audiology in Its Place

ADA embarked on this journey at the request of its members, who believe that autonomous practice is the best practice.
Communicate
Hearing Journal, May Issue Feature
Audiology Today, May/June
Audiology Online, June
Audiology Online Webinar, September 11th
www.18x18.org
ADA Opposes H.R. 2330
H.R. 2330 would enlarge the physician referral requirement under Medicare
18x18 aligns with ADA's mission, vision and beliefs
18x18
18 x 18 Update
Why
Amend Title 18 of the Social Security Act by 2018 to achieve:
Limited License Physician Status Under Medicare
Direct Access to Audiologists for Medicare Recipients
Medicare Expanded Coverage of Audiology Services
It would undermine patient access and practitioner autonomy.
It runs counter to the benefits of 18 x 18

It will mandate additional physician oversight, including a requirement for a physician plan of care that will necessitate periodic review and approval by the ordering physician.
It will make it more likely that audiologic services will be included in the therapy cap
H.R. 2330 does not provide a truly comprehensive audiology benefit
No cerumen
No tinnitus
No easy way to add services later

Initiate
Advocate
Composed Draft Legislation
Engaged Prime Policy Group
Held Inaugural D.C. Fly-in/Seeking Bi-partisan Congressional Support
Attended 60 Meetings with Legislators and/or Staffs to date
Received Encouraging Feedback/Promising Leads
18x18?
18x18 means professional autonomy, best practices, and patient access to safe, efficient care
What can you do?
Communicate
Advocate
Donate
Q&A
Not all audiology legislation is created equal
Next Steps
Putting Audiology in its Place: Moving Beyond the Au.D. Towards Professional Autonomy
Nancy N. Green, Au.D., President, Academy of Doctors of Audiology
The coming surge of retiring Baby Boomers, coupled with the impending drought of physicians to treat them, will create unprecedented challenges for patients and practitioners
Current Medicare challenges are merely the tip of the iceberg
Surge of Baby Boomers
There are 75 million baby boomers
The first baby boomers became Medicare-eligible in 2011. Between 7,000 and 10,000 become eligible for Medicare daily.
There are 47 million Medicare beneficiaries today. By 2030 there will be 80 million.

Audiologists cannot be utilized to help ease the burden to Medicare because they are not efficiently deployed.
Documented Shortage of Physicians
According to the Association of American Medical Colleges (AAMC), by 2025, the shortage of physicians in the United States is projected to exceed 160,000.
Growing Medicare Challenges
Inefficient Model of Audiologic Care
Physician Referral Required
Full scope of practice not recognized
Not treated as other non-M.D. doctoring professionals with similar training, education and skills
Even if a "medical home model is used, audiology should be independent, just as optometry and dentistry are. Would it make sense (even with a medical home) to require a referral to see a dentist or an optometrist?

Team-based health care and the medical home model will not be impeded by 18x18.
Audiology must become the recognized entry point for audiologic care
Audiology must complete its transformation to a doctoring profession.
1988-1989
1994
2007
ADA hosts Conference on Professional Education
The Audiology Foundation of America is formed to establish and promote the Au.D.
First Au.D. students begin studies at Baylor University
Au.D. is the required "first professional degree" in audiology; masters enrollment ceases
Degrees of Change
Establishing the Au.D. was the first step to the transformation to a true doctoring profession as defined by professional autonomy, reimbursement for services and achievement of Limited License Physician status.
Our work is not finished
18x18
Would 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
LLP
Comprehensive Benefit
DA
Would allow for Medicare coverage of medically necessary, covered treatment services such as vestibular rehabilitation, cerumen removal and aural rehabilitation services provided by audiologists, practicing under their state-defined scope of practice.
Would eliminate the need for a physician's order, required for a Medicare beneficiary to receive coverage of medically necessary, covered audiology services
LLPhysician
vs
LLPractitioner
Grouped with other doctoring professionals
Easier addition of direct access
Easier addition of full scope of practice
Less risk of reimbursement rate reduction
Ability to opt out
Grouped with auxiliary professionals
Harder to get direct access
Harder to add full scope of practice
Greater risk of reimbursement rate reduction
Ability to opt out
The Direct Access component mirrors previous legislation introduced by AAA
The comprehensive benefit includes everything that is covered by Medicare, contained in the audiologist's state scope of practice
Limited License Physician status is different than Limited License Practitioner status
Comprehensive Legislative Approach
Each component of 18x18 works in unison with the others
18x18 is the legislation that will unify the profession of audiology
18x18 will finish audiology's transformation to a doctoring profession, legislatively
Opening Medicare law is difficult and making a comprehensive ask will be most effective
18x18, if enacted will benefit audiologists in all settings
Au.D. programs will enjoy more robust demand and success if 18x18 is enacted
Over the long run, audiology will not succeed as an autonomous profession, unless these goals are achieved.
Military, VA and audiologists employed federally would be ensured rank and pay that is commensurate with doctoring profession
Medicaid and private insurers often follow Medicare's lead
Full transcript