On the Hill: Legislative Updates

Contributors:

Posted On: Sep 26 2005, 02:55 PM

Title: Medicare Proposes to Reduce Reimbursement Medicare Proposes to Reduce Reimbursement for Audiologists On August 8th, the Centers for Medicare and Medicaid Services (CMS) published their proposed reimbursement schedule for audiologists that will reduce payments by 21.3% over a four year period. Next year it is proposed that our reimbursement be reduced by 5.8%. These figures represent a reduction that is four times greater than any other health care provider. Chiropractors were second to audiologists with a reduction of 5.3% over the next four years. The pertinent section of the proposed fee schedule can be reviewed here. The complete document can be found on the CMS website. Why did CMS propose such a drastic reduction in our reimbursement rates? Audiology codes over the decades existed in a special category called “non-physician work pool.” CMS has decided to remove all non-physician work pool codes and place them in a category called “individual specialty pool.” This action results in a severe reduction in audiologists’ reimbursement. CMS’ proposed fees do not presently include practice expenses nor do they recognize that hearing and balance services include “physician work.” Physician work means that CMS views our services as not requiring any patient management. CMS assumes that audiologists only perform a test and then blindly turn over the results to a physician for interpretation and patient counseling. As we know, this is not truly the case. The CMS perception that audiologists do not manage patient care is perpetuated by their strong physician bias. CMS lags far behind all other insurance carriers in their utilization of non-physician providers. The audiology membership organizations have opened a dialogue with CMS to voice concern over this proposed fee structure and, more importantly, to point out issues that are not presently being considered. The ADA Board would like to assure you that we are working on your behalf to reverse CMS’s drastic reduction in your reimbursement rates. We realize that resolving this issue to benefit patients is your top priority. If CMS’ proposed reductions are not changed, then our profession will also be adversely affected by other insurance carriers who use Medicare payment rates to decide payment rates. Thus, the proposed Medicare reductions could easily impact our entire portfolio of diagnostic reimbursement with other insurance carriers. Call to Action You have the right to voice your opinion on this proposed fee reduction for our profession. Log on to this CMS website to send your comments via the Internet. When you enter your comments you will note that Medicare does not list audiologists as a category. Please list yourself as "other practitioner." We have placed a recommended letter on our Web site that you can cut and paste into the comments section. [Note: This document is in PDF format which requires Adobe Reader. After opening the document, choose the "Select Text" tool and highlight the text you wish to copy. Copy and Paste as you would normally. If you do not have Adobe Reader, it is available on the Adobe website at no charge: Download Adobe Reader] CMS must receive public comments by Friday, September 30th. So, act now on behalf of your patients and your profession! Please feel free to contact me with any questions (410-944-3100; cjohnson@audiologist.org). Thank you for your help. Craig Johnson, Au.D. President

Posted On: Jun 1 2005, 01:15 AM

Title: Dr. Johnson's Letter to the Editor (Feedback Mag) Dr. Craig Johnson's response to: Say What? Can you hear the sound of money? (April 20, 2005) Dear Editor: I am writing on behalf of the Academy of Dispensing Audiologists, a national association of audiology practitioners. We welcome your interest in the educational and clinical training of Doctors of Audiology. Your editorial expresses several concerns with respect to the profession of audiology transitioning to a doctorial degree. I would like to provide another perspective on our profession’s evolution to provide doctoring hearing and balance services to patients. One of the concerns noted in the editorial was that audiologists with a master’s degree education already possess adequate education to “test someone’s hearing”. Audiologists’ services have evolved due to research advances, which in turn, has lead to changes in treatment protocols. It has been over 40 years since a master’s degree was required in our profession. Insurance carriers and medical referral sources have come to rely on audiologists to manage, diagnosis, and treat hearing and balance problems. An audiologist’s initial evaluation, which is an hour-long process, includes various auditory procedures aimed at different anatomic levels of the hearing mechanism to determine the type and degree of hearing loss. The outcome of an audiologic evaluation includes detecting a medical problem, such as a tumor, or determination that a non-medical problem exists. Your editorial gave the impression that testing hearing is a simple process and that a doctoring profession is not necessary. This is clearly not consistent with the current practice of audiology. Many professions have evolved to a professional doctorial degree due to patient care needs. Audiology is just one of many such as pharmacology, optometry, physicians, etc. The other false impression presented in your editorial was that the evolution of audiology to a doctorial level was related in some way to increased revenue for practitioners. Health care professionals are reimbursed by insurance carriers based upon the services provided. The reimbursement is not related to the practitioner’s education. Thus, doctors of audiology will not receive increased fees due to their educational level. The primary goal in the audiology profession evolving to a doctorial level is to improve care to consumers. This process has evolved over the past several decades. I am pleased to tell you that 28 states are now in the process of requiring the Doctor of Audiology degree (Au.D.) for practice. Patients’ hearing and balance needs will be best served if they are diagnosed, treated, and managed by a Doctor of Audiology. =================================================== >> View/Print this letter in pdf format

Posted On: Apr 11 2005, 11:05 AM

Title: California Legislative Update Opposition to AB 615- CA The following position letter was sent to the Honorable Wilma Chan on April 11th, 2005 by ADA President and Legislative Committee Chair, Craig Johnson, Au.D.: The Honorable Wilma Chan State Capitol, Room 6005 Sacramento, CA 95814 Dear Delegate Chan: The Academy of Dispensing Audiologists (ADA) is an organization of approximately 1,000 audiologists whose qualification for fellow status membership is limited to audiologists who have earned the Doctor of Audiology (Au.D.) degree. ADA Fellows provide diagnostic hearing and balance examinations, hearing and balance rehabilitation services, counseling services for hearing impaired patients and their families, hearing aid evaluations, hearing aid fittings and follow-up services as a part of their professional practices. Doctors of Audiologists serve patients as the managers of hearing and balance services. Audiologists fit and dispense hearing aids as part of their rehabilitative services. The Academy of Dispensing Audiologists opposes AB 615. The February 15, 1977 the Food and Drug Administration (FDA) published regulations controlling the dispensing of hearing aids. These regulations, like other FDA requirements, serve to balance patient safety considerations with product availability. In 2004, the FDA addressed the issue of over-the-counter hearing aids and after review decided that consumers are best served being evaluated and fit for hearing aids by a licensed professional. Patient safety was a primary concern. AB 615 would remove the FDA safeguards for patients being fit with hearing aids. The legislation would allow patients to purchase hearing aid devices over-the-counter without the benefit of a licensed professional. The Academy opposes AB 615 for three reasons. First, patient safety would be compromised. Any hearing aid inserted into the ear canal can potentially cause harm to the user. This is especially of concern in diabetes that affects a significant number of Americans. Diabetics are at increased risk from complications of injury to the ear canal (Chartrand, 2003; Leonetti, 2004). This would also be true for patients who are taking blood-thinners such as aspirin and warfarin, which are common medical management regimes for patients over 60 years old. There is real risk of infection from abrasion (Leonetti, 2004), bleeding and wax impaction. Secondly, there is no objective research and/or data to address efficacy and safety issues with over-the-counter hearing aids, since these devices have been prohibited by the FDA as a category of hearing aids. Finally, since AB 615 specifically states the proposed legislation would “authorize the over-the-counter sale of hearing aid devices if consistent with federal law” the premise of the proposed legislation is in direct conflict with FDA regulations. The FDA does not recognize over-the-counter hearing aids as a product category. In view of these issues, the Academy of Dispensing Audiologists respectfully requests the rejection of AB 615. Sincerely, Craig W. Johnson, Au.D. Doctor of Audiology President Academy of Dispensing Audiologists 7113 Ambassador Road Baltimore, MD 21244 References Chartrand, M. S. (2003, July). Diabetes & Hearing Loss. Healthy Hearing Newsletter, http://www.healthyhearing.com/healthyhearing/newroot/articles/arc_disp.asp?id=206&catid=1053 Leonetti, J. P. (2004). Causes of Fungal Infection in the EAC. AudiologyOnline Healthy Hearing, http://www.healthyhearing.com/healthyhearing/newroot/askexpert/displayquestion.asp?id=178. U.S. Food & Drug Administration. (1977, February 15) Rules and Regulations Regarding Hearing Aid Devices: Professional and Patient Labeling and conditions for Sale, Part IV, Federal Register, 9286-9296.