The American Speech Language Hearing Association (ASHA), and their board of 12 speech language pathologists and four audiologists (two of which are employed by school systems), are again attempting to guide the professional and legislative future of audiologists in this country. I am attempting to clarify each aspect of this bill and what it really means to the day-to-day practice of audiology.
I have continually expressed concerns about this bill and its impact on my profession since it was first proposed in 2011. You can view an Audiology Online webinar I participated in with ASHA in 2011 at http://www.audiologyonline.com/audiology-ceus/course/potential-risks-versus-need-for-18818.
Please view my comments below in red. This reflects my research and knowledge of the Medicare system.
SEC. 2. COMPREHENSIVE AUDIOLOGY SERVICES FOR MEDICARE BENEFICIARIES.
(a) In General- Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended--
(1) in subsection (s)(2)--
(A) in subparagraph (EE), by striking `and' at the end;
(B) in subparagraph (FF), by adding `and' at the end; and
(C) by adding at the end the following new subparagraph:
`(GG) audiology services (as defined in subsection (ll)(3));'; and
(2) by amending paragraph (3) of subsection (ll) to read as follows:
`(3) The term `audiology services' means only the following services furnished by a qualified audiologist as the audiologist is legally authorized to perform under State law (or the State regulatory mechanism provided by State law), pursuant to an order or referral by a physician
So, while the American Academy of Audiology (AAA) and the Academy of Doctors of Audiology (ADA) have been advocating for direct access to audiologic care for the past 12 years, ASHA wants to add a physician order requirement to all audiology services, both diagnostic and rehabilitative. That is more physician oversight than we currently experience. This seems like a giant step backward to me. as would otherwise be covered if furnished by a physician:
`(A) Hearing and balance assessment services.
`(B) Auditory treatment services, including auditory processing and auditory rehabilitation treatment.
`(C) Vestibular treatment services.
`(D) Intraoperative neurophysiologic monitoring services.'.
You will notice that there is no mention of tinnitus rehabilitation or cerumen removal, two prominent and much needed services we currently offer our patients. Why were these omitted? Will these services still be non-covered by Medicare, even though they are within the scope of practice of the vast majority of audiologists in this country? In my opinion, if our goal were serving the needs of our patients, these would be included.
(b) Payment Under Part B Under Physician Fee Schedule for Comprehensive Audiology Services- Section 1848(j)(3) of the Social Security Act (42 U.S.C. 1395w-4(j)(3)) is amended by inserting `(2)(GG),' before `(3),'.
(c) Audiology Services Performed in Hospitals Excluded From Inpatient Hospital Services- Section 1861(b)(4) of the Social Security Act (42 U.S.C. 1395x(b)(4)) is amended by striking `and services of a certified registered nurse anesthetist' and inserting `services of a certified registered nurse anesthetist, and inter-operative neurophysiological monitoring provided by a physician or qualified audiologist (as defined in subsection (ll)(4)(B))'.
(d) Requirements of Service- Section 1835(a)(2) of the Social Security Act (42 U.S.C. 1395n(a)(2)) is amended-Now, this is the only aspect of this bill that makes any sense to me. The physician should be managing the care that occurs in the operating room.
(1) in subparagraph (B), by striking `and (D)' and inserting `(D), and (GG)';
(2) by striking `and' at the end of subparagraph (E);
(3) by striking the period at the end of subparagraph (F) and inserting `; and'; and
(4) by inserting after subparagraph (F) the following new subparagraph:
`(G) in the case of outpatient audiology services, (i) such services are or were required because the individual needed the specialized services of a physician or qualified audiologist to furnish such audiology services, (ii) a plan of care for furnishing such services has been established by the physician or qualified audiologist and is submitted to and periodically reviewed by the referring or ordering physician,
This is how PT, OT and SLPs provide care. I find it interesting that ASHA insists out of one side of its mouth that coverage of rehabilitation provided by audiologists will not increase Medicare costs as these services are currently being provided by other providers such as OT and PT and out of the other side of their mouth they insist (but have never supplied evidence) that audiology rehabilitation will not be included within the OT, PT and speech therapy cap. This makes no sense to me. Why would our rehabilitation, which they insist they PT and SLP is currently providing, be excluded from the cap?
Why would a qualified audiologist, practicing within their state defined scope of care, need physician oversight for the provision of rehabilitative services when this oversight currently does not exist for any patient under the age 65?
If we follow this rationale, an expert in auditory processing who happens to be an audiologist would need their plan of care for auditory processing treatment reviewed and approved by a physician. Heck, it can be any physician too, even an urologist. Wow, no wonder AAO-HNS signed on. It protects their status quo.
I strongly encourage everyone, before they sign on to support this bill, to really read what this obligates an audiologist to follow. You can learn more in section 220 of http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c15.pdf.
This plan of care requirement, as well as the need for physician oversight, will make the provision of care more time intensive, create more paperwork, and, as a result, drive up costs or reduce accessibility, as it becomes to difficult to administer and manage given the resulting reimbursement and limitations.
and (iii) such services are or were furnished while the individual is or was under the care of a physician.'. Why would the patient need to be under the continual care of a physician for aural rehabilitation and auditory processing therapies? What is a physician adding to this equation other than costs?
(e) Audiology Services Included as Designated Health Services for Purposes of Limitation on Certain Physician Referrals- Section 1877(h)(6) of the Social Security Act (42 U.S.C. 1395nn(h)(6)) is amended by adding at the end the following new subparagraph:
`(M) Audiology services (as defined in section 1861(ll)(3)).'.
(f) Participation in Medicare- Nothing in this section shall be construed to require a qualified audiologist (as defined in section 1861(ll)(4)(B) of the Social Security Act (42 U.S.C. 1395x(ll)(4)(B))) to participate in the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.). This is the weakest attempt at opt out language I have ever read. There is also nothing in this section that does not require participation either.