I was doing some reading online and have found that ASHA supports comprehensive benefit medicare reimbursement while several other audiology groups support direct access legislation. Asha says they support cb because it prevents legislation from labelling audiology as technical rather than professional. Can anyone shed more light on this issue giving the pros and cons of both reimbursement plans, which you support, and why?
comprehensive benefit or direct access?
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The reason many audiologists prefer direct access is it would mean direct access for all insurance companies since insurance companies often model their access, reimbursement, etc. after medicare. If audiologists gain direct access to medicare then it's a big victory. The majority of our patients are medicare plan holders so it would be a huge influx of patients and reduce a barrier to entry which often stops many seniors from doing something about their hearing loss. The other reason is then other insurance plans will follow suit allowing more patients to not jump through hoops to see us.
Also with direct access comes better recognition for our skill set. When you have direct access you are seen as a specialty usually and treated as such. This means usually better reimbursement rates. As a direct access provider you can also have a bigger hand at the bargaining table when deciding upon reimbursement for services rendered when dealing with insurance.
I also don't trust ASHA for several reasons. They don't ever seem to step up to the plate for audiologists and defend us when the government or insurance companies shaft us. I mean ASHA let medicare basically render SLP's incompetent to provide FEES evaluation without the presence of an ENT in the room! If the majority of their shareholders are SLP's and they won't/can't defend and safeguard their interests and scope of practice then what makes anyone think they would care about the minority of audiologists in their ranks?
I have kept my ASHA C's for 1 reason only. Students. Many programs still want their students to get their C's so the preceptors need ASHA C's so I keep mine for the students since I love teaching students.
A comprehensive medicare reimbursement would likely lead to more bundling of services which lowers reimbursement. Many services have been bundled in our field and have reduced reimbursement rates. VNG/ENG evaluations were bundled into a comprehensive code by Medicare and it drastically reduced our reimbursement rates for these procedures. The evaluation time stayed the same, but the reimbursement dropped by about 30%. Great for medicare. Bad for the provider. The immitance battery (bundling of tympanometry, acoustic reflexes, acoustic decay) bundled code is another example of a decrease in reimbursement for our services.
ASHA most likely supports a comprehensive benefit for medicare because it will probably help them somewhere with part B medicare reimbursement or part A reimbursement. Most likely it won't help audiology.
I think the more important thing I would like to see ASHA and AAA fighting for is to remove the upcoming 10% tax on medical devices issues to patients!!!!! Can you imagine paying $6000 for a pair of high end hearing aids then paying $600 in taxes to the government for purchasing those devices? Right now there is no tax on medical devices so the patient pays the $6000 and walks out with their hearing aids. It's a tax that needs removed from Obamacare.
Also with direct access comes better recognition for our skill set. When you have direct access you are seen as a specialty usually and treated as such. This means usually better reimbursement rates. As a direct access provider you can also have a bigger hand at the bargaining table when deciding upon reimbursement for services rendered when dealing with insurance.
I also don't trust ASHA for several reasons. They don't ever seem to step up to the plate for audiologists and defend us when the government or insurance companies shaft us. I mean ASHA let medicare basically render SLP's incompetent to provide FEES evaluation without the presence of an ENT in the room! If the majority of their shareholders are SLP's and they won't/can't defend and safeguard their interests and scope of practice then what makes anyone think they would care about the minority of audiologists in their ranks?
I have kept my ASHA C's for 1 reason only. Students. Many programs still want their students to get their C's so the preceptors need ASHA C's so I keep mine for the students since I love teaching students.
A comprehensive medicare reimbursement would likely lead to more bundling of services which lowers reimbursement. Many services have been bundled in our field and have reduced reimbursement rates. VNG/ENG evaluations were bundled into a comprehensive code by Medicare and it drastically reduced our reimbursement rates for these procedures. The evaluation time stayed the same, but the reimbursement dropped by about 30%. Great for medicare. Bad for the provider. The immitance battery (bundling of tympanometry, acoustic reflexes, acoustic decay) bundled code is another example of a decrease in reimbursement for our services.
ASHA most likely supports a comprehensive benefit for medicare because it will probably help them somewhere with part B medicare reimbursement or part A reimbursement. Most likely it won't help audiology.
I think the more important thing I would like to see ASHA and AAA fighting for is to remove the upcoming 10% tax on medical devices issues to patients!!!!! Can you imagine paying $6000 for a pair of high end hearing aids then paying $600 in taxes to the government for purchasing those devices? Right now there is no tax on medical devices so the patient pays the $6000 and walks out with their hearing aids. It's a tax that needs removed from Obamacare.
Thank you! That was very informative. Would you say that the AAA is a better organization to support and recongnize as our regulatory body than ASHA? Why does anyone still support asha if they do nothing to help the field's practitioners?
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AAA by far. Why people continue to join ASHA is because of misunderstanding and I think misconception that ASHA and the universities have and propagate to the public.
You do not need ASHA C's to gain licensure in any state.
You do not need ASHA C's for reimbursement under any insurance policy or plan that I am aware of
You do not need ASHA C's to supervise students, unless they want to count those hours towards getting their ASHA C's
The main reason ASHA still exists is because they are still the main accrediting body for speech and audiology. Another accrediting body exists for Audiology, but is not very popular (ACAE). Many schools have small Au.D. programs (<10 students) and large speech programs (>20) and accrediting is an expensive process so it's easier to have one accrediting body for both programs and let's face it universities are all about decreasing costs and maximizing profits.
You do not need ASHA C's to gain licensure in any state.
You do not need ASHA C's for reimbursement under any insurance policy or plan that I am aware of
You do not need ASHA C's to supervise students, unless they want to count those hours towards getting their ASHA C's
The main reason ASHA still exists is because they are still the main accrediting body for speech and audiology. Another accrediting body exists for Audiology, but is not very popular (ACAE). Many schools have small Au.D. programs (<10 students) and large speech programs (>20) and accrediting is an expensive process so it's easier to have one accrediting body for both programs and let's face it universities are all about decreasing costs and maximizing profits.
So due to the restricted ability to bill and the lack of a strong central/supportive representative body, do you feel that audiology as a profession will get better and become more lucerative or will it slowly fade away? I have read all of the information online about the increasing aging population and whatnot, however I'm not so sure that holds any water so long as auds can't bill for services rendered, don't receive any additional privileges or responsibility to reflect the new doctoral degree, and work under the thumb of ENTs. Is there any evidence this will change or will business as usual continue? My fear is that I will invest upwards of 100k for an aud but never will be able to make a profit or have a comfortable living comparable to other medical professionals such as optometrists. Would it be more economically feasible to just become a hearing aid dealer at this rate since they have the same privileges as auds? I do not mean to sound like a downer, I am just trying to justify whether an aud is worth pursuing and whether there is legitimate outlook of growth for the field.
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I think when we get direct access it will get better (see my post above), but I think the big battle no one is fighting that needs fought is sunsetting of hearing aid dealers. They have a huge group of members and they have a lot of money (when you overcharge grandma and grandpa for hearing aids and do little to no follow-up you have lots of cash to throw around) and the hearing aid companies make a lot of money off their sales. If we can cut them out and prevent any further issuance of hearing aid licenses to non-AuD or master audiology practitioners then we can grow and get more respect.
I think getting rid of the dealers is really what needs to be done first in my opinion.
What I'd like to see done and in what order is the following:
1. No more issuance of healer aid dealer's licenses to anyone without an AuD or master's level audiology degree
2. Direct access for Medicare and 3rd party payer sources
3. Advanced courses in pharmacology to be able to diagnose and treat minor illness such as otitis media and otitis externa
So to answer your question, yes I think eventually audiology will get there, but we have a long road to hoe to get there.
As I've said before I love what I do, but I could be making the same kind of money with a PA degree or a masters in nursing as a nurse practitioner and have more autonomy and career opportunities. SO if I was younger and know what I know now would I still have an AuD after my name? Probably not, but I don't regret my career choice. I love where I work and what I do and the money is pretty good.It beats being a lab rab like I used to be anyday and it definitely beats being an RN.
