The US government dictates, through their regulatory bodies and payment systems, how a profession is perceived in the healthcare system. Audiology, despite our increased education and clinical focus, has been relegated to “supplier” status, in the eyes of Medicare, for literally decades. It is this “supplier” status that leads to the dreaded the physician order requirement. Also, our services are pigeonholed into a category known as “other diagnostic services”. It is this that limits us to Medicare coverage of diagnostic services only, despite our scopes of practice including treatment and rehabilitative services. The ONLY way to remedy this situation is to finally change our status in the Medicare system.
The Academy of Doctors of Audiology (ADA) has been spearheading this movement since 2012, first with the Audiology Patient Choice Act (APCA) and now the Medicare Audiology Access and Services Act (MAASA). This legislative initiative morphed, in 2019, from APCA to MAASA as the latter bill allowed for support from and partnership with the American Academy of Audiology (AAA) and the American Speech Language Hearing Association (ASHA). MAASA allows for classification of audiologists as limited license practitioners, rather than suppliers. It also allows for the removal of the traditional Medicare physician order requirement and coverage of medically reasonable and necessary treatment and rehabilitative services. Passage of this piece of legislation would significantly change things for us. It would provide us with better footing and recognition within Medicare and other healthcare systems. It would also, once treatment is covered, allow us to better show the outcomes of our services.
This bill though is never going to pass without grassroots support and action from audiologists and audiology associations at both the state and national level. It is not enough for national audiology associations to say they support the bill. We need to see all of them devote resources, both human and financial, to the advancement of the legislation. I should NEVER see an advocacy update from a national association that does not stress MAASA in its contents! I should see fly-ins and write in campaigns. I should see a FOCUS on and a plan for passage of the bills. We need to see state associations formally endorse the legislation. Believe or not, this makes a HUGE impact when you go to meet with a legislator from a given state to be able to share the endorsement of the state association. We also need audiologists to be “all in” and support this legislation by writing their congressional leaders and/or visiting congressional offices both at home and in Washington, DC and asking them to sponsor the bill and through donating to political advocacy committees and advocacy funds (we can all donate something; we would have $1 million if 10,000 audiologists donated at least $100). None of us pay enough in association dues, to any organization, for them to be able to fund these types of initiatives without financial support. It is ALL of our jobs to make this a reality. We are a very small profession, compared to other healthcare entities, so we have to have everyone engaged and involved in order to move things forward.
Finally, we have to get physicians and consumers and patients to understand the “why” for each of their situations. In order to do that, we have to be honest about the bill, its limits, and its opportunities. If a physician does not want to create an order, tell them then to demand that their national organizations stop fighting regulations and legislation that want to remove this requirement. If a patient does not like obtaining an order or paying privately for cerumen removal, canalith repositioning, or auditory rehabilitation, explain that there is legislation in Congress that would change these situations and encourage them to write to their congressional delegation and ask them to support MAASA. Patients will dog their Congress people if they do not get their mail for one day; we have to make supporting this legislation just as important to them and their daily life. Stop providing free cerumen removal and auditory rehabilitation so they see the value and cost of the care you provide. They cannot be aggravated about coverage if they have no out of pocket expense for the services.
MAASA is not a pipe dream if every audiologist dedicates time and treasure to its passage. We need everyone to engage! It is not someone else’s responsibility but rather ours as a collective! Let’s get this done once and for all!
