Professionalism: The Audiologist’s Opportunity Alison M. Grimes, AuD University of California Los Angeles Medical Center Past-President, American Academy of Audiology What‟s New at the American Academy of Audiology? Over 11,000 members Incoming President Pat Kricos San Diego—greatest AudiologyNow! attendance ever! Next year—Chicago Association Research Conference This year Aging Next year Tinnitus Accreditation and Education Challenges Gold Standards Summit outcomes Student Academy of Audiology Future Leaders Audiology Assistants Long-range planning There aren‟t enough of us to meet the demand! Are Audiologists Professionals? How do we know? What do we do to demonstrate professionalism? What do we do that runs counter to being viewed as a professional? Why should we care? Without professional actions, concerns, we become technicians Culture of A Professional Demonstrating professionalism, and being recognized as a professional Distinguishes us from “technician”, “salesperson” or “the girl” (77% of our profession!) Culture of professional excellence is communicated to Students Other professionals with whom we interact Consumers Legislators Third-party payers Our History… Grew from an affiliation with Speech Pathology Placed our training programs in Education and/or Liberal Arts Departments Kept us from knowledge and experiences relating to running a business, billing for services Prohibited us from selling hearing aids and other devices Disincentive to private practice Grew a culture of subservience to „the physician‟ Encouraged an employee-employer relationship Our Transitions Dispensing hearing aids legally Led to growth in independent private practice Transitioning to a doctoral degree Acknowledging the tremendous growth in our Scope of Practice From ASHA to the AAA Every state in the US has licensure or registration of audiologists Able to bill 3d party insurance independently Opportunities for Professionalism Writing Clinical Practice Guidelines Conducting/publishing research in peer-reviewed journals Consumer of our own research, teaching based on our own research Collaboration with, as equal partners, physicians/educators Patients and consumers looking to us for information, resources, diagnosis/treatment, program development/management Public Awareness as “Audiologist”, not “Hearing Healthcare Provider” Accrediting our own training programs based on our own professional standards More Opportunities Own the research in all of the areas of our practice, teach our own research Develop and promulgate evidence-based practices or clinical practice guidelines to govern practice Ethics Not only have a code, but follow and enforce it! Public Policy/Advocacy Advocate for policies and laws/regulations that support our profession, our patients, and public- health issues (e.g., noise, early diagnosis, funding for treatment, etc). What is a Profession? Wiki says… “A profession is an occupation, vocation or career where specialized knowledge of a subject, field, or science is applied. It is usually applied to occupations that involve prolonged academic training and a formal qualification.” Wiki… Professional activity involves systematic knowledge and proficiency. Professions are regulated by professional bodies that set examinations of competence, act as a licensing authority for practitioners, and enforce adherence to an ethical code of practice. My Additions to Wikipedia…Professionals… Advocate, for their beneficiaries/consumers (individually and affected groups) Advocate for public policies and decisions that impact the consumers of the professionals‟ services, e.g., Noise levels in public places Prevention of conditions that lead to hearing loss Improved access to services (health insurance) Advocate For public policies and decisions that impact the profession itself: reimbursement, autonomy, direct access Provide pro-bono work Work more than a 40-hour week when the need is there… Volunteer to work in their professional organizations More Additions to Wiki… Professionals Write their own professional standards, based on evidence and research generated by audiologists and other professionals Accredit their own training programs Determine their own scope of practice Design, conduct and publish their own research in peer- reviewed journals Not just have a code of ethics, but adhere to it, and have consequences for lack of adherence Scope of Practice Defines the range of interests, capabilities and professional activities Defines audiologists as independent practitioners Provides examples of settings in which they are engaged in practice Academy members/licensees will provide only those services for which they are adequately prepared Through their academic and clinical training and experience Scope is consistent with the Code of Ethics SOP—Audiologic Assessment/ Diagnosis and Treatment Administration and interpretation of behavioral, physiologic, and electrophysiologic measures of the peripheral and central auditory systems In order to determine an audiologic diagnosis Assessment is accomplished using standardized testing procedures and appropriately calibrated instrumentation, employing evidence-based best practices/guidelines, and leads to an audiologic diagnosis and related treatment plan. the diagnosis of hearing Audiologic Treatment is patient-centric, patient-specific, and respects patient choice and autonomy. Treatment options are evidence-based and rely on evidence-based clinical practice guidelines for best outcomes. AAA Code of Ethics PRINCIPLE 4: Members shall provide only services and products that are in the best interest of those served. PRINCIPLE 5: Members shall provide accurate information about the nature and management of communicative disorders and about the services and products offered. Rule 5a: Individuals shall provide persons served with the information a reasonable person would want to know about the nature and possible effects of services rendered, or products provided or research being conducted. Rule 5b: Individuals may make a statement of prognosis, but shall not guarantee results, mislead, or misinform persons served or studied. Opportunities for Audiologists in 2010 Aging population, virtually all of whom need or will need our services With robust evidence that failure to access audiologic services has consequences for psycho-social function, cognition and dementia (Unfortunately) Tinnitus is the #1 health hazard resulting from combat (Unfortunately) Autism AAP stipulates that every child suspected of autism undergo audiologic evaluation Early Hearing Detection and Intervention An unparalleled opportunity One Thing that Audiologists Do That No One Else Does (Or no one else should do!) Pediatrics! How better to demonstrate our professionalism? Provide comprehensive services that no other professional or business group can With Federal dollars being dedicated to EHDI, audiologists are in the spotlight to carry out this Federally-mandated program Pediatrics: Start to Finish Prevention and Identification Newborn Hearing Screening Programs Comprehensive Diagnosis Infant electrophysiology/other physiologic measures Behavioral evaluations Treatment/Early Intervention Hearing Aid Fitting, Verification, Validation Collaboration with EHDI/IFSP/IEP Team, physician team(s) Cochlear implantation Candidacy evaluation Follow-up and long-term counseling/validation Parent/Family counseling Why Pediatrics? No other profession or provider can provide comprehensive services in pediatrics The “hearing healthcare professional” or “hearing instrument specialist” or ENT physician cannot (legitimately) lay claim to expertise and professionalism in pediatrics We publish a significant proportion of the research and set the standards for screening, diagnosis and follow-up Only Audiologists… Hearing aid dispensers don‟t provide pediatric services Typically prohibited by law Typically do not choose to test children Physicians (or their designees) can, but typically don‟t (and if they do, watch out!) Electrodiagnostic technicians can, but we shouldn‟t fit hearing aids based on their findings! Audiologists have a long-term commitment to the families of their patients Only Audiologists Diagnose Hearing Loss Audiologic Diagnosis: you can‟t see a hearing loss with an otoscope! Type, degree, severity, unilateral vs bilateral Based on measures and techniques Developed, verified, validated in the audiology literature Developmentally-appropriate Determine sufficient information to proceed to treatment Referrals Hearing Aids Cochlear Implants Provide parent counseling Professionalism: From Classroom to Practice to Research-Base Classroom: Training programs based on professional standards and accreditation developed by audiologists Practice Use of best-practices and evidence-based practice based on audiologic research and organizational practice guidelines Research PhD Audiologists‟ important role in providing and sustaining the research base of our profession We cannot advance our profession without growing our basic and translational research But…Do we get Paid? Insufficient codes for pediatric and adult evaluation/treatment Codes are insufficiently reimbursed Half of children in US are on Medicaid EHDI programs cannot succeed without pediatric audiology Unprecedented opportunity to advocate for coding and reimbursement Shortage is being noticed! Adult Services: payment is too reliant on hearing aid sales What Does This Have to Do With Me? So…you‟re not a pediatric audiologist… What Happens in One Area of Practice Affects Others When we achieve Direct Access for Medicare, it will influence other payer sources In California, we are paid E & M codes for children on Medicaid This model may translate to other payers When we give away “free hearing tests”, payers may come to expect the same for their insureds When we bundle hearing aids and reimbursement for hearing aids changes, we may not have the codes to get paid. So we get paid for “the thing” What Happens if We Don‟t Get Paid for Hearing Aids? California Medicaid (Medi-Cal) example Codes, or lack thereof How do we get paid for services (at a rate that we can afford to dispense) without codes? Importance of placing value on diagnostic and treatment procedures rather than “the thing” (HA, CI) A Professional Opportunity… To define each process in the diagnostic and treatment events Attach a value to services/processes separate from the value of the “thing” Advocate for new codes and related reimbursement Advance recognition of our value-added Hearing aids are useless without audiologists to fit The counseling and rehabilitation accompanying the hearing aid fitting is what brings professional value added What Do We Do That Diminishes Professionalism? Free hearing tests Be employees of ENT physicians Bill “incident to” Allow ourselves to be termed “Hearing Healthcare Professionals” lumped in with hearing aid dispensers Fail to adhere to best practices, current research findings, evidence-based practice Not distinguish between selling the thing and providing comprehensive rehabilitative treatment Barriers/Obstacles/”Opportunities” Inter-professional collaboration Other professional groups/organizations can/should be our allies, friends, collaborators Revenue/reimbursement Need revenue streams other than hearing aid sales Inadequate number of audiologists for population served Opportunity for use of Audiology Assistants Current Challenges in the US Inadequate reimbursement from Federal payers This becomes the model for private payers Too many AuD programs, too few student per program Accreditation standards not as rigorous as I‟d like Too many audiologists view hearing aid sales as only way to have a profitable practice/reasonable salary They might be right! Pediatrics, cochlear implants, vestibular diagnostics under- reimbursed Professionalism We‟ve come a long way Actions speak louder than words Achieving a doctoral degree doesn‟t ensure professionalism To paraphrase UCLA‟s John Wooden: “Be concerned with your professional character… because your character is what you really are”.
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