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Pediatric Audiology Opportunity

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Pediatric Audiology Opportunity Powered By Docstoc
					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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