Professionalism: The Audiologist’s Opportunity Alison M. Grimes, AuD University of California Los Angeles Medical Center Past-President, American Academy.

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 specialized knowledge of a subject, field, or science is applied. It is usually applied to occupations that involve prolonged academic training prolonged academic training and a formal qualificationformal qualification.”

Wiki…

Professional activity involves systematic systematic knowledge and proficiencyknowledge and proficiency..

Professions are regulated by professional bodies that set examinations of examinations of competence,competence, act as a licensinglicensing authority for practitioners, and enforce adherence enforce adherence to an ethical code of practiceto 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 EthicsPRINCIPLE 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”.