June 1, 2013 Departments

News in Brief: June 2013

Audiologist, SLP Rank as Top Jobs

Audiology and speech-language pathology are in the top 15 jobs of 2013, as ranked by CareerCast.com. Using data from the Bureau of Labor Statistics and other government agencies, the career website ranked 200 jobs from best to worst based on five criteria: physical demands, work environment, income, stress and hiring outlook. Analysts selected the 200 jobs based on relevance in the current labor market and availability of reliable data.

Audiologist ranked fourth—behind actuary, biomedical engineer and software engineer—with a national median salary of $66,660 and projected job growth of 37 percent.

Speech-language pathologists ranked 12th, with a national median salary of $69,143 and projected job growth of 22 percent.

See what ASHA-member audiologists have to say about the professions; SLP and school survey responses are available as well.

Clarification on Medicare Physician Identifier Rule

Speech-language pathologists and audiologists do not risk rejection of Medicare claims if the referring provider is not Medicare-enrolled, contrary to previous information from the Centers for Medicare and Medicaid Services ("No Physician Referral Equals No Medicare Payment," The ASHA Leader, May 2013).

CMS indefinitely postponed the May 1 requirement. It also clarified that only claims for Medicare Part B durable medical equipment and supplies—such as cochlear implants—and Part A home health referrals are required to have orders, referrals and certifications from Medicare-enrolled physicians. Referring providers are required for Specialty Part B services, including audiology diagnostic services and speech-language services, but these claims are not subject to the enrollment edit at this time.

President Obama's Budget Request Includes Preschool Education Program

President Obama's proposed fiscal year 2014 budget, sent to Congress in early April, replaces sequestration with a mix of spending cuts and revenue increases that produces $1.8 trillion in deficit reduction over the 10-year budget window.

This savings, according to the White House, is significantly more than the $1.2 trillion deficit reduction projected by sequestration, the one-time, across-the-board automatic spending cuts mandated by the Budget Control Act that took effect Jan. 1, 2013.

Specifically, the president's budget calls for:

  • $583 billion in new revenues.
  • $600 billion in mandatory program savings ($400 billion in health savings that build on the health reform law and strengthen Medicare and $200 billion from other mandatory programs, such as reductions to farm subsidies and reforms to federal retirement benefits).
  • $230 billion in savings from using a "chained" measure of inflation for cost-of-living adjustments throughout the budget—including Social Security and other benefit programs—that lowers cost-of-living adjustments.
  • $200 billion in discretionary savings from the pre-sequester levels, split between defense and non-defense, starting in 2017.

Congressional proposals

The president's budget was submitted after the House and Senate had already voted on their own budget plans. These plans, which passed on partisan votes, differ greatly in their visions of the federal budget and the role of the federal government. The House budget would maintain the sequester cap levels ($966 billion), but shift all of the cuts scheduled for defense to nondefense discretionary programs, such as those run by the Department of Education. If enacted, the House budget would cut education and other programs 12% below the final FY 2013 sequester levels. Overall, the House budget would achieve a balanced budget in 10 years through a total of $4.6 trillion in additional spending cuts, with no revenue increases.

By contrast, the Senate-passed budget reflects the Budget Control Act figure of $1.058 trillion for FY14, replaces sequestration, raises revenues by almost $1 trillion, reduces defense, and calls for modest cuts to mandatory programs.

Education priorities

According to information from the U.S. Department of Education, the president's FY14 budget invests $71 billion in discretionary funding for education programs.

This figure represents an increase of 4.5 percent over the FY13 pre-sequester level, but sequestration cut FY13 funding by 5.612 percent—so the proposed increase, in reality, is not that large. Further, most of the proposed increase in funding for FY14 is either for new programs or for increases in proposed new programs based on consolidations of existing programs.

The budget indicates the administration's emphasis on early education through several programs:

  • Preschool for All, a new partnership between the federal government and individual states to offer high-quality preschool to all 4-year-olds from low- and moderate-income families. This proposal would invest $75 billion over 10 years, starting with a $1.3 billion investment for FY14; it also calls for $750 million for FY14 for a competitive grant program to involve states in the project.
  • A "strengthened" Head Start program for children from birth to age 3.
  • A $20 million increase in FY14 for Part C (grants to infants and families, birth to 2) of the Individuals With Disabilities Education Act to fund state incentive grants to "facilitate a seamless system of services for children with disabilities from birth up to age 5." The increase would bring total IDEA Part C funding to $462.7 million in FY14.

These initiatives would be funded through an increased tax on tobacco products.

Although the president's proposal includes a $602 million increase for IDEA Part B Grants to States and a $19 million increase for IDEA Section 619 Preschool Grants for FY14, these increases bring funding for both of those programs back to FY12 levels. Essentially, the proposal restores the FY13 funds cut by sequestration.

This budget request is just that—a request, as Congress maintains control of the nation's purse strings. The budget request does, however, identify the administration's priorities and begins a long and convoluted process toward a spending agreement that is not expected until sometime after the fall congressional elections.

Neil Snyder is ASHA director of federal advocacy.

New Standards for Culturally and Linguistically Appropriate Health Care Services

The enhanced National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (known as the National CLAS Standards) and an accompanying "how to" guide are now available at Think Cultural Health.

The National CLAS Standards establish a blueprint for organizations to deliver effective, understandable and respectful services at every point of patient contact. They are designed to advance health equity, improve quality and help eliminate health care disparities.

The principal standard is to "Provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs." Fourteen other standards address issues of communication and language assistance; engagement, continuous improvement, and accountability; and governance, leadership and workforce.

The guidance document, "A Blueprint for Advancing and Sustaining CLAS Policy and Practice," describes the purpose and components of each standard, provides basic strategies for implementation, and offers resources for more information and guidance.

Hearing Loss Prevention Drugs Closer to Reality

A new way to test anti-hearing-loss drugs could help land those medicines on pharmacy shelves sooner. University of Florida researchers have figured out the longstanding problem of how to create safe, temporary, reversible hearing loss to determine how well the drugs work. The findings are described in the November/December 2012 issue of Ear & Hearing.

"There's a real need for drug solutions to hearing loss," said lead investigator Colleen Le Prell, associate professor in the UF Department of Speech, Language, and Hearing, who noted that the only options for protecting against noise-induced hearing loss—turn down what you're listening to, walk away from it or wear ear plugs—may not be practical, particularly for those in the military who need to hear threats.

Prevention is key because the damage to hearing-related hair cells in the inner ear inflicted by loud noise is irreversible. Though hearing aids can amplify sound and implanted devices can restore some sensation of sound, they do not restore normal hearing. Thus, researchers are trying to find drugs that prevent hearing damage in the first place.

Prototype drugs have prevented noise-induced hearing loss in laboratory animals, but researchers lacked an effective method for testing the drugs in people. Those tests, now achievable because of the UF efforts, advance the development of drugs that could help protect people from hearing damage. Three monitoring boards ensured that the studies met national safety standards for research in humans.

The UF method used controlled music levels to reliably cause low-level, temporary hearing loss in 33 young adult participants, who listened to rock or pop music on a digital music player via headphones for four hours at sound levels ranging from 93 decibels (a power lawn mower) to 102 decibels (a jackhammer). Each participant's hearing was tested four times, 15 to 95 minutes after the listening session, and one day and one week later. Fifteen minutes after the music stopped, those who listened to the highest music levels had lost just a small amount of hearing—six decibels, on average. Hearing returned to normal within three hours.

The researchers will use this testing model in clinical trials of two drugs designed to prevent noise-induced hearing loss in humans. The Food and Drug Administration will monitor the studies to ensure openness, analytical rigor and participant safety.


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