December 1, 2013 Departments

News in Brief: December 2013

Advisory Committee Alters Representation for Audiology and Speech-Language Pathology

The panel that recommends the values of certain health care procedures—and, therefore, how much providers are paid for performing them—has divided what was formerly a single seat into two separate seats for audiology and speech-language pathology.

ASHA held the single audiology/speech-language pathology seat on the Health Care Professional Advisory Committee of the American Medical Association's Specialty Society Relative Value Update Committee since 1992. Per the October decision, ASHA holds the speech-language pathology seat; ASHA and the American Academy of Audiology share the audiology seat, with each association holding it in alternate years.

The modification stems from a 2008 change in the Medicare statute that allows speech-language pathologists to bill Medicare independently for their services. ASHA worked with the AMA, AAA and the Academy of Doctors of Audiology to develop the proposal, which creates:

  • A separate seat for speech-language pathology held by an ASHA-appointed SLP member and an ASHA-appointed alternate member.
  • A shared seat for audiology, held jointly by ASHA and AAA, in recognition of the substantial audiologist memberships of both organizations. Each organization will appoint a member for a three-year term; the designation of "member" and "alternate" will switch annually, with the ASHA appointee serving as member for the first year. Only the member (or the alternate, in the member's absence) has a vote, but because of the annual rotation, both representatives need to work collaboratively.

The Health Care Professional Advisory Committee helps develop relative values for new, revised and potentially incorrectly valued CPT codes (Common Procedural Terminology © American Medical Association). Each code describes a specific procedure performed by the health care provider. CPT codes are used on bills submitted to Medicare and other public and private health insurers. The assigned relative value for each CPT code determines the reimbursement for that procedure.

The HCPAC is charged with providing fair and appropriate judgment of code valuation proposals. To make that determination, the committee surveys the appropriate professionals about the procedures in question. HCPAC members are prohibited from advocating for code values for their own professions or societies and must act as an independent, expert panel.

The HCPAC refers final values to the federal Centers for Medicare and Medicaid Services, which then finalizes the relative values for all Medicare-reimbursed procedures. The relative values, the number of procedure codes, the frequency of use of the procedures—and the overall Medicare budget—all determine the reimbursement rate across all codes.

There is no direct effect of the payment of one profession on another profession when codes are created or revised. Although CMS must keep the overall Medicare fee schedule "budget neutral"—that is, fee increases must be offset by decreases in other fees—valuation or re-valuation of one code does not directly affect the valuation of another code. By design, codes and specialties are not pitted against one another in valuation; rather, codes are reviewed and valued on their relative merits.

There was never any conflict of interest between audiology and speech-language pathology when both were represented by a single seat: Speech-language pathologists have never influenced the presentation or the values of any audiology codes, nor have audiologists ever influenced the presentation or values of speech-language pathology codes. Audiologists have always surveyed and presented the audiology procedure values, and SLPs have always surveyed and presented speech-language pathology procedure values.

The creation of a seat specifically for speech-language pathology increases ASHA's role on the HCPAC, and the representation of audiology in a jointly held seat will expand opportunities for collaboration among audiology organizations.

More information about the Relative Value Unit Update Committee and its HCPAC is available in AMA documentation [PDF] and the RVS Update Process booklet [PDF].

George Lyons Jr., JD, MBA, is ASHA director of government relations and public policy.

Senate Proposal Would Fix Medicare Formula

A bipartisan Senate proposal would kill the problematic Medicare payment formula that determines payments for health care providers—including audiologists and speech-language pathologists—and replace it with a system that links reimbursement to the quality of care provided. If the Oct. 30 discussion draft eventually becomes law, it would stop the annual end-of-year scramble to bypass the formula and the severe fee cuts that would result.

The draft, released by the Senate Finance and House Ways and Means committees, would do away with the sustainable growth rate. That formula, adopted in the 1997 deficit reduction law, will reduce 2014 Medicare payments by nearly 25 percent unless Congress intervenes. Stopping scheduled SGR-related payment cuts has become a yearly congressional ritual. The proposed framework would provide a permanent solution, rather than a yearly fix.

The framework would repeal the SGR and hold pay at current levels as alternative payment models are developed and tested, moving providers from the current system—in which they are paid for volume—to a plan that offers financial incentives to move to alternative payment models emphasizing quality care. It would combine some existing Medicare quality programs into a new system starting in 2017 that would offer providers additional pay based on their performance on value-based criteria, such as enhanced use of electronic medical records.

Providers who participate significantly in an alternative payment model would receive a 5 percent bonus through 2021. The proposal would also create a process to ensure accurate payment for provider services, reward care coordination for patients with multiple chronic conditions, and introduce physician-developed care guidelines to reduce unnecessary care.

Earlier this year, the House Energy and Commerce Committee approved an SGR repeal that would give providers a 0.5 percent payment increase from 2014 through 2018, with additional payments beginning in 2019 to providers who meet specific quality measures and clinical practice improvement activities.

The House and Senate were expected to hold mark-ups on this legislation in November. ASHA reviewed the proposal and its potential impact on audiologists and SLPs and submitted detailed comments to both committees.

Of serious concern is the white paper's failure to address repealing and replacing the therapy caps—the amount of speech-language, physical therapy and occupational therapy outpatient services a Medicare beneficiary may receive in a single year—which were instituted with the SGR in 1997. Congressional action on these two issues has historically gone hand-in-hand, and ASHA is working with other stakeholders to ensure that Congress includes the therapy cap issue in the overall SGR reform package.

Noise Harms More Than Hearing

Loud noise in everyday life—including occupational, recreational and environmental sounds—affects not just people's hearing, but also nonauditory health indicators, including cardiovascular disease, cognitive performance and mental health, and sleep disturbance.

These effects seriously threaten public health, according to an extensive review of research on the impact of noise. The review was conducted by an international team of researchers published in The Lancet.

The medical community knows that high noise levels can cause hearing loss, but because environmental and social noise is so ubiquitous, the authors suspected that nonauditory effects on people's health were underestimated. The authors found evidence that long-term exposure to environmental noise—such as earbuds blasting music during subway commutes, the constant drone of traffic heard by those who live or work near congested highways, or beeping monitors that make up the soundtrack heard by hospital patients and staff—affects the cardiovascular system, with connections to hypertension, ischemic heart diseases and stroke. In addition, many studies have found associations between environmental noise exposure and sleep disturbance, children's cognition, and hospitalized patients' ability to heal.

The authors hope that the information will increase awareness about the many negative health consequences of noise, and encourage educational campaigns that promote noise-avoiding and noise-reducing behaviors. The authors conclude that, "Efforts to reduce noise exposure will eventually be rewarded by lower amounts of annoyance, improved learning environments for children, improved sleep, lower incidence of cardiovascular disease, and, in the case of noise exposure in hospitals, improved patient outcomes and shorter hospital stays."


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