Know the Facts: H.R. 1116
H.R. 1116 Is Member Driven
The Medicare Audiology Services Enhancement Act of 2015 (H.R. 1116) is the culmination of more than four years of due diligence involving extensive input from ASHA audiology members in the field and among the volunteer leadership.
- The process for gathering member feedback goes back to 2009 and includes survey responses by audiologists, face-to-face discussions with the audiology members of ASHA's advisory councils and ASHA's Health Care Economics Committee, and extensive discussion within both the audiology subcommittee of the Board and the entire Board of Directors over many years.
- ASHA Government Relations staff met with members of Congress and senior staff of the Energy and Commerce and the Ways and Means Committees and consulted with legislative experts to understand what legislative proposals are politically feasible in the current economic and political climate.
- In anticipation of the changes expected through the Affordable Care Act and other health care initiatives, ASHA convened a health care summit with participation from presidents of American Academy of Audiology, Academy of Doctors of Audiology, Educational Audiology Association, and others to help us understand the changes coming in health care and how legislation might help audiologists respond to these changes.
How H.R. 1116 Helps Audiologists
The Medicare Audiology Services Enhancement Act of 2015 (H.R. 1116) recognizes audiologists as diagnostic and treatment providers able to receive Medicare reimbursement for the professional services they provide.
- The current Medicare benefit covers only diagnostic services performed by an audiologist, not treatment services. The proposed legislation will allow Medicare beneficiaries to receive diagnostic and treatment services from the audiologist and allow audiologists to bill Medicare directly.
- Audiologists would be able to provide professional evaluation and treatment services to Medicare beneficiaries as a covered benefit. Additionally, those audiologists trained to perform intraoperative neurophysiological monitoring will be eligible for reimbursement under this legislation.
- The four broad categories of treatment outlined in the bill will allow for coverage of current and future treatment services that are most important to audiologists and within their scope of practice.
- As payment continues to move toward pay for performance and outcomes, it is essential that audiologists be allowed to provide covered treatment services to Medicare beneficiaries in order to report meaningful outcomes measures in programs like the Physician Quality Reporting System (PQRS).
- The bill would expand coverage of audiology treatment services to more than 48 million Medicare beneficiaries and expand the number of insured patients who may seek audiologists to provide such services.
How H.R. 1116 Helps Private Practice
The Medicare Audiology Services Enhancement Act of 2015 (H.R. 1116) creates access to coverage for audiology treatment services to more than 48 million Medicare beneficiaries and expands the number of insured patients seeking services from an audiologist.
- Private practice audiologists are under tremendous pressure from online hearing aid sales, non-professional sellers, rapid technology changes, and more. Being recognized as a provider of treatment services by the largest medical payer (the Federal government) is key to the future of the profession.
- This legislation would not impact the current rules related to dispensing hearing aids, but it would allow dispensing audiologists to bill Medicare for other treatment services not related to hearing aids, which audiologists often provide without receiving consistent reimbursement.
- Many audiologists bundle all of their services into the cost of a hearing aid, when some of those services may be related to treatment for the hearing loss, not care of the hearing aid. Comprehensive audiology legislation would easily allow for unbundling of covered services while allowing for private contracts for services directly related to hearing aids.
Audiologists Need to Be Part of a Team
The Medicare Audiology Services Enhancement Act of 2015 (H.R. 1116) recognizes that a care coordination model is the future of health care. Congress and CMS have clearly indicated that the medical/health home and general physician oversight will be required for all specialty care.
- Audiologists need to be recognized and reimbursed for the treatment services they provide, be a part of the treatment team, and secure a rightful place in this rapidly changing health care landscape. As members of the diagnostic and treatment team, audiologists can improve patient care by using their expertise to help primary care physicians with their responsibility for overall care coordination.
- Nationally recognized experts in medicine and health care policy agree that a paradigm shift is under way. Audiologists need to reassess and rebrand in order to be part of the evolving health-care delivery system. Being recognized by CMS as a diagnostic and treatment profession is going to be in audiology's best interest and the best interest of the patients served.
- In general, the physician (or non-physician practitioner, including nurse practitioner, physician assistant, or clinical nurse specialist) is becoming the gatekeeper for referrals to all specialty services. They are increasingly responsible for referrals and care coordination.
- To ensure that the value of audiology is accurately reflected, it is essential that audiology move beyond diagnostics and into treatment in a meaningful way.
H.R. 1116 Helps Patients
Under the current system, Medicare patients who seek services from an audiologist are only covered for the diagnosis. The Medicare Audiology Services Enhancement Act of 2015 (H.R. 1116) fixes that.
- Medicare beneficiaries currently need to pay out-of-pocket or seek out other service providers for rehabilitation treatment. The bill would give Medicare beneficiaries access to audiologists for both diagnostic and treatment services.
- Audiologists will still maintain the ability to use their clinical judgment and expertise in treating the patient. The audiologist, after examining the patient, will develop a plan of care (required by CMS) tailored to that individual. Audiologists are in the best position to provide treatment services, and this bill will allow many more patients to receive treatment services from an audiologist.
- The subsequent regulations will allow for the coverage of many hearing and balance services that are most important to patients. The plan of care will help ensure care coordination across the spectrum of services the beneficiary is receiving.
- More than 48 million Medicare beneficiaries will have expanded access to hearing and balance services from an audiologist. Audiology will be available to meet the needs of those who cannot afford to pay out-of-pocket for the care they need.
The Future of Payment Is Outcomes
Reimbursement is going to be tied to patient outcomes related to treatment and functional abilities. By adding treatment services to the covered services performed by audiologists, the Medicare Audiology Services Enhancement Act of 2015 (H.R. 1116) ensures that audiologists will be part of the new payment system.
- Patient outcomes and functional assessments are areas to which Congress and other policymakers are looking as the basis for determining payment for services.
- Medicare continues to shift dollars from the diagnostic-only services, such as radiology and pathology, to outcomes and preventative-based services.
- With Medicare undergoing major changes and the enactment of the Affordable Care Act, health professionals who are diagnosticians only or who want to be “independent” rather than part of a care-coordination model will likely be left out of reimbursement.
- The audiology profession is struggling to identify true outcomes measures within the context of the profession's limited scope of practice as it is currently defined under Medicare. Passage would create opportunities to capture true outcomes data with which to promote the value of audiology.