Abstract
On March 3, 2021, the Medicare Audiologist Access and Services Act of 2021 (H.R. 1587) was introduced in Congress. The bill seeks to expand Medicare coverage to reimburse audiologists directly for certain diagnostic and treatment services without the contributions of physicians or other medical colleagues. This bill would provide direct access to audiology services to Medicare beneficiaries, as eligible veterans do through the Department of Veterans Affairs. The American Academy of Otolaryngology – Head and Neck Surgery recently lobbied strong opposition in a letter to lawmakers, cosigned by 110 medical organizations. The opposition’s basis is that audiologists “do not possess the medical training necessary to perform the same duties as physicians, nor are they able to provide patients with the medical diagnosis and full spectrum of treatment option they require.” The American Society of Geriatric Otolaryngology (ASGO) was not a co-signatory of this letter because the Executive Committee of ASGO was evenly split. Given population aging, advancing geriatric care is a public health imperative. However, the current structure of hearing healthcare limits the accessibility and affordability of care, and a substantial proportion of older people’s hearing loss is not addressed (leaving an increased risk for comorbidities). Updating health policies, particularly Medicare which was established in 1965 when there were fewer older adults, is one top-down strategy in preparing for an aging society’s needs. Furthermore, patient-centered advocacy for improving accessibility and affordability must include coverage for both services (e.g., aural rehabilitation) and devices (e.g., hearing aids), which H.R. 1587 does not accomplish fully. There are ongoing concerns surrounding patient safety if medical practitioners are excluded as well as structural barriers set in-place by a 50+ year old policy, though concerns such as these are ultimately rooted in different approaches to promoting health (i.e., clinical- vs population-level). The complexities of the hearing health landscape are likely to increase with the expected FDA approval of over-the-counter hearing aids. This approval may improve access but also will lead to unsupervised self-management. Advocacy for audiology direct access is not new and more dialog across professions is needed to clarify respective concerns across proponents and opponents. While disagreements remain among leading voices in the field, we have a professional responsibility to both individual patients and the whole population to ensure that hearing healthcare is both readily available and medically safe.
