Legislation Threatens Veterans’ Hearing Health Care, Undermines Audiologists A bill before Congress is designed to reduce long waits for VA appointments by allowing “hearing instrument specialists” to provide services. But this proposal is flawed. From My Perspective
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From My Perspective  |   July 01, 2014
Legislation Threatens Veterans’ Hearing Health Care, Undermines Audiologists
Author Notes
  • Chasity Moore, AuD, CCC-A, a recent graduate of Arizona State University, worked for the VA Health Care System Palo Alto last year and now works in a small hearing aid office in Peoria, Ariz. She is a volunteer for ASHA-PAC, and served as the student member of the ASHA Audiology Advisory Council and as the at-large audiology representative on the council of the National Student Speech Language Hearing Association. cmoore@hearusa.com
    Chasity Moore, AuD, CCC-A, a recent graduate of Arizona State University, worked for the VA Health Care System Palo Alto last year and now works in a small hearing aid office in Peoria, Ariz. She is a volunteer for ASHA-PAC, and served as the student member of the ASHA Audiology Advisory Council and as the at-large audiology representative on the council of the National Student Speech Language Hearing Association. cmoore@hearusa.com×
Article Information
Hearing Disorders / Regulatory, Legislative & Advocacy / From My Perspective
From My Perspective   |   July 01, 2014
Legislation Threatens Veterans’ Hearing Health Care, Undermines Audiologists
The ASHA Leader, July 2014, Vol. 19, 4-5. doi:10.1044/leader.FMP.19072014.4
The ASHA Leader, July 2014, Vol. 19, 4-5. doi:10.1044/leader.FMP.19072014.4
As a recent audiology graduate working at a private practice, I can tell you that being an audiologist has no place—and certainly not number one—on the “least stressful jobs” list. We feel stress from a variety of threats to audiology: the cost of the clinical doctorate, shrinking reimbursement rates, lack of reimbursement for services, hearing aid costs and online hearing aid sales. The less-publicized—but arguably more dangerous—threat is the rapid encroachment of hearing aid dispensers, who have little education or training, on audiologists’ scope of practice.
The International Hearing Society has successfully lobbied for the introduction of legislation that would allow the Veterans Administration to appoint “hearing instrument specialists” to independently provide hearing aid evaluations, fittings, orientation, verification and customary after-care services. All audiologists should oppose this bill, H.R. 3508: Although many hearing instrument specialists are qualified to provide services for routine age-related hearing loss, the majority of VA hearing health patients’ hearing disorders are more complicated and frequently include other conditions. These patients require a team approach to their hearing health and AuDs’ specialized knowledge of anatomy, physiology, acoustics, balance and tinnitus management.
With this bill, the IHS has politicized veterans’ health care for financial gain, using incomplete information about hearing health care to garner support from veterans groups. This is an issue of great concern for me, as I grew up near a large naval base and have many friends and family members who have served our country. I believe the groups co-sponsoring this bill fully intend to serve the best interests of our veterans, but I also believe they have been misled. With full knowledge of hearing health care, health care delivery mechanisms and the qualifications of various providers, those supporters would have a better understanding of the substandard care this bill would allow.
Without a doubt, there are many issues to resolve in the VA hearing health care system: long waits for hearing aid repairs, a two-year backup in compensation and pension cases that require audiologists to verify veterans’ claims of hearing loss or tinnitus, and long wait times for various types of appointments. After recently auditing VA hearing health services, the VA Office of Inspector General recommended strategic increases in staffing at clinics and the central repair lab to increase productivity and timeliness. We should give the VA a chance to make these changes before adopting legislation that will reduce the quality of services provided to veterans.
But H.R. 3508 is not the answer:
  • The bill will not increase access to or the speed of service delivery, because VA patients often require an interdisciplinary approach. Hearing instrument specialists cannot provide the rehabilitative care necessary to treat traumatic brain injury, post-traumatic stress disorder, tinnitus and balance disorders. Additionally, patients would still have to travel to a main VA campus to enroll in the system and see a physician before seeing an audiologist.

  • The VA already has the ability to contract with hearing instrument specialists. The VA employs more than 300 audiology health technicians, many of whom are licensed hearing aid specialists, according to the Association of VA Audiologists, which opposes the bill.

  • Many private practice audiologists can accommodate the VA patient overflow.

As a VA audiologist last year, I faced patients’ complex health concerns daily. To provide quality care, we conducted a variety of tests and consulted with physicians, speech-language pathologists and other professionals. The bill assumes that hearing instrument specialists can provide the level of care that audiologists are trained to provide.
In reality, the hearing instrument specialists have few educational requirements. They vary by state, with some requiring only a high school diploma, an exam and a brief internship. Their scope of practice is limited to hearing screenings for the purpose of selling hearing aids to adults.
In short, H.R. 3508 is designed to provide hearing instrument specialists with a publicly funded revenue stream with veterans—who lose access to high-quality hearing health care—paying the price.
As audiologists, we have a responsibility to provide informed feedback to our lawmakers. We need to protect the integrity of our profession and scope of practice and be at the forefront of advocating for high-quality patient care. I urge you to write to your elected officials and keep them informed about our profession. They rely on your expertise and perspective. Your passion empowers our profession.
I also urge audiologists to support ASHA-PAC. The PAC supports U.S. congressional candidates and committees that support the integrity of speech-language and audiology services. ASHA-PAC is our strongest professional advocate, and depends on the combined strength of our collective voices.
With our integrity at stake, if we’re not at the table, we’re on the plate.
2 Comments
June 30, 2014
Scott Sims
We must speak with a strong, ethical voice.
Dr. Moore, Thank you for a meaningful piece. I am thankful that we have courageous leaders like yourself. The facts indicate that the future of Audiology is threatened. Audiology has allowed hearing aids and our services to be commoditized while commonly engaging in ethically troublesome purchasing behaviors. While the landscape around us has changed dramatically, we have wasted effort quibbling over the smallest of things. It is time for Audiology to speak with one Voice while leaving the troublesome buying group practices of the past behind us. Attend an APO webinar, ask tough questions, and if it seems right for you sign the Pledge for Audiology. The hearing impaired in our country deserve to have access to skilled Audiology and we must secure our fields place in the treatment spectrum. Contact me personally if you have additional questions. Scott Sims, Au.D., CCC-A
July 2, 2014
Kathleen Peterson
Right on!
Thank you, Dr. Moore, for a very well written article that speaks to my heart. We must first be sure that our veteran's receive comprehensive hearing health care not simply the dispensing of a product. Secondly, as professionals we must be willing to fight for our rightful place in the healthcare community. If we do not do this ourselves, another group will do it for us. This means that we cannot simply sit back and expect our Association leaders to be the only ones advocating for our profession. It must be a grass roots issue. Do it today!!
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July 2014
Volume 19, Issue 7