Top of the License to You! Here’s how one private practitioner runs his business so its audiologists practice at the top of the profession. Features
Free
Features  |   January 01, 2018
Top of the License to You!
Author Notes
  • Stuart Trembath, MA, CCC-A, is the owner of 30-year-old Hearing Associates, P.C., in Mason City, Iowa. He is co-chair of ASHA’s Health Care Economics Committee and is an affiliate of ASHA Special Interest Groups 6, Hearing and Hearing Disorders: Research and Diagnostics; 7, Aural Rehabilitation and Its Instrumentation; 8, Audiology and Public Health; 9, Hearing and Hearing Disorders in Childhood; and 18, Telepractice. trembath@cltel.net
    Stuart Trembath, MA, CCC-A, is the owner of 30-year-old Hearing Associates, P.C., in Mason City, Iowa. He is co-chair of ASHA’s Health Care Economics Committee and is an affiliate of ASHA Special Interest Groups 6, Hearing and Hearing Disorders: Research and Diagnostics; 7, Aural Rehabilitation and Its Instrumentation; 8, Audiology and Public Health; 9, Hearing and Hearing Disorders in Childhood; and 18, Telepractice. trembath@cltel.net×
Article Information
Professional Issues & Training / Features
Features   |   January 01, 2018
Top of the License to You!
The ASHA Leader, January 2018, Vol. 23, 50-54. doi:10.1044/leader.FTR2.23012018.50
The ASHA Leader, January 2018, Vol. 23, 50-54. doi:10.1044/leader.FTR2.23012018.50
My practice, Hearing Associates, P.C., in Mason City, Iowa, has constantly evolved over the last 30 years in response to the changing marketplace.
It has had to for its survival. And today, audiologists in private practice face potentially greater challenges than we have in the past. Hearing devices are available directly to the consumer online—and soon, over-the-counter (OTC) hearing aids will be available without the help of an audiologist. Meanwhile, we see increased competition from manufacturer-owned offices and big-box retailers and we face changing payment models that could reduce reimbursement for our diagnostic evaluations.
To handle these challenges, the private practice model needs to parlay them into opportunities. So how do we respond? We need to adapt and get smarter about how we provide services. And that means we need to practice “at the top of our license”—in essence, ensure that we use our training effectively and avoid wasting our time on tasks that others could perform.
It also means we need to provide high-quality services more efficiently. But how? This is a question driving the business model for my practice, and I will share here how we operate.
One primary efficiency driver is employing two hearing-instrument specialists to assist in our hearing-aid dispensing. (In Iowa, we are unable to employ audiology assistants.)
Another key efficiency driver is leaving it to audiologists to diagnose hearing loss and develop a plan of auditory care—and determine how that plan may include hearing aids, auditory rehabilitation (AR) and involvement of a patient’s family and social network. By adapting our practice in these ways, we’ve increased our revenue: For instance, our return rate for hearing devices has dropped from 14 percent to 1 percent.

One primary efficiency driver is employing two hearing-instrument specialists to assist in our hearing-aid dispensing.

New challenges
Changes in the health care landscape are propelling the need for a more streamlined private practice. The Medicare Access and CHIP Reauthorization Act (MACRA) passed in 2015, moving us toward a reimbursement system that rewards quality of care over volume of procedures performed. Today we are paid for the number of evaluations we complete, rather than being rewarded or penalized for the quality of our work.
MACRA resulted in the new Merit–Based Incentive Payment System (MIPS), which may include audiologists as early as 2019. MIPS modifies provider payments based on performance in four categories—quality, resource use or cost, advancing care information or use of electronic health records, and clinical practice improvement activities. The resulting composite score—as compared with the scores of the provider’s peers—will dictate payment rates.
Once included for participation in MIPS, audiologists who provide the highest-quality services may see incentive payments, and those deemed to provide lower-quality services may see penalties. When MIPS is fully implemented, those incentives and penalties could adjust payments by up to 18 percent.
The Centers for Medicare and Medicaid Services (CMS) has not yet established the timeline for including audiologists in MIPS, nor what measures will be used to report quality. In anticipation of MIPS inclusion, ASHA’s National Center for Evidence-Based Practice (N-CEP) brought together an ad hoc committee—comprising a wide range of audiology stakeholders from within and outside of ASHA—to develop measures for use in ASHA’s audiology registry, scheduled to launch in 2019. ASHA’s Health Care Economics Committee and government relations staff are working with N-CEP and other audiology groups to advocate that CMS recognize these measures for MIPS quality reporting when audiologists are included in the program.
Another ongoing challenge private practice audiologists face is the rise in sales of personal sound amplification products (PSAPS) and hearing aids by big-box stores and online retailers. With increased competition, how do we make our practices relevant and grow? OTC hearing aids will also be here soon. Almost two-thirds of respondents said OTC hearing aids will have a negative or very negative impact on audiology’s future in recent online survey of 566 audiologists by Hearing Health & Technology Matters. Recent congressional authorization of OTC hearing aids (pending the Food and Drug Administration’s development of regulations) will only amplify this challenge.
Meanwhile, one of the greatest challenges we face is an inadequate number of audiologists to meet the needs of a growing number of people with hearing loss. Consider, for example, that nearly 25 percent of people ages 65 to 74 and 50 percent of those 75 and older have disabling hearing loss, according to the National Institute on Deafness and Other Communication Disorders.
But in our practice, we see all these challenges as new opportunities.

After our auditory rehabilitation class, the hearing-aid users and their significant others report significant improvement in their communication habits.

Practice evolution
How have we turned them into opportunities? By considering audiologists’ unique skill sets that allow us to practice at the top of our profession—and having others perform more routine tasks.
In our practice, we employ two hearing-instrument specialists to fit hearing devices, make programming adjustments and service the devices. They cover a daily walk-in clinic, troubleshoot and adjust devices, and provide routine follow-up care. They also check repaired hearing aids and program them appropriately.
Employing hearing-aid specialists allows our five full-time and one part-time audiologists to use their skill sets more efficiently. Audiologists are crucial in diagnosing hearing loss and impaired auditory function—and technological and scientific advancements in these areas only increase our crucial role in quality of hearing care. We are uniquely qualified to determine the best plan of care for those with auditory challenges.
As we develop that plan, we know the critical elements to include. Does the patient need medical treatment or do we need further assessment of their auditory skills? Once this assessment is completed, what services do we need to provide? For some, treatment may be as simple as an amplification device. Others may require AR services. Many will need both an amplification device and AR.

Audiologists are uniquely qualified to determine the best plan of care for those with auditory challenges.

AR expansion
Audiologists, as we know, are trained to provide AR services, which aim to bolster quality of life for people with hearing loss and help them participate more fully in daily activities. In our group AR program, participants meet for three hour-long sessions. Cost-wise, these classes are bundled into the investment the patient makes in the hearing instruments. As yet, Medicare and private insurance don’t reimburse audiologists for providing these services.
Each group includes new and experienced hearing-device users and their significant others. In each session, an audiologist and hearing-instrument specialist present integral AR topics, such as handling communication breakdowns and strategies to cope with hearing loss. We spend considerable time on the impact of hearing loss on the patient and those around them and encourage group discussion. Attendees report significant benefits from discussing the effects of their hearing difficulties on their daily activities.
Since we launched the program a year and a half ago, more than 120 patients and their significant others have participated. They’ve awarded it an average satisfaction rating of 9.6 on a 10-point scale. Of note, surveys show that the significant others leave the class with a much better appreciation of their loved ones’ experiences with hearing loss. Both the hearing-aid users and their significant others report substantial improvement in their communication habits, such as obtaining visual attention before attempting to communicate. They also report improved communication strategies.
Our program is just beginning, but our return rate on devices from this group is 1 percent compared to 14 percent for our overall patient population during this same time period. While we do not expect the overall return rate to be this low, a reduction in the return rate results in significant revenue for the practice. We are now seeing patients come to our practice because they have heard about the AR class from others who’ve taken it. Providing AR has been a winning proposition for those we serve and for our practice. As we move forward, we are looking to expand our AR services and may offer a more advanced AR class to follow the initial class.
As we continue facing challenges in our profession (as all professions do), our practice will continue seeking opportunities to grow and expand. How can we increase access to our services? I firmly believe it is by practicing at the top of our profession. Delegating more tasks to support staff and building out our AR services are key ways to achieve this. Moving forward, I am sure we will recognize many other opportunities.
0 Comments
Submit a Comment
Submit A Comment
Name
Comment Title
Comment


This feature is available to Subscribers Only
Sign In or Create an Account ×
FROM THIS ISSUE
January 2018
Volume 23, Issue 1