Medicare - the land where angels (and audiologists) fear to tread

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AAA 2019 "The Best of Audiology" must also embrace what for many professionals is the worst of audiology, namely the complexity and stress of medicare. A stellar debate at this conference will take a practical and detailed look at the economic intricacies and realities of the healthcare payment systems debate.

If there is one badland that US audiologists enter at their own risk, then it must be the area of healthcare finance administered by the munificent but inscrutable Medicare.

Signed into law by President Lyndon Johnson in 1966 to provide a safety-net health insurance for the over-65s, the scheme has perplexed and tormented many hearing care professionals obliged to engage with it for patients from the most likely segment to present with age-related hearing loss, but for whom no cover is available beyond diagnostic evaluation services (in certain conditions); Medicare does not recognize agerelated hearing loss as a chronic medical condition and, therefore, does not pay for services related to treating that loss.

For some twenty years, US audiologists have pushed for change to Medicare regulations, watching as patients beaten by the system’s bureaucracy and hearing aid prices either pay up or forego treatment altogether. There are now signs from both within and outside audiology that the timing could not be better for the 2019 American Academy of Audiology’s annual Conference to hold a bumper three-hour featured educational session on Audiology and Medicare: Where Economic Reality Collides with Hearing Care (March 29, 15:00 - 18:00).

Ian Windmill
Ian Windmill (Photo: ARR).

Immersed in studying this “dilemma” for audiologists is the leader of the session, a past-president of the Academy (2016-2017), Ian Windmill. While also setting out to improve delegates’ “understanding of what this intersection of audiology and Medicare is”, the session anchor underlines that “our overall aim is to instruct the audience and provide them with the information and data with which to make appropriate decisions, particularly with regard to being advocates for change in the system. Rather than just having an emotional reaction we want it to be something that is evidencebased, as in ‘here’s what you really get paid, here’s what you don’t, here are the impacts.’ Some see a few Medicare patients, some see thousands; everybody comes at it from their own box, so we want to give it that broad perspective.”

"I don't want dementia; I'd rather have a hearing aid"

Windmill appreciates how factors coming from different quarters may now be bringing critical mass to the arguments of a “complex and curious debate”. One such factor is the number of recent studies linking hearing disorders to systemic and socially sensitive conditions, among them diabetes but also, perhaps most crucially in recent papers, to cognitive decline, links seized upon across the audiology panorama from industry to campaigners such as Windmill, who recognizes that “the issue about cognitive status is part of the motivation for our session because of the emerging evidence there.”

“One of the things I would say out loud,” he affirms, “and I have no evidence to back it up, is that in the scheme of healthcare, hearing loss is not scary; people live with it, people don’t die from hearing loss. Heart disease is scary, and dementia is scary, but if you suddenly link hearing to dementia, it is now a treatment or prevention for a scary condition, so more people are going to become interested. People then say ‘I don’t want dementia; I’d rather have a hearing aid.’”

“So we’re seeing these emerging groups that haven’t really been targeted before. Another group is in the children’s area, kids with attention disorders, and autism where you’re helping to focus better,” he adds.

Non-clinical skills are a key part of this year’s new inaugural event, the Audiology Career Enhancement (ACE) Symposium. “We’re thrilled that over 120 people have already registered,” enthuses Miller. “We are bringing in an improv group that works with businesses, attorneys, and outside healthcare to focus on non-clinical skills to help audiologists grow as professionals and leaders. They really try to enhance your ability to think on your feet, so this is a hands-on opportunity I’m very excited about. We have great audiologists but I also think it’s important to learn from others.”

Timing right for debate as universal healthcare hits the campaign trail

One of the efforts to change laws specifically in favour of audiology involves the Audiology Patient Choice Act which, says Windmill, “is one of the initiatives that we have been trying over the last 20 years to get through Congress, and that’s still languishing on Capitol Hill.”

There are also now key elements of a national political backdrop ahead of the 2020 presidential elections, with the cry of ‘Medicare for All’ once again proving something of a litmus test for Democrat candidates.

Meanwhile, a newly unveiled New Green Deal proposed by representatives of this party embraces the idea of universal healthcare, no doubt encouraged by a 2018 Reuters poll suggesting nationwide support for ‘Medicare for All’ in the region of 70 percent (85% Democrats; 52% Republicans).

“This is definitely a national event that is going on now and I think everybody is looking to see where that goes, and that could really change a lot of the conversation in audiology simply because ‘Medicare for All’ really started embracing all these other issues such as hearing loss,” affirms Windmill.”

“The cry of ‘Medicare for All’ is fairly recent,” he adds, “and is really wrapped in this same kind of universal healthcare system, with different iterations, cover from birth to death, or buying into it, etc., as in the UK or Scandinavian countries; some people support it, some people really don’t.”

Positions either side of this moral debate do not seem to have gained balance from the US being able to look across the Atlantic at examples of governmentrun and taxpayer-funded national health systems or citizenries given free therapy, surgery and, for example, hearing devices from the cradle to the grave. The battle is fiercely polarised, one extreme perhaps best exemplified by the Republican Senator for South Carolina Lindsey Graham’s crusade against the USA ever having a national health service: “Don’t consolidate all your hopes and dreams for your family into the arms of the federal government, because it’s not going to work. [...] We’re going to go one of two ways in this country. We’re going to create a future for our children that they can actually afford. We’re going to deal with a $20 trillion debt or we’re going to pass it on to somebody else. And driving the debt is Medicare, Medicaid, Social Security, and interest on the debt. Somebody needs to deal with this.”

Read the rest of the article on the Audiology Worldnews AAA special issue (free-access flipbook):


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Peter Wix