Hearing Health Care for Adults Priorities for Improving Access and Affordability (2016) / Chapter Skim
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5 Improving Affordability of Services and Technologies
5 Improving Affordability of Services and Technologies
Pages 205-234
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From page 205... ...
. The cost of hearing health care includes the cost of services and technologies, and these costs may be incurred multiple times over a period of many years in order to maintain and replace hearing aids and other technologies, to continue to monitor hearing status, and to retain the benefits from auditory rehabilitation and other services.
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This package price may also include an unlimited number of visits to the dispenser for programming adjustments until the consumer is satisfied and has adjusted to the hearing aids or other technologies. Visits for auditory rehabilitation services may also be included.
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These marketing and sales strategies can restrict competition and the asso iated benefits that competition provides for consumers. c The average retail price for a pair of hearing aids in 2013 was $4,700 (bundled price which includes professional services)
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From page 208... ...
The VA procures hearing aids for its beneficiaries directly from hearing aid manufacturers as part of large-volume contracts. According to one report published in early 2014, the VA paid an average of $369 per hearing aid, while one vendor's retail price for a similar hearing aid in the open market was $1,400–$2,200 (VA Office of the Inspector General, 2014)
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and may overlap in some or many of the technological features that hearing aids have. Food and Drug Administration guidelines note that these products cannot be marketed for the intended purpose of addressing hearing loss.
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Extending Medicare coverage of auditory rehabilitation to provide reimbursement to audiologists, whom many consumers and patients are already seeking out for other elements of hearing health care, would make this treatment more affordable for Medicare beneficiaries. Technologies As stipulated in the Social Security Amendments of 1965, Medicare does not provide coverage for hearing aids.
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From page 211... ...
The question of whether Medicare should cover hearing aids has been raised (Whitson and Lin, 2014) ; however, some hearing health care and hearing industry professional associations discourage this measure for many reasons, including the projected loss of revenue from private and out-of-pocket payers (Wallhagen, 2014)
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. Many states that provide Medicaid coverage for hearing aids for adult beneficiaries require that an individual obtain a medical exam and an audiological evalu
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. As part of this program, each state must provide minimum hearing health care services to Medicaid beneficiaries under age 21 years, such as diagnosis and treatment, including hearing aids.
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Many states have chosen benchmark insurance plans that do not include hearing health care services or hearing aids for adults; if the benchmark plan does not include hearing health care coverage, then the expanded Medicaid program (if the state chose to expand) and the plans offered in that state's marketplace are not required to offer hearing health care coverage.
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TRICARE, which provides health care for members of the military, military retirees, and their families, covers hearing aids and hearing aid services for beneficiaries with hearing loss that meets specific parameters (TRICARE, 2015)
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. The VA's audiology services include the assessment, evaluation, treatment, and management of hearing loss and tinnitus; the fitting and programming of hearing aids and hearing assistive technologies and rehabilitation with cochlear implants and other bioelectric auditory implants; hearing screening and prevention services; and auditory rehabilitation services to optimize residual hearing.
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From page 217... ...
Wait times to see a professional for the purpose of accessing hearing health care can be several months in some public health systems, which may lead some individuals with hearing loss to choose self-pay options to avoid long wait times. In some countries that subsidize the cost of hearing aids or provide them free of charge, use of the devices is greater than in the United States (see Chapter 4)
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From page 218... ...
people 18+ years) by those with hearing loss SOURCES: Anovum, 2016a,b,c,d; Australian Government Office of Hearing Services, 2016a,b; Bisgaard, 2009; Egbert et al., 2012; Hear-it.org, 2016a,b,c,d,e; National Health Service, 2015.
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countries that provide subsidized or free hearing health care indicate that the cost of hearing aids is one of a complex combination of factors that contribute to an individual's decision of whether to seek help for hearing loss and is not necessarily the sole reason that some of those who could benefit from hearing aids do not get them (see Chapter 4 for other contributing factors)
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From page 220... ...
This type of "fee-for-service" model is familiar to patients in other areas of health care where they are accustomed to paying for visits to health care professionals, including those providing a combination of devices and services, such as in the cases of physical therapy and dental care, or the separate costs associated with a procedure versus professional services, such as often occurs when billed for visiting a primary care provider and receiving a vaccination or laboratory test. Separating out the price of the technologies from the price of associated professional services educates the consumer about the retail prices of hearing aids and facilitates a direct comparison of similar devices across manufacturers.
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From page 221... ...
Price transparency for hearing aids and hearing assistive technologies, professional services, and follow-up care is particularly relevant under new health insurance and health care financing models that are increasing consumer exposure to health care costs (HFMA, 2014)
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For example, costs might include training, salary, and benefits for the community health workers; equipment for basic screening and education; consultation time for community health workers with health care professionals (e.g., audiologists) ; and other overhead costs (e.g., transportation, community engagement and outreach)
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. If proven effective, this approach to basic care and treatment options could offer a significant reduction in costs for individuals with mild hearing loss when compared to the much higher cost (discussed earlier in this chapter)
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The legislation also led to an amendment to the Centers for Medicare & Medicaid Services' rules regarding who may be paid for preventive services under the Medicaid program; although this ruling was not directly relevant to audiology, it may open a door for other types of services to be added in the future. Effective October 2013, nonlicensed care providers, including community health workers, may be eligible to receive payment under Medicaid, as long as these services are recommended by a licensed health professional (CDC, 2015; CMS, 2013)
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. For example, Medicare coverage of telehealth services is currently limited to beneficiaries who live in rural areas; a defined set of services provided by specific providers;8 and live, synchronous interactions between the patient and provider (CMS, 2015c)
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Given the uncertainties about time requirements, administrative and technical costs and requirements, and reimbursement coverage and rates, some hearing health care professionals may be reluctant to offer telehealth to their patients. Further investigation and policy changes will be required to ensure the widespread adoption of tele-audiology services that satisfy the needs and preferences of both p atients and providers.
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From page 227... ...
These hearing aid centers offer hearing tests and sell hearing aids from four of the six largest hearing aid manufacturers at prices lower than average retail prices (from $499.99 per hearing aid) (Costco Wholesale, 2016b; Kirkwood, 2014; Stock, 2013)
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From page 228... ...
is affordable for Medicare beneficiaries; • CMS should examine pathways for enhancing access to assessment for and delivery of auditory rehabilitation services for Medicare beneficiaries, including reimbursement to audiologists for these services; • State Medicaid agencies should evaluate options for providing coverage for treating hearing loss (e.g., assessment, services, and hearing aids and hearing assistive technologies as needed) for adult beneficiaries; • Vocational rehabilitation agencies should raise public awareness about their services that enable adults to participate in the work force, and they should collaborate with other programs in their respective state to raise this awareness; • Hearing health care professionals and professional associations should increase their awareness and understanding of vocational rehabilitation programs and refer as appropriate; and • Employers, private health insurance plans, and Medicare Advan tage plans should evaluate options for providing their beneficiaries with affordable hearing health care insurance coverage.
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From page 229... ...
This excludes direct access to audiologic testing for assessment of vestibular and balance disorders and dizziness, which require phy sician referral. Successful outcomes would provide evidence of ef fective communication and coordination of care with primary care providers within a model of integrated health care, and evidence of appropriate identification and referral for evaluation of medical conditions related to hearing loss and otologic disease.
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2016b. Health insurance coverage for hearing aids.
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In Hearing aids com munication: Integrating social interaction, audiology and user centered design to improve communication with hearing loss and hearing technologies, edited by M Egbert and A
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2008. Despite having more advanced features, hearing aids hold the line on retail price.
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2016. Hearing aids.
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From page 234... ...
2016. Health > Home health care > Hearing aids.
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