Episode 15 Striving for Better Service

The Transcript

Dale Johnson:
Dr. Sandra Miller with Complete Hearing in Lincoln is here for The Conversation Starts Here on KFOR FM 103.3, 1240 AM. Dr. Miller recently in Washington D.C. lobbying on behalf of her profession. Thank you very much. Lot to learn?

Dr. Miller:
Oh my goodness, it’s always such a learning curve. If you ever want to learn something about yourself or how our government runs or just a really great place, Washington, D.C. Is amazing. I’m amazed at how clean it is of course. It’s super-clean there. And just the process of how the Senators work and how the Congress people work and we had a great time. It was really, really a great time. So being away, and just so people know maybe why would an audiologist go to Washington D.C. or why were you there? We belong to a professional organization called the Academy of Doctors of Audiology, and so I thought it’d be really important to share with your listeners some things that we run into our office, especially with our Medicare patients. And we call this word simply direct access.

Dr. Miller:
Well, what the heck does that mean, direct access? If you are a Medicare patient and you currently have Medicare Part B insurance, what happens when you call our office for an appointment is we have to tell you that in order for Medicare to cover your visit, you have to have a referral or an order from your primary care physician or referring physician. Why?

Dale Johnson:
Mm-hmm (affirmative). Why?

Dr. Miller:
Right. So, right. This was legislated probably in the 1960s. At this point in time, audiology really wasn’t where it is currently in terms of us being doctors of audiology, our scope of practice, things like that. So, it creates a little bit of a roadblock for the patient and that just means it creates an extra step. So, “Oh, I can’t come see you directly? I have to go see my primary care, then they need to write me a referral?” “Yes.”

Dr. Miller:
And so we were up on Capitol Hill. There’s currently an act that is out called the Medicare Audiologist Access and Services Act. And that’s a big long word, they’ve shortened it up to call it MAASA. There’s a bill for the House and the Senate. And currently, we were able to meet with Senator Fischer and Congressman Fortenberry’s chief of staff, so we got to go visit all the congressman for Nebraska as well as all the senators and just talk to them about how important this is for the patients in Nebraska in terms of getting them directly to us. We just want the barrier taken down. Can you please just say we would like audiology, not to be a diagnostic profession, but to be a practitioner profession. That just means we can see those patients directly. What that does is it saves the government money. What?

Dale Johnson:
You would think they would jump on that.

Dr. Miller:
I know. They did a study that said it would save the government $240 million over 10 years. Who wouldn’t take that savings? I don’t know how much of a dent that would put in the budget, but I think it would help. And just because there’s lot of, what would happen there is it creates a less of a barrier in terms of less office visits, them having to jump around, duplication of services, things like that. In addition to that, it would allow audiology as well to really work within our full scope of practice. What the heck does that word mean?

Dale Johnson:
You’ve used that term twice and I want you to help us understand that phrase.

Dr. Miller:
Such a great thing. What I want your listeners to know is that anybody who is licensed in our state to provide a service in terms, especially medical, we fall under a guideline, not even a guideline, it’s our scope of practice. What does that mean? That means what are you allowed to do within your professional training? Okay, so what kind of services can you perform? What kind of test procedures can you do? What kind of treatment can you provide? So every profession has a scope of practice. And currently we have a great scope of practice which allows us to do a lot of things.

Dr. Miller:
Here’s the hard part with Medicare Part B. When that patient comes to me, has their referral, awesome. They can come to me now that they had the referral and they come in and they have wax in their ear, I have to tell them two things. Medicare will not pay me to take this out. You have two options. You can pay out of pocket for this if you’d like, or you can go back to your primary care or ENT physician and have this removed. Now we’ve created a whole other visit again.

Dr. Miller:
So scope of practice just simply means what am I allowed to do within that scope. And the way Medicare Part B currently has audiologists categorized, it doesn’t even allow us to do like tele-health. So, oh my goodness, do we have great technology right now where we can have our patient who was fit in Lincoln and lives in Stromsburg or lives away and they need some assistance, that we can tele-health them in, sync up some changes to their hearing aid through the cloud, and download them right where they are. Wow, wouldn’t that be great? But what you need to know as an audiologist in the State of Nebraska, currently that is not allowed, especially for Medicare Part B, and isn’t even written into the scope of practice. So there’s lots of things that go on when some things are new and we think let’s just go do that. Us as audiologists, to be ethical and to make sure we’re obeying the law, we want to make sure we stay within our scope of practice of what is allowed for us to do.

Dale Johnson:
To answer the question that I hear listeners asking right now is, “Well, maybe the scope of practice is narrow because you’re not trained in that.” Let’s use your example of the taking wax out of the year.

Dr. Miller:
Exactly.

Dale Johnson:
You are trained-

Dr. Miller:
Right.

Dale Johnson:
… to take wax out of the ear.

Dr. Miller:
Exactly. So I think it’s really interesting when you compare what are you trying to do versus somebody else? So an audiologist’s scope of practices is broad in terms of treating hearing loss, balance, and what’s really interesting I think is that every state is different. The scope of practice for audiologist’s is different in every state. How is that possible? Right? You would think it’d be-

Dale Johnson:
The same.

Dr. Miller:
… but it’s not, it’s not the same.

Dale Johnson:
Do you know where Nebraska is in the scheme of things? Is that scope wide, narrow, comparable?

Dr. Miller:
I think the problem with the scope of practice currently is that audiology became a doctrine profession, which trained us to do so much more. And I think when we talk about, okay, how are we going to make this work? Because we’ve now been allowed to be trained to do so much more, but it’s not written in our scope of practice. We can’t do it. So some of the language tends to be vague, and it’s vague on purpose, but sometimes we need to have that scope even looked at a little bit more.

Dr. Miller:
Medicare can say to us, “Okay, audiology, what we’re going to allow you to do now is we want you, and for billing purposes, we want you to look and make sure, is this patient having cognitive decline?” Meaning they’re starting to lose their memory. “Are they having balance issues? Can you test them for that? Are they having issues with … do you need to talk to them about smoking cessation?” So there’s all these things that we are going to be starting to bill for, but is it in your scope of practice to do those screenings? So you have to ask yourself, because Medicare may come down and say we want you to do this now, but we have to look in sometimes our laws or regulations, our scope of practice don’t align with what they’re wanting us to do. So you can see where there’s kind of this mismatch.

Dale Johnson:
You have so many cross-references you have to check-

Dr. Miller:
Exactly.

Dale Johnson:
… before you can even act.

Dr. Miller:
Exactly. And we get excited because technology is new or we want to do X, Y, Z and this sounds great. Is it allowed within your state’s scope of practice? You always have to ask yourself that. And so I think even when we have, currently coming up, is going to be the over-the-counter hearing aid and we’ve talked about that a little bit. What does that mean for us? What does that mean for people buying hearing AIDS over the counter? And we want to make sure people are educated. So it’s just such a fascinating process to me to make sure that we are not only making sure we’re following what our regulations say we can and can’t do, but when new things come out, do we have to open these regulations and make them change so we are still operating under our scope of practice.

Dale Johnson:
What one would think would be a simple process when you get on Capitol Hill, it’s anything but.

Dr. Miller:
Exactly.

Dale Johnson:
Talk about your experience, albeit a little frustration in that experience.

Dr. Miller:
I think it’s just such a super-interesting process, and what we talked about before we went on the air, is you definitely see why there’s gridlock in Washington. You would think this would be such an easy thing, right? This should not be hard. We’re trying to save the government money, we’re trying to make it more accessible for our patients. We want to put tele-health on for our rural Nebraskans who need this. And we want to make sure we can operate so that we can give our patients the best care, all-inclusive at one visit, but it’s not that easy. Right? And so the purpose of us going to Capitol Hill was to make sure we get more co-sponsors on this bill to get it pushed on, and it’s going to get attached to another healthcare bill. I’m sure. Because we’re tiny, tiny when you consider big Washington.

Dr. Miller:
But I think the frustration part of it, and you all know this out there, as your listeners would know, it’s just gridlock there. It’s more about, unfortunately I think, “Well, I don’t want to give them the win. I don’t want to give that other party the win.” What’s really great about the bill that we currently have is it’s bipartisan, so it already has bipartisan support, which is a great thing. So, Elizabeth Warren and Paul Rand are already on this for us in terms of advocating for this for us. And we were able to get a confirmation from Congressman Fortenberry as well from his chief of staff to say, “Yeah, we want to sign on to this.” And so when you think about the bipartisan part of what bills need to have to be processed through and be voted on and be approved, that’s where the gridlock happens in Washington. And I think unfortunately there’s just so much.

Dr. Miller:
We had the conversation I think, which is very interesting. Remember in the old days when our politicians would go to Washington and they would live there? They don’t live there anymore.

Dale Johnson:
No. They come back.

Dr. Miller:
Okay. So when they there, what happens is they can have their arguments during the day, but at night they get together and they have dinner and they bring casseroles to each other’s house and they’re friends. Well that just doesn’t happen anymore.

Dale Johnson:
No, it doesn’t.

Dr. Miller:
So you think about the divisiveness that happens at that level and it’s gone away so much from community to being party against party and such a big division. And I think that it’s hard to watch sometimes when you’re the American just going, “I just want to do what’s right and I want to do what’s good. I want to help my patients and I want to help our profession.” And you go, “Oh, this is such a,” it’s so big. It’s so, so big.

Dale Johnson:
Were you lobbying on the House bill or the Senate bill?

Dr. Miller:
Both sides.

Dale Johnson:
Both of them?

Dr. Miller:
Mm-hmm (affirmative). Yeah, both sides.

Dale Johnson:
Do they differ?

Dr. Miller:
It’s the same bill. We talked about this when we have a unicameral here in Nebraska so you don’t think about having different bill numbers, but they do have a different bill number based on Senate versus House.

Dale Johnson:
Spoiled by that.

Dr. Miller:
Yeah, so they do have a different number. So, it was just such a great experience to see how our government works and just to to meet honestly, people who represent us from Nebraska. It was wonderful to meet them and just-

Dale Johnson:
You met Senator Fischer?

Dr. Miller:
… We sent met Senator Fischer, which was wonderful. We all encouraged them to come visit, not only complete hearing, but you should come back for a Husker game and we just wanted … they love their state anyway, which was wonderful. But just to talk to them about … I know how busy they are. Being a legislator, being a Congressman, being a Senator is a lot of work. And I appreciate that, just for what they do for us. And that we live in the land of the free is one of the most amazing things. So even if we’re frustrated with how Washington functions, it’s still a really good process.

Dale Johnson:
But what do you tell listeners who are customers of Complete Hearing and those who are now drawn to you because of this program? What do you tell them with a timeframe?

Dr. Miller:
That’s such a great question.

Dale Johnson:
Things plod so slowly in D.C.

Dr. Miller:
Things plod so slowly. What I would tell you is, this bill’s been out there for about five years, honestly. That doesn’t surprise you, does it?

Dale Johnson:
No, it doesn’t.

Dr. Miller:
And then you have to imagine that our organizations that we belong to have to pay a lobbyist. So it’s expensive to do this. At this point in time we’re just trying to gain momentum for it. So it just means we have to get more people on board. So, bills move really, really slowly and they can’t even tell us what the timeframe is. But our job to be on Capitol Hill was simply to say, “Please support this because we need to get this.” It’s a smart bill. It’s definitely worth it for the patients to have better access to save the government money, to have the audiologists do what they need to do within their scope that they have.

Dale Johnson:
Right. So if you see it pop up, it’s the Medicare Audiologist Access and Services Act, and how did they shorten it? What abbreviation?

Dr. Miller:
MASSA.

Dale Johnson:
MASSA.

Dr. Miller:
Yeah. If you go onto our Facebook page, you will find all the wonderful photos that we took while we were there, even playing on the leaves on Capitol Hill.

Dale Johnson:
Those are fun photos, Dr. Miller. They are. You had some fun while you were there.

Dr. Miller:
Who can walk by a pile of leaves and not go? I said to Dr. Wood, I go, “Are you thinking when I’m thinking?” She goes, “Yeah, let’s jump in.”

Dale Johnson:
And those were on your Facebook page?

Dr. Miller:
They were on her Facebook page, so check it out.

Dale Johnson:
Dr. Miller, just a couple of minutes left, tell us about Hear Together, Give Together.

Dr. Miller:
Please remember listeners to go onto our website or our Facebook page. This is our third annual Hear Together Give Together campaign. This is such a great way to bless somebody you know who needs hearing help. We take the nomination from you. Please send us a note, a letter, something explaining of who you want to nominate, where they struggle, what’s happening, how you know them, and get them honestly nominated. And when they’re nominated they come in, they get their hearing tested and then our whole entire staff reviews those nominations and we vote on a winner.

Dr. Miller:
The winner then receives a free pair of premium hearing aids and you get to be a blessing this holiday season right along with us. We want to reach out to the community and say, “Please nominate, because this is such a wonderful gift to give during the holiday season when so many people struggle to hear.”

Dale Johnson:
And again, how do they get the nomination to you?

Dr. Miller:
The nomination can be mailed to us on our website, complete-hearing.com or on our Facebook page.

Dale Johnson:
Listen to us every Saturday morning here for The Conversation Starts Here.

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