Interview with Angela Loavenbruck Ed.D., President-Elect of the American Academy of Audiology

AO/Beck: Hi Dr. Loavenbruck, as always, it is a pleasure to speak with you.

Loavenbruck: Hi Doug, it's nice to spend some time with you too.

AO/Beck: I'd like to speak with you about the Academy and your vision for the future.

Loavenbruck: Sure. Those are some of my favorite things to talk about!

AO/Beck: I believe your presidency begins on January 1, 2002? Is that correct?

Loavenbruck: Yes, we have terms starting and finishing with the calendar year, so it's easiest for all concerned.

AO/Beck: Can you give me a brief 'thumbnail sketch' as to where the Academy is, and where it's going?

Loavenbruck: Sure. We've been working very hard for the last few years at the Academy to make sure that the transition from one president to the next is 'seamless.' So in other words, when Dr. Glaser's tenure as president ended, Dr. Fabry was ready and waiting to take over. Likewise, I have been working very closely with Dr. Fabry, so that when his presidency expires, my presidency will be initiated, with virtually no down time. Since the presidency lasts only a year, we have precious little time to serve, and we need to be ready to hit the bricks running when the calendar says 'go.' Therefore, the president and the president-elect communicate constantly to discuss the issues, the viewpoints, the alternatives, how to govern the academy to maintain and increase the momentum we have in accordance with the Strategic Plan. The strategic plan is very useful because it defines our goals and objectives and it serves as a roadmap for focus and governance.

AO/Beck: Within the strategic plan, what are the issues you believe will demand most of your attention during your presidency?

Loavenbruck: The continued support and promotion of Au.D. programs is very important. The early success of the Au.D. movement has been fantastic, but as we transition the profession, over a number of years to a doctoral profession, we must continue to develop doctoral programs that best serve the members, the patients and the profession. We have a task force on accreditation of Au.D. programs, and this is the right time to address this critically important issue. We are also examining and re-evaluating our Code of Ethics because it hasn't been updated in quite a few years and it may need some revision and clarification. We are examining certification and licensure, and as you know, we've been exploring all of these issues for years, but I believe we are closer than ever to instituting action points which will move these issues forward. We are working with people at HCFA to achieve the goals we've initiated there. We've had some excellent new successes there and we're very proud of them.

AO/Beck: Let me try to clarify that a little for the readers who may not be aware of what recently happened. My reading of the new HCFA memorandum is that the outcome of the test is no longer the issue. In other words, in the past, some insurers interpreted and based their obligation to pay the audiologist based on whether the diagnostic audiologic test indicated a 'medical etiology.' However, if the loss was simply diagnosed as 'presbycusis,' it was deemed not-reimburseable. HCFA has now clarified that the test is reimburseable, regardless of etiology, as long as the physician has ordered the test for diagnostic purposes.

Loavenbruck: Yes, that is correct. That has been a very important clarification for many reasons. However, it's also important to realize that this is what the HCFA regulations have said for years, this is not a new rule, this is only a clarification of the existing rule. The clarification was needed because a few of the insurance carriers across the country were interpreting this HCFA guideline erroneously.

AO/Beck: Looking from the outside, this looks like another mutually beneficial collaboration between the AAA and the ADA?

Loavenbruck: Yes indeed. The AAA and the ADA were once again successful in representing the profession and our patients and I'm very proud to say that we were once again successful working together. We jointly met with HCFA on two or three separate occasions and we jointly communicated with HCFA for follow-up, and the resultant cooperative effort was successfully concluded. I am looking forward to a continued collaboration with ADA.

AO/Beck: I think the profession and the patients have seen a number of useful, pragmatic and tangible benefits based on the cooperative efforts of the AAA and the ADA and I applaud you for maintaining and further developing that relationship.

Loavenbruck: Thanks. The ADA and the AAA leadership meet regularly and we speak constantly and everyone involved with that effort believes it has been and will continue to be fruitful.

AO/Beck: Can you please tell me a little about the presidential task force regarding the review of the AAA Code of Ethics?

Loavenbruck: Brian Walden Ph.D. is Chair of the Ethics in Audiology Presidential Task Force. Dr. Walden and his committee is charged with reviewing AAA's Code of Ethics, as well as the current environment in which audiologists practice, to determine whether any changes are needed to update the Code. Let me get back to you on this once the Task Force has completes their assignment.

AO/Beck: Let's shift gears to accreditation of Au.D. programs. Can you tell me where we are and where is that going?

Loavenbruck: As you know Doug, the only nationally recognized accrediting body is the Council on Academic Accreditation (CAA) which is ASHA's accrediting body. The CAA is referred to as a 'semi-autonomus' body. However, the impression I get is that it is not autonomous, it is ASHA's accreditation board. Importantly, there are also no standards yet in existence for Au.D. programs. Accreditation is important because when students and programs want to obtain Department of Education funds, such as grants, scholarships and other funding, they need to be enrolled in accredited programs within an accredited university. Additionally, the writing and creation of standards for the Au.D. programs is very important, and we need to proceed on that front also, to maintain and enhance the educational opportunities and programs that are offered to the students. Au.D. programs are significantly different from master's and Ph.D. programs and we have a task force at AAA that is working on this issue. The task force is being chaired by Ross Rossier and the task force will work with other task forces within AAA to create standards for Au.D. programs.

AO/Beck: Let's explore accreditation issues a little more.

Loavenbruck: We may have to initiate a whole new accreditation body, or explore a venue which is perhaps already in existence, but may allow a new path for us. Of course, this will be highly time intensive and extremely expensive. Program directors and university presidents already have a plethora of accrediting bodies marching in on a regular basis, and I hesitate to add another, but it may be where we need to go. I know it's a burden for the universities, but it's an important issue and we need to explore all open avenues for the benefit of the programs, the students, the professionals and ultimately the patients. So to me, there are two distinct issues here; the standards for Au.D. programs, and the accreditation of those programs. If you look at medical schools or dental schools, by definition, an individual graduating from an accredited program is considered to have met the entry-level requirements for those professions. That's what accreditation does. There is no other profession that has a 'certificate' which states you are competent. The purpose of accreditation is to say the program was in compliance with the standards, and therefore, the graduating students are ready to enter the profession. In medicine, you can go from state to state, get licensed, and practice medicine because you graduated from an accredited program. We need to have that recognition for our practitioners too. We want accreditation to be based on the notion that the program was in compliance with the standards, and therefore the graduates meet entry level standards and are therefore eligible for licensure. Completing the requirements of an accredited program should be the guarantee of 'portability' of our licenses.

AO/Beck: Do you think there is any opportunity or possibility for the desired accreditation body to exist cooperatively within the CAA, or must the accrediting body by wholly independent?

Loavenbruck: Dr. Fabry and I recently met with some of the people from the Council of Graduate Programs in Speech Pathology and Audiology. The council is not the CAA. This group of some 250 educational leaders from across the USA, gets to nominate two people to serve on the CAA, the other CAA members are nominated by the executive board of ASHA. Basically, the AAA goal is to make sure there is a truly independent body accrediting Au.D. programs. If indeed, the CAA can achieve that, perhaps we can support the CAA. However, we need to go into that with our eyes wide open and realize that many people consider the CAA to be the 'CCC Police.' We need assurances and guarantees that the CAA would be 100 percent independent and totally separated from CCC and ASHA issues, and then perhaps we'll be able to work with the CAA. I hope that can progress quickly and I would anticipate that could serve as a reasonable solution to the accreditation issue.

AO/Beck: So the bottom line, is that there is a chance AAA could work with the CAA to accredit Au.D. programs?

Loavenbruck: Yes, it is possible. In other words, the AAA is willing to work with the CAA on accreditation if it's in the best interest of the students, the professionals, the programs and the patients. We believe the university programs should be focused on standards, not on certification. Accreditation should mean that university programs are preparing people to meet entry level standards, not that they are responsible for funneling students into purchasing ASHA's CCC. If the CAA can separate itself from being the CCC police, AAA could support accreditation of AuD programs, once standards exist, through a single accrediting body. Again, these are separate issues which need to be addressed independently.

AO/Beck: Before I let you go, what about the issue of 'diagnose and treat?' I know we are seeing more and more recognition for the work we do, and I personally think of audiologic solutions as 'treatment' for hearing loss. What are your thoughts on that?

Loavenbuck: I agree. I think that to a large extent, we need to incorporate the word 'treatment' into our professional lexicon. In fact, when we work with patients on rehab, counseling, fitting hearing aids, adjusting hearing aids, setting and tuning cochlear implants and adjusting middle ear implants, we are indeed 'treating' the patient for hearing loss. I think the word 'treatment' is very important, and it goes hand in hand with the word 'diagnosis.' Audiologists have been treating and diagnosing hearing loss for many decades, and we are starting to earn recognition for our skills and knowledge. The term 'aural rehab' and the term 'rehab' are highly problematic because codes used to bill for those services are essentially speech-language codes. We need to address this and get it straightened out. Audiologists provide treatment and we need the recognition for that, as well as the appropriate codes to bill for those services. Again, just to be clear, to obtain recognition in the SOC Codes, and to further the profession, we need to be listed within the Diagnosis and Treating professions. And of course, that is actually what we really do, and we need accuracy in our terminology to reflect these activities and realities.

AO/Beck: Dr. Loavenbruck, I want to thank you for your valuable time and your viewpoints and knowledge. I am certainly looking forward to your presidency with enthusiasm and excitement and I will look forward to speaking with you again soon.

Loavnbruck: Thank you Doug. It's a pleasure to speak with you and to address the Audiology Online audience.