Interview with Angela Loavenbruck Ed.D., Nominee, President, American Academy of Audiology (AAA)
AO/Beck: Dr. Loavenbruck it is an honor to speak with you. Please tell me about your education.
Loavenbruck: My doctorate in audiology is from Teacher's College at Columbia University in New York. I earned my doctorate in 1973
AO/Beck: After receiving your doctorate, did you go straight into private practice?
Loavenbruck: No, my first professional position was teaching for two years at Catholic University in Washington. It was an exciting time because I actually worked for Ralph Nader as an audiology consultant for a group titled 'The Retired Professional Action Group (RPAF)'. They investigated the hearing aid industry in the USA. That project got me very interested in the relationship between audiologists and hearing aids.
AO/Beck: What were your findings in the early 1970s?
Loavenbruck: The findings were very critical of the hearing aid industry, and they were also very critical of audiologists because audiologists were not actively involved in dispensing and aural rehab. In essence, the report stated that audiologists had the skills, the knowledge and the education to address the day-to-day problems of hearing impaired patients but had reneged on our treatment responsibilities. Additionally, the RPAF believed then that audiologists should have been dispensing hearing aids and should not have been referring to hearing aid dispensers to fill that vital role. My involvement in the Nader project was my inspiration for starting a private practice which had hearing aid dispensing as part of its services.
AO/Beck: That is very interesting and frankly, I have never heard about that group before, nor have I heard about Mr. Nader's involvement in hearing aids. I'm just happy he didn't catch me in a Corvair at the time!
Loavenbruck: The RPAF really was a very early player in the issues related to audiologists and hearing aid dispensing. The ASHA decision to allow dispensing followed a few years later. I believe I was on the first ASHA committee which addressed whether or not audiologists should dispense. As you know, at that time, dispensing by an audiologist was considered (by ASHA) to be a violation of the ASHA Code of Ethics.
AO/Beck: So where'd you go after Washington?
Loavenbruck: Then I went back to Teacher's College and I taught for seven years. It was at that time (about 1975 or so) that I started my private practice in New City, New York. We're in Rockland county, about 30 miles north of Manhattan. We've had the practice going now for 25 years. When I started I had partners, but now it's a solo practice.
AO/Beck: How long have you been involved with AAA?
Loavenbruck: I've been involved for 8 or 9 years and I've been on the Board since 1995. Unfortunately, there was an error in the Audiology Today (AT) magazine, let me correct that here if I may. The AT stated I was on the ASHA Board of Directors, that was a typo. The actual Board I'm on was (and is) the AAA Board.
AO/Beck: Dr. Loavenbruck, what do you think your strongest assets are regarding your candidacy for AAA president?
Loavenbruck: I am an advocate for audiology and for AAA, and I have been for years. I love this profession and I have been, and continue to be, willing to work hard for the benefit of the profession and for audiologists.
AO/Beck: What do you perceive as the primary obstacles to our professional growth?
Loavenbruck: We have some prominent groups around us that have historically been adversarial with us. On an individual basis, many of us have excellent, collegial relationships with ENT colleagues. In the political arena, however, medical professional associations like the AMA and AAO-HNS often stand in our way. They have different goals and different needs than we do. We all know there are a few ENTs who do not want audiologists to be recognized as independent, autonomous professionals. ENT physicians perceive that their practices will be diminished if they recognize audiologists as colleagues - that is their fear. I think it is an unwarranted fear and I believe it would be far better for both professions, and our patients, if our professional organizations were not antagonistic towards each other. Additionally, hearing aid dispenser organizations oppose our efforts to become identified as the entry level hearing health professional. Again, they have different goals and needs than we do. Lastly, I believe that ASHA's opposition to HR 1068 continues to be harmful and not in the best interests of either the profession or our patients. So the obstacles are numerous, and many of them are double-edged swords. I think we need to have a strong and powerful unified voice through the AAA and we need to take charge of the reality and the perception to better associate the words 'hearing' and the word 'audiologist'. We need to have the AAA recognized as the voice of the profession and we need to overcome the obstacles as a unified and powerful professional national organization.
AO/Beck: How do you go about fighting these issues?
Loavenbruck: You fight with information, data and outcomes. We can show that going directly to the audiologist is the most efficient and cost effective way to manage hearing health care. Going from the primary care doc, to the ENT, to the audiologist and back to the ENT is a terrible waste of time and money and resources. The most efficient model for the patient is to go directly to the audiologist as the entry point to hearing healthcare, using a model that has been successfully used in the VA for years. Then, based on the audiologist's analysis, the audiologist refers to the physician as needed, or directs the patient towards non-medical treatment - assistive listening devices, hearing aids, or whatever the appropriate treatment or course of action is. Audiologists certainly have the knowledge, the training and the ability to triage these patients. At this time, our new audiologist doctors have spent just as long studying hearing and related issues, as physicians spend in medical school studying the entire body. We need to get the message out, and the AAA has the interest, the power, the authority and the ability to accomplish this. We are the experts in hearing health care. We write the research studies, the books on hearing loss, hearing aids, aural rehabilitation, managing hearing impairment, classroom amplification, soundfield amplification, FM systems, outcomes with amplification and on and on. We are the people with doctorates in audiology and these numbers are growing dramatically. Again, we fight these issues with facts. We have earned recognition as hearing healthcare experts and now we need to demand recognition and appropriate reimbursement for those skills and for that knowledge base.
AO/Beck: It seems to me that one of the most important issues facing us, in the very near future, is how to achieve limited license practitioner (LLP) status. What are your thoughts on that?
Loavenbruck: LLP status is critical to our professional growth and recognition. The issues relates to the way we are recognized in the Medicare laws. Medicare laws recognize five categories of health care practitioners 'as if' they were physicians. That is, for reimbursement and diagnostic purposes, Medicare views them as the same. Those five are dentists, osteopaths, optometrists, physicians and podiatrists. These five professionals are considered by Medicare to be autonomous, they can make the diagnosis and they are the entry level for Medicare patients into the Medicare system. Then, there are other professionals such as chiropractors, who are recognized by Medicare as limited license practitioners. The law varies, but usually say that LLPs, if they are practicing within their scope of practice, can be regarded as if they were physicians, for purposes of diagnosis and payment. This is where we need to go. In New York state we have 'any qualified provider' laws. That is, if a specific test is covered within the professional's scope of practice, the third party payer must pay the professional providing the service the same rate they would a physician. The value of LLP status is enormous. It allows us to be the entry level for hearing health care, it promotes and allows our autonomy and it allows us to be paid the true value for the services we provide. LLP status in Medicare law and regulations would permit us to provide both diagnostic and treatment services to Medicare patients. Right now, Medicare recognizes audiologists as 'diagnosticians', but does not allow an audiologist to bill for either our 'evaluation and management' work, or for treatment services , such as cochlear implant rehabilitiation or mapping activities. While some managed care and private insurance companies do permit audiologists to bill for this work, it would help us and the patients if Medicare regulations were changed, since many companies base their treatment of audiologists (as providers) on federal regulations. This is also why HR 1068 is critical - Medicaid law dictates how states regard us. Federal and state laws should consistently define us as autonomous professionals.
AO/Beck: Dr. Loavenbruck, do you see any way to better involve the AAA state affiliates in the day-to-day activities of the AAA?
Loavenbruck: Yes, I think we need to redouble the communication between the states and the AAA. President Glaser has initiated member to member conference calls that many of us have participated in as a way to reach and hear members concerns. We have to continue and build on this initiative. We need an efficient two-way communication system with our state organizations - so much happens on the state level - and this will help keep everyone informed and active. You know, the AAA is only ten years old. We have focused our early efforts on national issues - rightfully so. However, I think the time is here to redirect some of our efforts and energies back to the states to provide an inclusive national effort, to better promote and manage hearing healthcare at the state and national levels. We need to re-evaluate many state laws to be sure the audiology laws are written to support our patients and our profession. I think the AAA can help provide some guidance there. We need to make sure the laws address the needs of the patients, and not the needs of a national association. We need to make licensure the key to our profession. AAA can and should work with the state affiliates to help write the words and the laws that reflect the needs of the patients and how we impact their lives. In essence, I believe we need to separate the requirements of ASHA CCC and ASHA membership from the requirements for state licensure. I do not know of any other profession which has membership or certification, issued by a national association, so blatantly entrenched in state laws. Licensure should be the key credential to practice audiology and I believe it should be based on a degree from a regionally accredited college or university, and not based on membership or certification from a national association. We also need to improve the reciprocity sections of our licensure laws, so states recognize state licensure in audiology, not certification, as the important issue when an audiologist moves to a different state.
AO/Beck: Dr. Loavenbruck, what can you tell us about the divisiveness between the AA and ASHA? I believe many of us are saying we're tired of the squabbling and the bickering. Can't we just work together towards mutually beneficial goals?
Loavenbruck: Yes, well the problem is that AAA is 100 percent audiologist membership based, and ASHA has 90 percent of it's membership in Speech-Language Pathology. ASHA's primary concern appears to be the certification program and maintaining cashflow from that certfication program. I certainly agree that we need to get past the squabbling. The way to do that, as best I can tell, is to have the Speech-Language Pathologists continue to grow and prosper within ASHA, and likewise, audiologists should continue to grow and prosper within AAA. I think the two professions can work very well together with mutually beneficial and separate national organizations. I think you would see the same difficulties if physical therapists were in a national organization with occupational therapists. The daily practice, the research, the education and the philosophies and goals of the two professions are different, and no one organization can best represent the combined interests of two professions, even though they sometimes work together with the same patients. That's the problem and the basis of the squabbling. The best answer I know is to separate the professions and allow them each to prosper. I also think there should be a completely separate organization which is the standards setting body, both for entry into the profession and for accreditation of our academic programs. That organization should be independent from any professional organization, and should be supported by all of them
AO/Beck: Dr. Loavenbruck, thanks for your time this evening. I wish you luck in your presidential candidacy and it's been a pleasure speaking with you. Any closing comments?
Loavenbruck: Yes, if I may, I'd certainly like to encourage the readers to vote in the AAA elections this summer. This is a critical time for the profession and it's a critical time for the AAA. We need to grow the AAA and we need the AAA to be recognized as the national voice of audiology. Thanks for allowing me the time and space to address these issues via Audiology Online.
