Interview with Larry Higdon President, ASHA
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AO/Beck: Good morning Larry. Thanks for your time.
Higdon: Hi Doug. Nice to be with you.
AO/Beck: Larry, let's start with a brief review of your education and professional experiences, and then we'll address your presidency and ASHA.
Higdon: Very good.
AO/Beck: Where did you get your graduate degree?
Higdon: I did all of my audiology-based university work at the University of Texas and then completed my master's at Texas A & M Kingsville in Educational Administration in 1968.
AO/Beck: After you graduated, what type of practice did you have?
Higdon: Initially, I worked with an ENT group and then I moved to Corpus Christi where I was the sole audiologist in the city for about 15 years! I was with a community speech and hearing center and pediatric hospital. During that time I developed a private practice where I contracted with other hospitals and facilities the agency didn't elect to service.
AO/Beck: What was the most challenging aspect of your practice back in the early days?
Higdon: Other than the isolation of not having colleagues across the hall or down the street, the challenges didn't differ greatly from those we face today: lack of autonomy; having to earn the respect of referral sources because they didn't know what to expect in terms of scope of services and quality they could expect; building visibility among our publics and increasing consumer knowledge of who we are, and what we can do for those with hearing and balance problems. It isn't difficult to spread the word, but it is difficult to build an understanding of what they should expect from an audiologist.
AO/Beck: And fast-forwarding a few years, you hold two academic appointments currently, I believe?
Higdon: Yes, that's right. I hold a position at Ole' Miss in the Speech Communication and Writing Institute, and I'm an adjunct associate professor in the Department of Communicative Disorders. Because I'm not in a tenure track position, it allows me to maintain my private consulting practices, and continue many of the volunteer activities, including serving as ASHA's president. I have a private consulting audiology practice that includes a hearing conservation business. I'm a lobbyist for the Texas Speech and Hearing Association in Austin, and I'm also co-owner and practitioner in a conflict resolution business.
AO/Beck: So what city do you actually live in? Where do you spend most of your time?
Higdon: Seems like most of my time is spent on Delta Airlines! But, Carolyn and I live in Oxford, Mississippi, and have a townhouse on the lake in Austin.
AO/Beck: OK, very good. How long have you been involved with ASHA?
Higdon: 36 years now.
AO/Beck: Which key positions have you held at ASHA?
Higdon: I've held quite a few positions with the Association, but I pretty much grew up in the Standards and Ethics sections of ASHA. My first official function as an officer was as the first Vice President for Professional Practices in Audiology in 1994. Following that, I was elected the Vice President for Governmental and Social Policy, in 1999. In 2003, I assumed the office of President-Elect, and became President January 1, 2004.
AO/Beck: I suppose there have been quite a few audiology- or dually certified ASHA presidents, can you tell me some of their names please?
Higdon: Over the last few years we have had several audiology- or dually certified presidents whose primary practice area was audiology. Included in that group were; Donna Geffner, Gil Herer, Laura Wilbur, Anne Carey, Alan Feldman, Phil Yantis, Hayes Newby and Raymond Carhart.
AO/Beck: Larry, I understand the presidency is actually a three year commitment. You served as president-elect, and now you're the president and then next year past-president. Can you briefly review the primary responsibilities of the president-elect?
Higdon: The president-elect attends meetings of the Executive Board and chairs the "committee on committees," is a non-voting member of the Legislative Council and participates in the Committee on Resolutions, the Budget Committee, and the Long-Range Strategic Planning Board, as well as other responsibilities at the discretion of the president.
AO/Beck: Very good. What are the duties of the president?
Higdon: The President serves as Chair of the Legislative Council and Chair of the Executive Board, and is charged with coordinating the functions of both bodies. The president represents ASHA and the professions in a variety of liaison and public information activities, including federal agency and national legislative concerns. There are other responsibilities too, but those are the key issues.
AO/Beck: And past-president?
Higdon: The past-president participates in meetings of the Executive Board and the Legislative Council and then serves as Chair for the Committee on Resolutions and the Committee on Nominations and Elections.
AO/Beck: I suppose one year as president seems like a long time when you're on the outside of the presidency, but when you're the president, it probably seems like one year is too brief a period to really run the organization? What do you hope to accomplish as president? And if you don't mind, let's limit the discussion to audiology issues.
Higdon: Sure, we can do that. Well, you're right, one year is too brief. I think it's a narrow opportunity to represent all the ideas and thoughts that we'd like to push forward. Nonetheless, it's a wonderful opportunity to be attentive to the members needs, and to cooperate with all entities that interact with the people we serve as audiologists. I think it's important to present a unified front and stand up for what we believe in. I hope we can make significant headway with our Audiologic Rehabilitation and Treatment legislation to allow payment to audiologists for their audiologic rehabilitation work. I certainly hope we can be instrumental in moving "direct access" legislation along, although I view that as a long term project. ASHA has proposed a number of new codes for tinnitus evaluation and treatment to the AMA's CPT coding committee that I believe will have come to fruition. I would like to see a better open working relationship established with other audiology organizations and related organizations.
AO/Beck: Very good. Regarding accreditation and certification, this really has been somewhat controversial with many audiologists. Can you review your thoughts on those topics?
Higdon: I am very much in favor of the accreditation and certification programs that ASHA has developed, and I also support licensure as a hand-in-glove approach to maintaining consistency and quality of services. I believe the ASHA accreditation and certification programs are in the best interests of professionals and consumers. The C's were the model for most Licensure Bills, and should continue to be. Certification is developed and monitored by audiologists. Audiologists are the principals in all updates as our scientific knowledge expands. Licensure is governed by legislators, who, while well-meaning, largely don't know who we are or what we do yet they govern our right to practice. We must maintain a strong, visible, nationally recognized model as an example for them to follow or use as a model. Within ASHA, the semi-autonomous Council for Clinical Certification (CFCC) is made up of equal numbers of audiologists and speech-language pathologists, with each primarily addressing their own profession's certification issues. The current chair is an audiologist.
Accreditation works in much the same way with the semi-autonomous Council on Academic Accreditation (CAA) being comprised of an equal number of audiologists and speech-language pathologists, each addressing their profession's issues. It is a fine line between maintaining an academic standard and allowing for academic freedom in the preparation of our future professionals.
AO/Beck: Can you comment on the idea that once you've been awarded the CCC-A, it should or shouldn't be yours forever? The argument has been made that after you've earned a graduate degree you own that degree forever, so why renew the CCC-A annually?
Higdon: Well, to achieve licensure and to have good licensure laws that provide basic consistency across states, we have to have a highly recognized, visible, standard and that has historically been the CCC-A. The recent CMS Medicaid ruling on the qualifications of audiologists underscores the value and importance of the CCC-A as a national credential. The CCC-A allows the states to not have to develop their own standards for licensure, and if they did, there would probably be 50 different standards, and they'd be all over the place. I think it's better to say.... Certification represents our core knowledge and abilities, as represented by the CCC-A. We can also say we maintain current knowledge and skills, and if you hold the CCC-A, you can be eligible for a state issued audiology license, and the states already recognize that. Nationally we have to deal with federal legislation, CMS, congress, lobbyists and our ongoing efforts to make sure the profession is visible, represented and respected, and all of that requires monetary support. So when I hear people say they are "renting" their CCC-A, I believe that is a narrow thinking. I view my CCC-A certification fees as supporting all of the things that make it a national standard - not renting it. And remember Doug, certification is voluntary, not mandatory. If we don't have the CCC-A, then we're really not supporting a strong national standard that is developed and maintained by audiologists. If we have only licensure, the state-by-state variability will be greater, thus reducing the mobility of audiologists. However, with the CCC-A, we have a national foundation upon which we build our profession in multiple arenas.
AO/Beck: Larry, what about the definition of an audiologist? What are your thoughts on that? Should an audiologist be defined by their degree, their CCC-A, their license or something else?
Higdon: It's the feeling of ASHA's leadership that the qualifications of an audiologist are critically important and needs to be uniform across the nation, and that the profession should define it, not the states and not the federal government. Specifically, the profession can define it via the CCC-A, but if we go with licensure as the defining issue, then it may ultimately have 50 definitions! The current Medicaid definition is a good one. It states that the audiologist must be certified, and that makes sense to us because it is uniform across the nation.
AO/Beck: Larry, many audiologists believe they should, and do, practice by virtue of their license, and not their CCC-A. Can you comment on that?
Higdon: Sure Doug. I believe very strongly in licensure as does ASHA. The reason licensure is out there, and is reasonably uniform across states, is a result of the ASHA certification program. Licensure does grant you the right to practice and we need strong licensure laws. But to obtain and maintain strong licensure laws, we need a strong certification program on which to base licensure. I don't know of any other way to have uniform laws across all states.
AO/Beck: Where does ASHA stand on government involvement in the sale of hearing aids?
Higdon: ASHA supports H.R. 3103, "Hearing Aid Assistance Tax Credit Act of 2003" that was introduced last year by Representative Jim Ryun (R-KS) and ASHA is actively participating in a coalition of manufacturers, consumer and professional organizations to advance the legislation. The bill was referred to the House Committee on Ways and Means last September. H.R.3103 amends the Internal Revenue Code to allow a "non-refundable" tax credit of up to $500 for the purchase of a qualified hearing aid for an individual who is either: (1) over age 55; or (2) is claimed as a dependent. Changes sought by ASHA from the original bill H.R.943, such as lowering the original bill's age threshold from 65 to 55 and including dependents, were incorporated into the current legislation. We have also urged Congressman Ryun to consider making the personal tax credit "refundable" so that low-income seniors (who do not have enough tax liability and itemizations beyond the standard deduction) could utilize such a deduction for the purchase of hearing aids.
ASHA is also supporting legislation introduced this year in 11 states to provide health insurance coverage for hearing aids for children, as well as adults. Hawaii, Illinois, Maine, New Jersey, and Washington would provide coverage for both children and adults while California, Minnesota, Missouri, New York, Rhode Island, and Virginia would restrict coverage to children only. At present, only seven states--Connecticut, Kentucky, Louisiana, Maryland, Minnesota, Missouri (1st hearing aids only), and Oklahoma--require that health benefit plans pay for hearing aids and only children are covered. Details on these laws can found on ASHA's Web site at https://www.asha.org/about/legislation-advocacy/state/issues/ha_reimbursement.htm.
AO/Beck: What is ASHA doing relative to the FDA petition?
Higdon: ASHA sought input from our members and leadership in the development of potential comments on two "Citizens Petitions" filed with the Food and Drug Administration (FDA) by Gail Gudmundsen, AuD and Mead Killion, PhD. FDA received over 30 comments on these petitions, which were divided in support and opposition to the petitions. The OTC petition, in particular, presented a number of complex issues that we wanted to carefully weigh to accurately reflect the views, thoughts and concerns of our audiologist membership.
Historically, only a small percentage of citizen petitions are ever acted upon favorably by FDA, and in both these cases, as you know, FDA chose to deny acting on the petitions. Through this process, ASHA maintained regular communication with FDA regarding the status of these petitions.
AO/Beck: Can you tell me a little more about billing for aural rehabilitative (AR) services, what's going on there?
Higdon: Well, as you know Doug, one of the most important things audiologists do is audiologic rehab, yet audiologists cannot bill separately for those services. One of our goals is to have AR as a reimbursable service. We asked Representative Jay Inslee (D-WA) to introduce The Medicare Audiologic Rehabilitation Act of 2003 (H.R. 3464). ASHA is supporting and seeking co-sponsors this year for H.R. 3464. The bill would allow Medicare coverage for audiologic rehabilitation and treatment services provided by qualified audiologists. ASHA is also currently seeking new codes through the AMA CPT process to better define for reimbursement purposes the range of audiologic rehabilitation services provided by audiologists, such as tinnitus and auditory processing disorders. Audiologic rehabilitation (AR) services provided by audiologists includes helping individuals who have hearing problems learn how to fully utilize and manage devices (such as cochlear implants, middle ear implants, hearing aids, and assistive listening technology) and initiate interventions for persons without devices to alleviate hearing loss and other hearing disorders.
AO/Beck: Wouldn't it be better if the AR effort were coordinated across both the AAA and ASHA? It seems like this might be an ideal time to work together.
Higdon: As a matter of fact ASHA did sign on to support the AAA initiated "Direct Access" legislation. The AAA leadership had some issues with our proposed H.R. 3464, and we hope they are able to resolve their issues so the profession will be unified behind the bill. As you are well aware a split profession is the quickest way to stall a bill in the legislative process.
AO/Beck: OK, very good. What about the relationship between ASHA and the AAA?
Higdon: I think ASHA and AAA agree on issues related to audiology about 95% of the time. Sometimes we may decide to approach an issue from a different tact, and neither one may be wrong, but just the chosen approach based on our research. The sticking point between the two is certification, which we just talked about. I think that we've had some good conversations with AAA over the last year or 18 months., and as you know Doug, when I go out and speak across the nation, I do not bash AAA. Audiology needs us all individually as advocates for the profession, and I urge folks in my presentations to become an advocate, and work collectively with an organization that reflects their views. ASHA and the Council on Academic Accreditation recently invited AAA along with the Council of Academic Programs in Communication Sciences & Disorders (CAPCSD) to participate in a series of meetings leading to a national conference designed to explore all the aspects of quality doctoral education of audiologists. To date, AAA has not indicated they will participate - we hope they will.
I think we (ASHA leadership) are always willing to visit with AAA on any issue, and that's true for all audiology groups. We're willing to talk and to listen. ASHA has the best interests of the profession at heart, as does AAA, and though we may approach an issue from a different angle, I think we're all working for many of the same ultimate goals. Last year we met with Drs. Loavenbruck, Stach, and Fabry, and my take was we were in sync on many issues, except again, certification. In fact, recently AAA ran the "direct access" issue up the flag pole in congress and we are supporting that legislation, and asked our members to support it too. We thought we'd like to go a little different tact, and ASHA put forward the Medicare Audiologic Rehabilitation and Treatment bill to gain reimbursement for audiologists providing audiologic rehabilitation. So although we're approaching it a little differently, we're all working for audiology and trying to facilitate our ability to provide quality services to the public and be reimbursed adequately for our professional services.
AO/Beck: So in essence, you are willing, ready and able to work with the AAA on all audiology issues that both organizations are willing to collaborate on?
Higdon: Of course, but this is a two-way street, Doug. AAA must also be willing to meet with ASHA leaders in a open and collegial forum, as well. I believe a unified front is essential to pushing forward our agendas. You know the perception out there is a bit skewed. I consider many of the AAA leaders to be my friends, and I view some of the differences between the groups as healthy. I am willing to listen, and ASHA is willing to listen, and that's in the best interest of the profession and the patients we serve. I believe we can and should work together and that we both want the best for our profession. The audiologists on the ASHA Executive Board are all very talented and reasonable professionals who are volunteering their time to move the profession forward in an efficient carefully considered manner.
AO/Beck: Thanks Larry. You've been very generous with your time, and I really appreciate you sharing your thoughts with us this morning.
Higdon: Thank you too, Doug. I appreciate the chance to address the Audiology Online readers.
Higdon: Hi Doug. Nice to be with you.
AO/Beck: Larry, let's start with a brief review of your education and professional experiences, and then we'll address your presidency and ASHA.
Higdon: Very good.
AO/Beck: Where did you get your graduate degree?
Higdon: I did all of my audiology-based university work at the University of Texas and then completed my master's at Texas A & M Kingsville in Educational Administration in 1968.
AO/Beck: After you graduated, what type of practice did you have?
Higdon: Initially, I worked with an ENT group and then I moved to Corpus Christi where I was the sole audiologist in the city for about 15 years! I was with a community speech and hearing center and pediatric hospital. During that time I developed a private practice where I contracted with other hospitals and facilities the agency didn't elect to service.
AO/Beck: What was the most challenging aspect of your practice back in the early days?
Higdon: Other than the isolation of not having colleagues across the hall or down the street, the challenges didn't differ greatly from those we face today: lack of autonomy; having to earn the respect of referral sources because they didn't know what to expect in terms of scope of services and quality they could expect; building visibility among our publics and increasing consumer knowledge of who we are, and what we can do for those with hearing and balance problems. It isn't difficult to spread the word, but it is difficult to build an understanding of what they should expect from an audiologist.
AO/Beck: And fast-forwarding a few years, you hold two academic appointments currently, I believe?
Higdon: Yes, that's right. I hold a position at Ole' Miss in the Speech Communication and Writing Institute, and I'm an adjunct associate professor in the Department of Communicative Disorders. Because I'm not in a tenure track position, it allows me to maintain my private consulting practices, and continue many of the volunteer activities, including serving as ASHA's president. I have a private consulting audiology practice that includes a hearing conservation business. I'm a lobbyist for the Texas Speech and Hearing Association in Austin, and I'm also co-owner and practitioner in a conflict resolution business.
AO/Beck: So what city do you actually live in? Where do you spend most of your time?
Higdon: Seems like most of my time is spent on Delta Airlines! But, Carolyn and I live in Oxford, Mississippi, and have a townhouse on the lake in Austin.
AO/Beck: OK, very good. How long have you been involved with ASHA?
Higdon: 36 years now.
AO/Beck: Which key positions have you held at ASHA?
Higdon: I've held quite a few positions with the Association, but I pretty much grew up in the Standards and Ethics sections of ASHA. My first official function as an officer was as the first Vice President for Professional Practices in Audiology in 1994. Following that, I was elected the Vice President for Governmental and Social Policy, in 1999. In 2003, I assumed the office of President-Elect, and became President January 1, 2004.
AO/Beck: I suppose there have been quite a few audiology- or dually certified ASHA presidents, can you tell me some of their names please?
Higdon: Over the last few years we have had several audiology- or dually certified presidents whose primary practice area was audiology. Included in that group were; Donna Geffner, Gil Herer, Laura Wilbur, Anne Carey, Alan Feldman, Phil Yantis, Hayes Newby and Raymond Carhart.
AO/Beck: Larry, I understand the presidency is actually a three year commitment. You served as president-elect, and now you're the president and then next year past-president. Can you briefly review the primary responsibilities of the president-elect?
Higdon: The president-elect attends meetings of the Executive Board and chairs the "committee on committees," is a non-voting member of the Legislative Council and participates in the Committee on Resolutions, the Budget Committee, and the Long-Range Strategic Planning Board, as well as other responsibilities at the discretion of the president.
AO/Beck: Very good. What are the duties of the president?
Higdon: The President serves as Chair of the Legislative Council and Chair of the Executive Board, and is charged with coordinating the functions of both bodies. The president represents ASHA and the professions in a variety of liaison and public information activities, including federal agency and national legislative concerns. There are other responsibilities too, but those are the key issues.
AO/Beck: And past-president?
Higdon: The past-president participates in meetings of the Executive Board and the Legislative Council and then serves as Chair for the Committee on Resolutions and the Committee on Nominations and Elections.
AO/Beck: I suppose one year as president seems like a long time when you're on the outside of the presidency, but when you're the president, it probably seems like one year is too brief a period to really run the organization? What do you hope to accomplish as president? And if you don't mind, let's limit the discussion to audiology issues.
Higdon: Sure, we can do that. Well, you're right, one year is too brief. I think it's a narrow opportunity to represent all the ideas and thoughts that we'd like to push forward. Nonetheless, it's a wonderful opportunity to be attentive to the members needs, and to cooperate with all entities that interact with the people we serve as audiologists. I think it's important to present a unified front and stand up for what we believe in. I hope we can make significant headway with our Audiologic Rehabilitation and Treatment legislation to allow payment to audiologists for their audiologic rehabilitation work. I certainly hope we can be instrumental in moving "direct access" legislation along, although I view that as a long term project. ASHA has proposed a number of new codes for tinnitus evaluation and treatment to the AMA's CPT coding committee that I believe will have come to fruition. I would like to see a better open working relationship established with other audiology organizations and related organizations.
AO/Beck: Very good. Regarding accreditation and certification, this really has been somewhat controversial with many audiologists. Can you review your thoughts on those topics?
Higdon: I am very much in favor of the accreditation and certification programs that ASHA has developed, and I also support licensure as a hand-in-glove approach to maintaining consistency and quality of services. I believe the ASHA accreditation and certification programs are in the best interests of professionals and consumers. The C's were the model for most Licensure Bills, and should continue to be. Certification is developed and monitored by audiologists. Audiologists are the principals in all updates as our scientific knowledge expands. Licensure is governed by legislators, who, while well-meaning, largely don't know who we are or what we do yet they govern our right to practice. We must maintain a strong, visible, nationally recognized model as an example for them to follow or use as a model. Within ASHA, the semi-autonomous Council for Clinical Certification (CFCC) is made up of equal numbers of audiologists and speech-language pathologists, with each primarily addressing their own profession's certification issues. The current chair is an audiologist.
Accreditation works in much the same way with the semi-autonomous Council on Academic Accreditation (CAA) being comprised of an equal number of audiologists and speech-language pathologists, each addressing their profession's issues. It is a fine line between maintaining an academic standard and allowing for academic freedom in the preparation of our future professionals.
AO/Beck: Can you comment on the idea that once you've been awarded the CCC-A, it should or shouldn't be yours forever? The argument has been made that after you've earned a graduate degree you own that degree forever, so why renew the CCC-A annually?
Higdon: Well, to achieve licensure and to have good licensure laws that provide basic consistency across states, we have to have a highly recognized, visible, standard and that has historically been the CCC-A. The recent CMS Medicaid ruling on the qualifications of audiologists underscores the value and importance of the CCC-A as a national credential. The CCC-A allows the states to not have to develop their own standards for licensure, and if they did, there would probably be 50 different standards, and they'd be all over the place. I think it's better to say.... Certification represents our core knowledge and abilities, as represented by the CCC-A. We can also say we maintain current knowledge and skills, and if you hold the CCC-A, you can be eligible for a state issued audiology license, and the states already recognize that. Nationally we have to deal with federal legislation, CMS, congress, lobbyists and our ongoing efforts to make sure the profession is visible, represented and respected, and all of that requires monetary support. So when I hear people say they are "renting" their CCC-A, I believe that is a narrow thinking. I view my CCC-A certification fees as supporting all of the things that make it a national standard - not renting it. And remember Doug, certification is voluntary, not mandatory. If we don't have the CCC-A, then we're really not supporting a strong national standard that is developed and maintained by audiologists. If we have only licensure, the state-by-state variability will be greater, thus reducing the mobility of audiologists. However, with the CCC-A, we have a national foundation upon which we build our profession in multiple arenas.
AO/Beck: Larry, what about the definition of an audiologist? What are your thoughts on that? Should an audiologist be defined by their degree, their CCC-A, their license or something else?
Higdon: It's the feeling of ASHA's leadership that the qualifications of an audiologist are critically important and needs to be uniform across the nation, and that the profession should define it, not the states and not the federal government. Specifically, the profession can define it via the CCC-A, but if we go with licensure as the defining issue, then it may ultimately have 50 definitions! The current Medicaid definition is a good one. It states that the audiologist must be certified, and that makes sense to us because it is uniform across the nation.
AO/Beck: Larry, many audiologists believe they should, and do, practice by virtue of their license, and not their CCC-A. Can you comment on that?
Higdon: Sure Doug. I believe very strongly in licensure as does ASHA. The reason licensure is out there, and is reasonably uniform across states, is a result of the ASHA certification program. Licensure does grant you the right to practice and we need strong licensure laws. But to obtain and maintain strong licensure laws, we need a strong certification program on which to base licensure. I don't know of any other way to have uniform laws across all states.
AO/Beck: Where does ASHA stand on government involvement in the sale of hearing aids?
Higdon: ASHA supports H.R. 3103, "Hearing Aid Assistance Tax Credit Act of 2003" that was introduced last year by Representative Jim Ryun (R-KS) and ASHA is actively participating in a coalition of manufacturers, consumer and professional organizations to advance the legislation. The bill was referred to the House Committee on Ways and Means last September. H.R.3103 amends the Internal Revenue Code to allow a "non-refundable" tax credit of up to $500 for the purchase of a qualified hearing aid for an individual who is either: (1) over age 55; or (2) is claimed as a dependent. Changes sought by ASHA from the original bill H.R.943, such as lowering the original bill's age threshold from 65 to 55 and including dependents, were incorporated into the current legislation. We have also urged Congressman Ryun to consider making the personal tax credit "refundable" so that low-income seniors (who do not have enough tax liability and itemizations beyond the standard deduction) could utilize such a deduction for the purchase of hearing aids.
ASHA is also supporting legislation introduced this year in 11 states to provide health insurance coverage for hearing aids for children, as well as adults. Hawaii, Illinois, Maine, New Jersey, and Washington would provide coverage for both children and adults while California, Minnesota, Missouri, New York, Rhode Island, and Virginia would restrict coverage to children only. At present, only seven states--Connecticut, Kentucky, Louisiana, Maryland, Minnesota, Missouri (1st hearing aids only), and Oklahoma--require that health benefit plans pay for hearing aids and only children are covered. Details on these laws can found on ASHA's Web site at https://www.asha.org/about/legislation-advocacy/state/issues/ha_reimbursement.htm.
AO/Beck: What is ASHA doing relative to the FDA petition?
Higdon: ASHA sought input from our members and leadership in the development of potential comments on two "Citizens Petitions" filed with the Food and Drug Administration (FDA) by Gail Gudmundsen, AuD and Mead Killion, PhD. FDA received over 30 comments on these petitions, which were divided in support and opposition to the petitions. The OTC petition, in particular, presented a number of complex issues that we wanted to carefully weigh to accurately reflect the views, thoughts and concerns of our audiologist membership.
Historically, only a small percentage of citizen petitions are ever acted upon favorably by FDA, and in both these cases, as you know, FDA chose to deny acting on the petitions. Through this process, ASHA maintained regular communication with FDA regarding the status of these petitions.
AO/Beck: Can you tell me a little more about billing for aural rehabilitative (AR) services, what's going on there?
Higdon: Well, as you know Doug, one of the most important things audiologists do is audiologic rehab, yet audiologists cannot bill separately for those services. One of our goals is to have AR as a reimbursable service. We asked Representative Jay Inslee (D-WA) to introduce The Medicare Audiologic Rehabilitation Act of 2003 (H.R. 3464). ASHA is supporting and seeking co-sponsors this year for H.R. 3464. The bill would allow Medicare coverage for audiologic rehabilitation and treatment services provided by qualified audiologists. ASHA is also currently seeking new codes through the AMA CPT process to better define for reimbursement purposes the range of audiologic rehabilitation services provided by audiologists, such as tinnitus and auditory processing disorders. Audiologic rehabilitation (AR) services provided by audiologists includes helping individuals who have hearing problems learn how to fully utilize and manage devices (such as cochlear implants, middle ear implants, hearing aids, and assistive listening technology) and initiate interventions for persons without devices to alleviate hearing loss and other hearing disorders.
AO/Beck: Wouldn't it be better if the AR effort were coordinated across both the AAA and ASHA? It seems like this might be an ideal time to work together.
Higdon: As a matter of fact ASHA did sign on to support the AAA initiated "Direct Access" legislation. The AAA leadership had some issues with our proposed H.R. 3464, and we hope they are able to resolve their issues so the profession will be unified behind the bill. As you are well aware a split profession is the quickest way to stall a bill in the legislative process.
AO/Beck: OK, very good. What about the relationship between ASHA and the AAA?
Higdon: I think ASHA and AAA agree on issues related to audiology about 95% of the time. Sometimes we may decide to approach an issue from a different tact, and neither one may be wrong, but just the chosen approach based on our research. The sticking point between the two is certification, which we just talked about. I think that we've had some good conversations with AAA over the last year or 18 months., and as you know Doug, when I go out and speak across the nation, I do not bash AAA. Audiology needs us all individually as advocates for the profession, and I urge folks in my presentations to become an advocate, and work collectively with an organization that reflects their views. ASHA and the Council on Academic Accreditation recently invited AAA along with the Council of Academic Programs in Communication Sciences & Disorders (CAPCSD) to participate in a series of meetings leading to a national conference designed to explore all the aspects of quality doctoral education of audiologists. To date, AAA has not indicated they will participate - we hope they will.
I think we (ASHA leadership) are always willing to visit with AAA on any issue, and that's true for all audiology groups. We're willing to talk and to listen. ASHA has the best interests of the profession at heart, as does AAA, and though we may approach an issue from a different angle, I think we're all working for many of the same ultimate goals. Last year we met with Drs. Loavenbruck, Stach, and Fabry, and my take was we were in sync on many issues, except again, certification. In fact, recently AAA ran the "direct access" issue up the flag pole in congress and we are supporting that legislation, and asked our members to support it too. We thought we'd like to go a little different tact, and ASHA put forward the Medicare Audiologic Rehabilitation and Treatment bill to gain reimbursement for audiologists providing audiologic rehabilitation. So although we're approaching it a little differently, we're all working for audiology and trying to facilitate our ability to provide quality services to the public and be reimbursed adequately for our professional services.
AO/Beck: So in essence, you are willing, ready and able to work with the AAA on all audiology issues that both organizations are willing to collaborate on?
Higdon: Of course, but this is a two-way street, Doug. AAA must also be willing to meet with ASHA leaders in a open and collegial forum, as well. I believe a unified front is essential to pushing forward our agendas. You know the perception out there is a bit skewed. I consider many of the AAA leaders to be my friends, and I view some of the differences between the groups as healthy. I am willing to listen, and ASHA is willing to listen, and that's in the best interest of the profession and the patients we serve. I believe we can and should work together and that we both want the best for our profession. The audiologists on the ASHA Executive Board are all very talented and reasonable professionals who are volunteering their time to move the profession forward in an efficient carefully considered manner.
AO/Beck: Thanks Larry. You've been very generous with your time, and I really appreciate you sharing your thoughts with us this morning.
Higdon: Thank you too, Doug. I appreciate the chance to address the Audiology Online readers.
