Interview with Robert Glaser Ph.D., President, American Academy of Audiology
AO/Beck: Good Evening Dr. Glaser. As always, I am very appreciative of your time. I'd like to thank you for making yourself available for this interview. The accomplishments of the AAA, under your leadership for the past 12 months, has been nothing short of staggering.
Glaser: Thanks Doug. The accomplishments of our Academy have been impressive. I attribute the successes to the diligence and phenomenal vision of our volunteer Board of Directors. They are, without a doubt, the finest group of professionals I have had the pleasure to work with. We have faced opposition from inside and outside our profession, carefully considered the future of our profession and tried to continue the efforts of past leaders...always considering our profession and its ability to not just survive, but to prosper in every venue in which audiologists are found. This year we completed a new Strategic Plan. The Board has stayed focused on that Plan--as a guide which was established by a diversified, representative group selected from the membership at large--it is a blueprint for progress as well as fiscal responsibility since each item to come before the Board must be in the Plan. Each item in the Plan is tied directly to budgetary implications. The Plan helps to set our agenda relative to our fiscal status.
This has been a very busy year for the Academy and the Board of Directors can be proud of their accomplishments. I can tell you that each member of the Board has worked diligently on behalf of the membership of our Academy and our profession.
I am honored to have served on this Board. At the heart of our positive, forward thinking plans and accomplishments, is the driving force of passion. Passion for our profession. Passion for success and motivation as audiologists, to be the primary hearing care providers in the world—and that means passion for the Academy as the home of Audiology. We have found similar passion in our colleagues throughout the country. Audiologists are winners and they take pride in what they do and how they serve those in need of our services. It is not about the organization, never has been, with the Academy, the Board and the members, it has always been about the profession and that's why we are in the profession of audiology. Others in our community share the passion. As you know, the Academy has worked closely with other organizations this year in a variety of collaborative efforts. Most visibly, the Academy of Dispensing Audiologists, lead by Jim McDonald and Bob Manning have worked with us closely on a variety of reimbursement issues. We have been successful in putting the right people together, assembling the right lobbyists--from both AAA and ADA--and opening the right doors at HCFA and other areas dealing with reimbursement for audiologists. Its been a great year for all of us!
AO/Beck: Bob, before we go any further, will you please outline who was on the AAA Board for 2000 and their positions and who will be leaving and joining the Board for 2001?
Glaser: Sure, I am honored to do so. The 2000 Board included; President-elect David Fabry from Minnesota who will assume the presidency 1-1-2001. Angela Loavenbruck, New York, served as a member of the Board of Directors and will serve in 2001 as President-Elect. She will be President of our Academy in 2002. The three newest Board members to serve in 2001 are Richard Gans from Florida, Katherine Palmer from Pennsylvania and Gail Whitelaw from Ohio. These newly elected members are extremely talented, bright and energetic and they will serve as 'members-at-large'. The people leaving the Board will include Michael Marion and Yvonne Sinniger and Sharon Fujikawa, all from California. Those Board members continuing their terms include Robert Sweetow and Allison Grimes from California, Gail Gudmundsen from Illinois, Gyl Kasewurm from Michigan, Brad Stach from Missouri and Sheila Dalzell from New York. Board member's terms and email addresses are available on the Academy's website; www.audiology.org. Both the 2000 and the 2001 Boards enjoy a diverse representation of audiologists; private practitioners, educators, researchers, balance disorder specialists, and the hearing aid industry. That mix of talents and knowledge is really helpful to accomplish the Board's missions and in serving the needs of a diverse membership.
AO/Beck: I'd like to just 'line listing' some of things you and the Board addressed and accomplished over the past 12 months to help the readers understand exactly how important and productive the year 2000 was for the AAA...First of all, membership of the AAA is now over 7000, a 'Long Range Plan' has been completed and is being implemented, the AAA 'Government Affairs' and 'Reimbursement' committees worked together with the AAA lobbyist and the ADA lobbyist and the results included...HCFA now allows vestibular testing by audiologists without the previously mandated 'physician's supervision', and very importantly, HCFA has agreed that SN loss will now be reimbursed even though there is no 'medically treatable' issue there. Additionally, HCFA is working with the AAA to potentially remove the restraints based on 'physician's referral', and HCFA is considering reimbursement for audiologists for aural rehabilitation, vestibular rehab and cochlear implant services. These are extremely important advances that will impact the day-to-day practice of the profession across the country.
Glaser: Those are important issues and I thank you for mentioning them. Frankly, again, the reason we came so far so fast has to do with the strength of conviction of the Board members. These are dedicated people so focused that failure was not an option. If you cannot get paid for your services and expertise, the profession cannot survive. For too long we have provided exceptional research, products and services without professional recognition and that continues to change at a rapid pace. As mentioned earlier, the collaborative efforts of the AAA and ADA have been a most important and beneficial relationship for our profession. The two academies are indeed working together on many fronts but I want to be clear that they are two separate and distinct academies, and they serve different roles. Some of the AAA members have become concerned about AAA becoming the ADA and have asked if I see the two academies 'melting into one' eventually. Each Academy has its distinct and important role and each provides different and important commodities to audiologists. Although we have worked together and, I certainly hope, we will continue to work together, there is no plan to incorporate the ADA into the AAA or vice versa. We certainly maximize our strength as a profession whenever these two potent audiology-based groups work together, but each serves a different role and each will continue to maintain their own identity to best serve their memberships. Having said that, I hope everyone can see that we have achieved unprecedented successes and I think we all look forward to maintaining and building the relationship between the two academies...and other audiology-based organizations when needed.
AO/Beck: Other major developments included the 'coming of fruition' of the 1996 initiative by the AAA's Government Affairs committee that goes into effect 1-1-2001, and essentially says federal employees covered by the FEHBP program (some 70 percent of all federal employees) can go directly to an audiologist for hearing health care services. That is a milestone development. I anticipate many other insurance companies and third party payers will adopt these guidelines and write them into their own policy and procedure guidelines as the federal government seems to have agreed that the direct path to the audiologist was efficient, safe and cost effective.
Glaser: I think you're correct. Others will follow the lead of the federal government. However, it's important to realize that even though the federal protocol goes into effect in a few weeks, it will probably take at least a year or so for this to get worked out and run smoothly on the local level. The Academy is addressing this issue and I urge everyone to read Audiology Today and to check the Academy Website for details and suggestions. Already, Craig Johnson, AuD., Chair of Government Affairs for the Academy has issued suggestions on how to prepare for billing. But, again, it is a very important step and I anticipate it will be a pivotal point for our profession as we look back on it 5 years from now. Because of the FEHBP BC/BS accomplishment, we will be working from a better position in future negotiations with third party payors. The success with the FEHBP BC/BS is critically important to our professional growth and recognition as we move forward. This really is another milestone for the Academy but most importantly it creates better access to those in need for our services. It is a win-win situation for all; professionals and patients alike.
AO/Beck: I remember when Dr. Carol Flexer was the AAA President, she brought to light the importance of the SOC (standard occupational classification) codes. It seems that after pounding away at that for years, progress has been made there too.
Glaser: Yes. Dr. Flexer was a visionary and leading proponent of this change. Basically, we have recently had audiology removed from the combined 'Speech-Language/Audiologist' descriptor code to our own distinct code, called....'Audiologist'. Obtaining that classification took a great deal of time, talent and patience. And we are not finished yet, unfortunately, they still have us placed in the 'Therapist' class of providers. The Academy will continue working on this important topic since it is used by third party payors, those who employ audiologists, insurance companies and others seeking a 'federalized' definition and description of what we as audiologists do and how we should be characterized. This is one situation where our association with the field of Speech/Language Therapy has been directly detrimental to all of us. This has been an intense and lengthy battle and that's the way it is when you work with federal rules and regs, but we're making progress and we're moving forward and we owe a great deal of gratitude to Past-President Flexer.
AO/Beck: One thing that many audiologists are concerned about has to with the nurturing and retention of Ph.D.'s in the profession. What can you tell me about that regarding the AAA's viewpoint?
Glaser: Doug, in the last year we've established the President's Initiative on Science in Audiology to help enhance our scientific approach to hearing health care and to help attract new academicians and scholars to continue producing the backbone of our profession - which is our good science and research. As you know audiologists not only diagnose and treat patients with hearing loss, but audiologists produce the vast majority of the research in hearing and amplification, universal newborn screenings, vestibular sciences, aural rehabilitation, auditory processing disorders, intraoperative monitoring, evoked potentials and on and on - our profession is a unique combination of scholars and clinicians and we need to maintain both ends of the profession. To that end, the I President's Initiative on Science in Audiology will be the AAA venue which supports, broadens and enhances those goals. It is our goal to bring in a small group of our leading scientists to focus on needs and initiatives and to establish a national meeting about this critically important issue. I must thank Lisa Hunter, Brenda Ryals and Jack Roush for taking the lead on this...David Fabry will be tending to this issue during his Presidency. I am certaint it is a high priority item on his list.
AO/Beck: Switching gears, Bob, what can you tell me about the upcoming FDA rules and regs on hearing aid dispensing?
Glaser: In March 2000 The Academy adopted the position statement on 'Pre-Purchase Assessment Guideline for Amplification Devices'. Basically, that document stated that every person seeking hearing amplification devices needs to have a thorough audiologic evaluation by an audiologist. Importantly, the evaluation is not conducted for the purpose of fitting or selecting a hearing aid, but rather to assess the functional integrity of the auditory system to be certain that amplification is the correct treatment activity. We obviously think that is the correct stance to take and we are hopeful the FDA and Health and Human Services will incorporate that into it's final statement. The position statement can be viewed in it's entirety at the AAA website (www.audiology.org). At this point, the document is in Secretary Shalala's office in HHS and is undergoing review and consideration. It has been an ongoing process for us since 1993. Time will tell.
AO/Beck: Swithcing gears again, regarding the CCC-A, I think many audiologists have considered dropping their CCC-A, but they are scared to do so. Additionally, apparently less and less new graduates are seeking CCC-A certification. With that in mind, can you address the necessity of any certification, and in particular, the necessity of CCC-A?
Glaser: Our colleagues in audiology are beginning to realize that inertia has carried their pen to their checkbook every year rather than any particular value. As for those who think that they must have their CCC-A to be licensed or maintain their CCC-A to stay licensed, they are functioning in the dark. Certification, any certification including the American Board of Audiology Board Certification in Audiology is NOT required for licensure. It is voluntary and, as such, has no place in the law of the state with licensure or registration. Certification is a peer statement of accomplishment and nothing more. Licensure is what enables any of us to practice audiology--certified or not. Specialty certification may be a different matter when it comes to reimbursement in the future. But that is an issue for third party payors, not state licensure boards. ASHA's CCC-A was designed to establish a minimum qualification standard when there was no licensure. Those days are over. Only three states do not have licensing or registration and that is subject to change. There is a myth that you are not competent without your CCC-A. That myth is not true. Of course there is the issue that our colleagues in university settings may be held hostage to their program accreditation in that ASHA's program accreditation requires the faculty and clinical staff to maintain their CCC-A, and if you do not keep your CCC-A, ASHA says you cannot supervise a CFY nor a student in training. To clarify, you can supervise without your CCC-A, but the hours will not count toward that student's CCC-A, assuming they choose to seek that certificate and, as you say, the data seems to indicate that many new graduates are not actively applying for certification. How long can ASHA maintain this grip? As long as we permit them to do so by supporting their certification program and sending them our money.
AO/Beck: It appears that a few ENT community members have begun a war of words against our profession. What is your feeling on this and what is the impact on our profession?
Glaser: Doug, this is nothing new. It's simply more important to them now since the ENTs, in general are getting hit hard by cutbacks in reimbursement for surgeries. It is simple economics. If you see the latest Audiology Today, you will see excerpts from the American Academy of Otolaryngology, Head and Neck Surgery (AAO/HNS) August and September Bulletins. They arrogantly describe their preferred 'Scope of Practice for Audiology' in their terms, with ENT as the head of the hearing health care team. That horse left the barn a long time ago. In the subsequent issue, an ENT indicates that they are going to regain that 'Captains' role for ENT and, in effect, keep audiologists down where they belong (that is my interpretation, please read it for yourself). The bottom line is clear. We have been successful in improving the quality of the lives of the hearing impaired patients we serve and a small vocal minority of ENTs are threatened by our skills, knowledge, success and viability as a doctoring profession. In brief, they are feeling threatened and they are fighting to keep us under their thumb, rather than greeting us with open arms as colleagues and professionals. I feel confident in stating that the small vocal minority of antagonistic ENTs are not representative of ENTs in general. Most ENTs are dedicated to the well being of their patients as their primary goal. The maintenance of a subservient role for audiologists is not the goal for the vast majority of ENTs, although it is clearly a goal for a few of them! Their comments about our AuD programs being 'mail order degrees' are ridiculous, incredulous and serve no purpose but to inflame...as I mentioned in my last President's Message, rhetoric solves nothing. The difference is simple. We have been successful because of passion. Something, in my opinion, a minority of ENTs traded in a long time ago for money. This is a tense time in some respects but most of our colleagues in audiology who work with or for an ENT or in an ENT group are respected members of a team that serves our patients quite well. The ENT leadership appears to be out of line with their general membership and maybe that membership should speak up. In any event, we are moving forward and our profession will continue to prosper.
AO/Beck: Yes, it is annoying to hear our doctorates referred to as 'mail order'. I personally think it's unprofessional to mock other people's doctorates, but I know it happens every day. My 'mail order' degree was from the University of Florida at Gainesville. After 15 years as an audiologist, my doctorate was an additional 45 credit hours beyond my master's degree. I had to enroll as a full-time student for 18 months in addition to working full-time as a clinician for the entire time. I spent about 3 to 4 hours every single night for 18 months studying, taking exams, watching and taking notes from recorded video-tapes from prominent audiologists, I had to attend national and regional chats online twice a week. Additionally, I had to fly into Chicago every 7 or 8 weeks for 18 months to attend the Saturday-Sunday examinations and hands-on sessions. 'Mail order'. Right. But I digress, I think this is supposed to be me interviewing you. Sorry. OK, back to the interview. Where are we with regards to Newborn Hearing Screenings?
Glaser: Another Position Statement was adopted by the Academy and released was in March 2000. It addressed 'The Role of the Audiologist in Newborn Hearing Screening Programs'. Again, I'd like to urge the readers to visit the AAA website for the entire document, but in essence it says that audiologists are the experts in hearing health care, and in this arena, specific to newborns, we have the Early Hearing Detection and Intervention (EHDI) program which assures that the audiologists are the leaders, managers and supervisors of the programs as the audiologist is the professional who performs the diagnostic tests, the screenings, and manages and counsels not only the newborn, but the families too regarding amplification, education, aural rehabilitation, and all areas related to the hearing health care of the newborn. As with the document on pre-purchase hearing evaluation by an audiologist, this document was also sent to all licensing boards throughout the country. It may be more important than we had originally thought in view of ASHA's recently proposed changes in the Scope of Practice of SLPs which includes neurophysiologic tests as screening tools for those in Speech-Language Pathology.
AO/Beck: Again, if I were to line list other accomplishments and works in progress for the year 2000 they'd include.... The Task Force on Hearing Aids has apparently finished their work and will soon have a consumer brochure available on hearing aids. The Tinnitus Task Force has already produced a Position Statement and a patient brochure and those are available from AAA. The Task Force on Supervision is progressing, the Task Force on Hearing Screenings is progressing, the Task Force on AAA Communications is progressing, and a new Task Force on Hearing Conservation is up and running under Mark Stephenson with NIOSH in Ohio, and apparently they will soon have a Position Statement and a patient/consumer safety brochure available soon. The AAA needs to take the leadership role in Hearing Conservation, and we will certainly do that.
Glaser: The Task Forces serve an enormous role in the Academy and benefit both consumers and professionals alike. Task forces are usually limited in duration to 6 to 12 months and have very specific focus and agenda. We have the expertise within the Academy to evaluate the status quo of any issue related to hearing health care and we have the ability to plan where we need to go for the benefit of the patients and the professionals in each of these topic areas. I am very pleased with the progress the Task Forces have made and I am excited about getting their important results in the hands of the membership. There are actually two new, standing committees of the Academy you didn't mention. The Committee on Linguistics and Cultural Diversity chaired by Dr. Ballachanda from New Mexico will seek out and help minorities join and participate in the Academy and the other new International Committee of the American Academy of Audiology chaired by Drs. Traynor (of the USA) and Baguely (of the UK) will be an enormous area of growth for the Academy over the next decade. Our international participation has skyrocketed and the new International Committee will be extremely valuable to all of the hearing health care practitioners across the globe. I see this committee as a two way street benefiting the development of audiology-based knowledge and practice beyond our borders, while bringing fresh ideas from across the world home to the USA .
AO/Beck: What other areas has the AAA progressed in throughout 2000?
Glaser: I think we've addressed many of the highlights of this past year already, but there are many more. I'm particularly pleased with the 'Audiology Clinical Practice Algorithms and Statements' which was published in a Special Edition of AT (Audiology Today) in August 2000. That document represented a collaborative effort of the AAA, ASHA, and the Department of Veteran's Affairs. In essence, that document identified areas in which common policies and practices for the entire profession would benefit the recipients. Another new area for us is the Members Concerns Program which has initiated over 300 contacts between the Board and the membership. This program provides the membership with direct access to the Board and it too, is a pivotal program to be certain the Board stays in touch with the needs and concerns of the membership.
Other areas include...We have developed the Physician's Referral Kit and it too is currently being field tested, we have signed an affiliation agreement with NAFDA, which allows us to help support and advise them, if and when requested, but in no way impacts the decision making of their Board of Directors. We have setup a new position at AAA headquarters, the Public Information Specialist, we have adopted a new format for the AAA Board of Directors meetings which includes an open door policy for all staff members and a final thought here might be that we established the President's Panel on Governance. This panel is made up of past-presidents of the AAA to review the structure of governance of the AAA. As a result of their report, the AAA has hired a consultant to evaluate the viability of the current structure. So again, we are constantly looking at the status quo and evaluating and re-evaluating to improve. It's been an exciting year and the future of the profession and the Academy is very bright.
AO/Beck: Bob, before I let you go, I want to thank you for the amazing productivity and leadership you have demonstrated as the president of AAA. David will have his hands full filling your shoes! I hope you get some rest soon and I wish you the best for a happy and healthy 2001.
Glaser: Thanks Doug, I wish you and the Audiology Online participants a happy, healthy and prosperous new year too.
