- Hey guys, welcome back to the Dr. Cliff AuD VLOG.
This is vlog number 97, and today,
I'm actually going to be talking about
the Build Back Better act
that was recently passed through the House
and is on its way off to the Senate.
But there were a couple of changes that were actually made
to this particular act,
in regards to hearing aids being provided under Medicare.
So I wanna talk about
some of the new modifications to that,
and some of the contentions that individuals have,
including myself with these either modifications,
or just things inside of the act in general.
Now, if you have not yet seen my review of me talking about
this particular act in regards to the hearing aids
being provided under Medicare,
you can go back and check out my vlog,
it was vlog number 94,
where I was talking about this particular subject.
With that said, if you guys could do me a huge favor
and click the like button,
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encourages me to make more videos like this one
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With all of that said, let's go ahead
and get into some of the modifications
that occurred since the last video
that I made on this particular topic.
And one of the modifications were is that
it actually lowered the threshold
for being able to qualify for hearing aids under Medicare,
it was severe to profound levels of hearing loss,
now it is moderately severe
to profound levels of hearing loss.
So it actually lowered the threshold down
to make it easier for individuals
to qualify for hearing aids under Medicare.
So, pretty much a good thing.
The one aspect of contention within this is that
it's still very kind of up in the air
with the qualifications
for who would actually qualify for hearing aids,
and just like any insurance program,
if you have this loosely defined subjective aspect to it,
it is going to end up being a thing
where insurance fraud is at play,
and I guarantee you that there's gonna be
a significant amount of insurance fraud,
either individuals are going to manipulate test results
in order to qualify for hearing aids,
or hearing care professionals potentially could say that
the hearing loss isn't as bad
in order to make those individuals
private pay for hearing aids,
instead of having to go through Medicare
with all the restrictions that
that would likely carry with it.
So that's one of the modifications that was included was
actually lowering the threshold
for being able to qualify for hearing aids.
The second modification is that
the exclusion of hearing aids from competitive bidding
when furnished by a physician or other practitioner
to their own patients, as part of a professional service.
Now, typically, suppliers will submit bids
to provide certain, you know, devices, or items,
or supplies to individuals
who are going to be receiving these through Medicare.
And I have to imagine that
this makes hearing aid manufacturers extremely happy
because they don't actually have to bid for
them being able to provide their devices within Medicare.
So they can continue to charge whatever they want
for this particular technology,
and I know that the hearing aid manufacturers are likely
trying to get this top up thing accomplished,
which means that even if Medicare only covers
a certain like level of technology, let's say,
that the consumer, the end user,
the beneficiary of Medicare would actually be able
to pay the difference to upgrade technology.
So this is a win-win for hearing aid manufacturers,
meaning that they basically have a guaranteed sale
and they also are going to be able to make better,
you know, profits, if a patient is allowed to pay for
the next higher level of technology.
Now, I also agree with this, but I agree with it
from the perspective of this allows a patient
to get a better hearing aid,
even though when you start to look at,
because the clinician, like myself,
we have to pay more money to the manufacturers
to get those devices in,
so we don't benefit as much of having an individual
pay for an upgrade in technology,
where hearing aid manufacturers,
they make it, it's a huge incentive for them.
So we'll see what happens with that.
But nonetheless, the point of contention with that is that
there's essentially unregulation of
the cost of hearing aids,
even though Medicare is paying for them,
which seems kind of odd, but it is what it is.
I'm sure I'll get more clarification with that
as time goes on.
A couple of different points of contention.
So there were individuals from my previous vlog
who kind of raised flags of like,
"Hey, Cliff, do you realize that
"what you were saying in that vlog,
"some of it is actually a bad thing?"
And they explained to me why, they reached out,
I've had talks with multiple individuals
to kind of get more clarification on it.
Now, as you guys know,
I am in full support of hearing instrument specialists
being able to dispense hearing aids through Medicare,
and dispense hearing aids in general.
But the problem with the way that
things are worded inside of the Build Back Better act is
that it includes hearing instrument specialists,
essentially, as providers of audiology services.
Now it's important to understand that
hearing instrument specialists are not audiologists,
their scope of practice is limited to
the evaluation for hearing aids, and that is it.
There is no additional scope of practice for them
to practice audiology on individuals with hearing loss.
Now, again, I am not saying that
hearing instrument specialists
should be removed from this particular act,
but I am saying that they should essentially reword it
either to create essentially a sub category
that specifically outlines
what a hearing instrument specialist can do
in terms of selecting hearing devices
and fitting hearing devices to a Medicare recipient.
But they should not be included as practitioners
inside of Medicare for audiology services.
Now, there are a ton of different audiology services and,
you know, individuals who are audiologists,
they went to school, it's a very structured program
that they go to to be able to diagnose
and treat hearing loss.
Hearing instruments specialists, they have a very,
I would say random training,
I mean, you can have a high school degree or a GED,
and then ultimately, shadow someone for,
I think, a couple of years
and get your hearing instrument specialist license.
But I really think it's a slippery slope
when you start expanding the scope of practice
to individuals who haven't been trained on the things
that they would have to be able to do
inside of that scope of practice.
I know I'm gonna take a lot of heat for this.
And again, I wanna make sure that I'm clear here,
I have nothing against hearing instrument specialists,
my best practice, Pro Network.
I allow hearing instrument specialists
to be inside of the network
if they've proven to be competent
and actually follow best practices
when providing care to individuals with hearing loss,
but they should not be diagnosing individuals
with hearing loss.
They should be conducting testing
for the purpose of fitting individuals with hearing aids,
there's nothing wrong with that,
but in terms of how things are written out currently
in this bill that has to change,
there's no way that that should be able to stay in there
the way that it currently is.
Now, with all that, the second point of contention
that just boggles my mind because
audiologists are the experts
when it comes to treating hearing loss.
And to think that individuals would have to go through
their physician to get an order to get a hearing test
and the experts on providing hearing tests or audiologists,
to think that they would have to go
and get an order from a physician
to have Medicare pay for their hearing test,
or their audiology services, or whatever through Medicare,
I think that's ridiculous, it is absolutely ridiculous.
This is something that we've been fighting for for a while.
It just adds costs to individuals with hearing loss
and it delays treatment for individuals with hearing loss.
And it's relying on arguably a profession
who does not understand hearing loss
as well as an actual audiologist does who controls
whether or not someone can actually get a hearing test
provided through Medicare.
So it just seems silly to me
how they wouldn't change that as well.
You're already kind of opening up
and calling audiologists practitioners inside of Medicare,
take it the step further
and remove this physician order requirement
that is bad for basically everybody,
even the physicians who are like, okay,
you know, they're just being bombarded with requests
to send an order to an audiologist
so a hearing test can be done and billed to Medicare.
So it's silly when you really think about it.
But those are really the main things
that I wanted to talk about here.
As this particular act was essentially approved
through the House, very minimal changes to it.
Hearing aids within Medicare is basically,
I think the only change that was made to Medicare in this,
everything else was removed, which kind of shows you
where the influence of money lies, I guess I would say,
if certain health services were going to be included
inside of Medicare and the lobbyists were successful
at getting those things pulled out,
and the lobbyists on the other side were successful
at keeping things in.
So that just kind of shows you where the incentive lies
in terms of money when it comes to
including this stuff inside of Medicare.
The other thing here is that
just because the House approved this
does not mean that this is in its final form.
There are going to be changes
to some degree done by the Senate,
and the Senate might not even approve any of this.
They're really in a rush
to try to get this thing to happen before Christmas,
because then you start having midterm elections happening
and that kind of throws things all up in the air
and things tend not to get done
'cause everyone just cares about
getting reelected at the midterm.
So who knows, if, and when this will actually go through?
Who knows if hearing aids stay inside of this?
There are some, I would say,
rather conservative Democrat politicians
inside of the Senate who may not like any or all of this
and who may just refuse to vote on this.
And even if things are approved through the Senate,
it all has to go back to the House again to get revoted on.
But if it makes it back to the House,
you can rest assured that is probably going to be voted on
and passed essentially at that point in time.
So again, a lot of this stuff's speculation,
just kind of like my thoughts on all of this,
where it's at, where it's going.
We'll see if this ultimately ends up being a good thing
for individuals with hearing loss,
or a bad thing for individuals with hearing loss,
because it could quite honestly go either way.
We'll see if this actually increases
the quality of care of hearing treatment,
or rather just increases accessibility to hearing treatment.
But there's arguments to be made across the board of
whether or not accessibility is more important than quality
and vice versa.
To be quite honest with you,
we need a combination of the both of them.
So whatever ends up getting passed,
if it has the ability to allow individuals
to still receive high quality of care
by getting hearing aids through Medicare
and then individuals who have affordability issues,
or accessibility issues,
if those individuals can at least get something
to treat their hearing loss, that's a positive as well.
But I don't see why this can't be a win-win
for everybody involved.
And really that's what I hope it ends up becoming
because if it ends up being a win-lose situation,
things are gonna get ugly out there in the real world
when it comes down to treating hearing loss
and treating hearing loss successfully.
So that is really all that
I wanted to talk about today, guys.
I hope you had a fantastic Thanksgiving,
this is still Thanksgiving weekend.
I'm enjoying some time with family,
but if you guys liked this video, like I say before,
go ahead and give it a thumbs up,
it really helps out the channel.
And that being said, I really appreciate it
and I'll see you next week.
(upbeat music)