Direct Access FAQs
Direct access (i.e., giving the patients the option to see an audiologist directly without the need for a physician referral) would ensure high-quality hearing health care for Medicare beneficiaries. This document addresses some of the questions and concerns that have been raised about direct access.
Why should the Medicare patient have direct access to an audiologist for hearing health care?
Audiologists are professionals with graduate degrees who specialize in the evaluation and the diagnostic testing of hearing and balance disorders. At the minimum, all audiologists hold masters degrees and complete clinical practicums. Audiologists fulfill at least nine months of full-time internship and pass a national certifying examination. To further meet the demands of new technology and better treatment modalities, the audiology curriculum has been mandated to be a doctoral-level program by the year 2012.
What coursework is required in the audiology training program?
Audiology degree programs mandate coursework in auditory anatomy and physiology, hearing and balance disorders, speech and hearing science, pharmacology, psychoacoustics, and differential diagnosis. In addition, the audiologist is trained to perform the appropriate hearing test battery to fully evaluate the auditory pathways. As testing reveals abnormal conditions, the audiologist is taught to recognize different types of pathology. This educational foundation allows the audiologist to be proficient in knowing when to refer to the physician for medical diagnosis and medical/surgical intervention. The audiologist is also trained to recommend appropriate amplification when medical or surgical management is not indicated.
Would direct access compromise high-quality care?
Besides being trained to perform a comprehensive test battery that identifies the presence and type of hearing loss, audiologists have the expertise to properly differentiate between cases that require medical intervention or those that do not. In view of the fact that the majority of geriatric hearing loss (80 to 90 percent) does not require medical treatment, the audiologist is eminently capable of providing hearing health care that is appropriate for the condition.
Does outcome data prove that direct access to audiologists benefits the patient without compromising health care?
Yes, direct access is included in the Federal Employees Health Benefit Plan (FEHBP), and is an accepted protocol for third party payers, such as PPOs. The programs' experiences show that direct access provides both cost-effective and quality care. In addition, many patients find direct access to be less intimidating than first seeing a physician for hearing complaints. The Centers for Medicare and Medicaid Services (CMS) should follow suit with other federal health programs.
Are there other non-MD/DO health care providers who can see Medicare beneficiaries without physician referral?
Yes, the Medicare system provides for many different types of allied health care professionals to see patients by direct access. Specifically, Medicare allows Medicare beneficiaries to see all of the following:
- oral surgeon
- clinical nurse specialist
- clinical psychologist
- clinical social worker
- nurse practitioner
- physician assistant
Will the physician or patient be harmed by direct access?
The existing paradigm that allows patients direct access to audiologists has proven that referrals to physicians for medical and surgical conditions of the hearing and balance systems have been timely and appropriate. When an audiologist suspects a pathologic condition the patient is referred to the physician for medical diagnosis intervention. Currently, physicians who have a collegial relationship with the audiologist see increasing numbers of patients who might not otherwise have received medical care.
Are audiologists attempting to expand their scope of practice, or to usurp the role of physicians?
No, audiologists are not seeking to expand their scope of practice through direct access. Scope of practice is governed by state licensure laws and cannot be expanded except by amending those laws.