On May 1, 2017, U.S. Rep. Tom Rice (R-SC) introduced the Audiology Patient Choice Act of 2017. The bill proposes two major provisions. The first provision would amend Title XVIII of the Social Security Act to include audiologists in the definition for "physician." The second provision would allow audiologists unlimited, direct access to Medicare patients without the need for supervision or referral from a physician.
The American Academy of Otolaryngology – Head and Neck Surgery (AAO-HNS) opposes this bill and has reached out to state medical associations and societies seeking support for its position. Similar legislation from the last congressional session was opposed by more than 120 state, local, and national medical-related organizations, including PAMED and the Pennsylvania Academy of Otolaryngology – Head and Neck Surgery. AAO-HNS has raised concerns about the following in regards to allowing audiologists unlimited, direct access to Medicare patients without a referral from a physician under the proposed bill:
- Patient Safety: Patient safety would be compromised by allowing an audiologist to bypass the physician's initial evaluation. Without an evaluation, the physician could not determine the appropriate treatment for the patient's condition. This could lead to a patient being misdiagnosed and/or receive unnecessary, or worse, fatal treatment. Unnecessary tests or services would cause the patient to suffer economic loss. The Centers for Medicare and Medicaid Services (CMS) has stated that the physician's initial evaluation is crucial to make sure the patient is only receiving medically necessary services. The additional tests might not be covered under Medicare in which the patient would have to absorb the cost. These tests or services might also have a lasting impact on the patient or cause harm.
- Quality of Care: The quality of care would diminish by deleting the initial evaluation performed by a physician. Since audiologists are not medically trained, they cannot provide the appropriate medical services as compared to physicians. Without proportional medical training, patients cannot be treated with the same level of quality they would receive from a physician. If the need to be seen by a physician is taken away, the quality of care is compromised.
- Access to Care: The access to the highest quality of health care would be compromised. Expanding the population of whom audiologists may treat does not solve the access to care problem. Physician shortages have been a recognized problem. However, allowing audiologists access to Medicare patients expands access to care that is not of the highest quality. Audiologists often times work in the same regions as physicians, so the physician shortage would not be helped.
PAMED is currently reviewing this legislation to determine what position, if any, it will take on this bill.