Jacksonville, Fla – In a study published in the Journal of the American Academy of Audiology, Zapala et al investigated whether it was safe for Medicare beneficiaries to self-refer to audiologists for evaluation of hearing loss. Some clinicians have been conerned that audiologists might miss significant otologic conditions.
The retrospective study "Safety of audiology direct access for medicare patients complaining of impaired hearing looked at 1550 records comprising all Medicare eligible patients referred to the Audiology Section of the Mayo Clinic Florida in 2007 with a primary complaint of hearing impairment.
Assessment and treatment plans were compiled from the electronic medical record and placed in a secured database. In the first group. pecords of patients seen jointly by audiology and otolaryngology practitioners were reviewed by four blinded reviewers, two otolaryngologists and two audiologists, who judged whether the audiologist treatment plan, if followed, would have missed conditions identified and addressed in the otolaryngologist’s treatment plan.
In a second group, records of patients seen by audiology but not otolaryngology were evaluated by a neurotologist who judged whether the patient should have seen an otolaryngologist based on the audiologist’s documentation and test results.
The researchers found that in the first group who saw both the audiologist and otolaryngology practitioners, there were no audiology discrepant treatment plans in over 95% of cases. In no case where a judge identified a discrepancy in treatment plans did the audiologist plan risk missing conditions associated with significant mortality or morbidity that were subsequently identified by the otolaryngologist.
For group two, neurotologist judged that audiology services alone were all that was required in 78% of cases. An additional 9% of cases were referred for subsequent medical evaluation. The majority of remaining patients had hearing asymmetries. Some were evaluated by otolaryngology for hearing asymmetry in the past with no interval changes, and others were consistent with noise exposure history.
The authors conclude in the abstract, "These findings are consistent with the premise that audiology direct access would not pose a safety risk to Medicare beneficiaries complaining of hearing impairment."