Audiology Practice in Transition : How to Remain R elevant and Ethical in the 21 st Century

2. Audiology Practice in Transition:How to Remain Relevant and Ethical in the 21st Century Erin L. Miller, Au.D. The University of Akron Northeast Ohio Au.D. Consortium

3. Disclosure President-Elect

4. Disclosure Coordinator, Northeast Ohio Au.D. Consortium (NOAC) Clinical Faculty, The University of Akron

5. Disclaimer "The opinions and assertions presented are the private views of this presenter and are not to be construed as official or as necessarily reflecting the views of the American Academy of Audiology or the University of Akron or the NOAC."

6. Learner Outcomes • Describe current professional issues impacting the provision of audiologic care • Identify ways to be successful amidst the changes in healthcare • Identify and examine the ethical dilemmas that new delivery models of audiologic care pose to practitioners

7. Outline • Ethics Review • Changing environment for healthcare practitioners • Current hot topics in audiology • Strategies to manage audiology’s “new reality” • Ethical dilemma’s that may result from our “new reality”

8. Ethics Again Why here… Why now

9. Ethics here, there and everywhere…

10. Continuum of Professional Obligations Professionalism Ethics Law Shoup & Garner, 2012

11. Considerations • Professionalism • Expected behaviors • Accountability to one’s peers • Ethics • Beneficial actions to patients • Accountability to one’s peers and patients • Law • Accountability to legislation or regulation Shoup & Garner, 2012

12. Why study ethics? • Ethical dilemmas are an inevitable part of professional and clinical practice • We need a framework for resolving ethical dilemmas to help guide the audiologist’s decision-making

13. Ethics Evolution • Ethical standards in society evolve • Ethical standards in professional associations evolve • Dispensing hearing aids

14. Morals and Ethics

15. Morals • Morals are shaped by ones own individualized values or beliefs • Influenced by one’s family, religion, culture, and individual character development

16. Ethics • Ethics is the science that explains the valuing process • Ethical behavior is governed by following an agreed uponset of standards

17. Ethics • You may be bound by one or more codes of ethics • State Licensure Code of Ethics • Professional Association Code of Ethics

18. Why do we need a Code of Ethics? • Patients place a high degree of trust in the practitioner • Protect the integrity of the profession • Always best to govern ourselves rather than be governed by others

19. Why should professionals support codes of ethics? • COE serves as a collective recognition by members of a profession of its responsibilities • COE helps create an environment in which ethical behavior is the norm • COE serves as an educational tool • Code can indicate to others that the profession is seriously concerned with responsible and professional conduct

20. Principles of Healthcare Ethics • Autonomy • Beneficence • Nonmaleficence • Justice • Confidentiality • Fidelity • Accountability • Veracity

21. Autonomy • Patients right to make their own decisions • Informed, competent adult patients can accept or refuse treatments • Decisions must be respected

22. Beneficence • To do the most good for the patient in every situation • Consider each situation individually • May in some cases require us to go beyond the treatment or services we typically provide

23. Nonmaleficence • “First, do no harm” • Doctrine of “double effect” – where a treatment intended for good unintentionally causes harm

24. Justice • Be fair when offering treatments and allocating scarce resources • Requires us to be non-judgmental – able to justify all actions

25. Confidentiality • Both legal and ethical considerations • Only time this can be violated • If the patient may harm themselves or someone else • When the patient gives permission for the information to be shared

26. Fidelity • Loyalty • Promise to fulfill your commitment to your patient

27. Accountability • Individuals need to be responsible for their own actions • We are also accountable to our colleagues and our profession

28. Veracity • Implies “truthfulness” • Important component to building a trusting relationship with your patient

29. Case Scenerio #1 • 86 yo female patient referred by ENT for hearing aid evaluation • Medical hx of cholesteatoma • 12 yo hearing aid no longer functioning for her • Eligible for Medicaid hearing aid • HAE completed and HA selected • Medicaid hearing aid clearance form requested and completed by ENT

30. Case Scenerio #1 • At HAF discovered that according to the completed form, ENT did not clear her for a hearing aid • Case notes from ENT visit recommends surgery however, patient and family member declined and subsequently referred for HAE • Discuss clearance form with physician and he declines to revise form without seeing the patient to further discuss surgery • Patient does not want to return to see ENT for repeat discussion

31. Case Scenerio #1 • What are your options? • Does this follow healthcare ethics? • Does patient have a choice? • What issues are present? • What do you do with the hearing aid?

32. Healthcares Changing Landscape • Current system of healthcare in US is unsustainable • Changes must be made • Audiology is seeing some of these changes • New delivery models for hearing evaluations • New delivery models for hearing instruments

34. The Patient Protection and Affordable Health Care Act, H.R. 3962

35. The Patient Protection and Affordable Health Care Act, H.R. 3962 All 2407 pages

36. The Patient Protection and Affordable Health Care Act, H.R. 3962 We have to pass the Bill so that you can find out what is in it! All 2407 pages

37. The Patient Protection and Affordable Health Care Act, H.R. 3962 Signedinto Law March 23, 2010 All 2407 pages

38. Comparison to Other Entitlement Laws PASSED 1935 372-33 77 - 6 PASSED 1965 313 - 115 68 - 21 After Tate, 2013

39. Comparison to Other Entitlement Laws PASSED 1935 PASSED 2010 PPACA 220 - 215 372-33 77 - 6 56 - 44 PASSED 1965 313 - 115 68 - 21 After Tate, 2013

40. Comparison to Other Entitlement Laws PASSED 1935 PASSED 2010 PPACA 220 - 215 372-33 77 - 6 56 - 44 PASSED 1965 313 - 115 Supported 5 – 4 68 - 21 After Tate, 2013

41. PPACA (aka ACA) GOALS • Greater access to healthcare • 37 million without healthcare • 50 million in US • 13 million not eligible and illegal aliens • Puerto Rico opted out of health exchanges/Federal monies used to support Medicaid program through 2019 • Reign in out of control healthcare costs • Focus on quality rather than quantity • Moves away from fee for service – “value” • Add benefits and protection • No penalties for pre-existing or chronic health conditions • Miscellaneous issues • Pilot programs

42. Health Care Reform • Requires US citizens to carry health insurance • Implements the use of state health exchanges for purchasing insurance • Establishes Essential Health Benefits (EHB’s) to be included in all plans – defined by state • Companies >50 or more employees must offer coverage • Medicaid expansion

43. Health Care Reform • Requires US citizens to carry health insurance • Implements the use of state health exchanges for purchasing insurance • Establishes Essential Health Benefits (EHB’s) to be included in all plans – defined by state • Companies >50 or more employees must offer coverage DELAYED UNTIL 2015 • Medicaid expansion

44. Concerns in Puerto Rico • Medical Licensing and Studies Board: number of doctors in Puerto Rico dropped by 13 percent in the last five years • 11,397 to 9,950 • Biggest loss was among primary care physicians

49. Health Care Reform Challenges • Reduce cost of care • Bundled or episodic payments • Value based • All stakeholders participate in the economics • Providers do more for less • Organizations take reimbursement risk • Beneficiaries to pay some of the cost

50. The Stakeholders • Providers • Consumers • Payers and health plans • Suppliers (“vendors”) • Society • Government