Aural Rehabilitation Support Programs for Adults

Abstract

Since the end of World War II, the American health-care system has generally operated under the traditional fee-forservice reimbursement model that provides little incentive for service-care providers to cut costs, resulting in unnecessary care. 1 High volumes of unnecessary care have, in part, driven the cost of health care to at least 20% of the gross domestic product (GDP) by the end of the century. 1 Managed care has been offered as one way to reduce the costs of health care by combining financing, clinical services, and management under one system. 2 Audiologists often participate in managed care by affiliating with a hearing care network consisting of other audiologists in the same geographic area who contract with health-maintenance organizations (HMOs) to provide hearing health-care services to enrollees. 2,3 Many HMOs expect audiologic testing to be capitated under the primarycare physician and contract only for hearing aids. Unfortunately, few hearing plans have provisions for aural rehabilitation beyond the fitting of hearing aids. Many sole-proprietor private practitioners fear hearing networks and feel pressured to either affiliate with networks or lose their patients and/or provide less than adequate care. 4-6 To compete in today's hearing health-care system, audiologists must adopt a proactive approach to managed care and design innovative models of aural rehabilitation to meet the audiologic needs of patients in the new millennium.Innovative models of adult aural rehabilitation are needed to manage the hearing impairments of the 33 million Americans-13% of the population, over the age of 65. 7 ABSTRACT The number of individuals aged 65 years and older is expected to increase dramatically during the next 30 years. The Medicare caps on rehabilitation services experienced in the 1990s may be just a preview of the future limitation of services as an overextended health-care system attempts to provide for an unprecedented number of senior citizens. Innovative audiologic service-delivery models are needed to meet the hearing health-care needs of this population. The purpose of this article is to discuss the establishment of aural rehabilitation support programs in health-care and long-term, residential-care facilities for the elderly.