meeting the challenges of va audiology care in the 21 st century lucille b. beck, ph.d. chief...

Meeting the Challenges of Meeting the Challenges of VA Audiology Care in the 21VA Audiology Care in the 21stst Century Century Lucille B. Beck, Ph.D.Lucille B. Beck, Ph.D.Chief Consultant for Rehabilitation Services, and Director, Chief Consultant for Rehabilitation Services, and Director, Audiology and Speech Pathology ServiceAudiology and Speech Pathology Service

Disclaimer: The opinions expressed herein are solely those of the author and do not necessarily reflect the views or official policies of the United States Government or the Department of Veterans Affairs.

VETERANS HEALTH ADMINISTRATION

VA MissionVA Mission To serve America's Veterans and their families with dignity and

compassion and to be their principal advocate in ensuring that they receive the care, support and recognition earned in service to this Nation.

VHA core missions: —Health Care—Graduate Medical Education—Research—Emergency Preparedness


2121stst Century VA Health Care Century VA Health Care People Centric

Honor and Serve Veterans and Their Families Embrace VA Core Values of Compassion, Integrity, Respect, and Commitment Engage, Inspire, and Empower Employees

Results Driven Ensure Improved Access for All Veterans Provide High-Quality Care and Exceptional Client Relationship Management Leverage Technology and Adapt Business Processes with Agility Demonstrate Leadership, Accountability, and Effective Results

Forward Looking Communicate Widely and Effectively and Conduct Systematic Outreach and Collaboration Anticipate Veterans Needs and Be Pro-Active in Meeting Them Develop a VA Culture that Is Forward Looking, Innovative, and Veteran-Focused


VA Health CareVA Health Care Honor America's Veterans by providing exceptional health care that

improves their health and well-being.

The largest integrated healthcare system in US:—152 hospitals—135 community living centers—209 veterans counseling centers—807 community based outpatient clinics (CBOC)

$2 billion budget for prosthetics and sensory aids

VHA manages the largest medical education program in the U.S, partnering with 107 medical schools, 55 dental schools and 1,200 other schools. Over 109,000 health care professionals train in VA each year.


The Veterans We Serve…The Veterans We Serve… All Veterans

– 22.2 million Veterans and 35.2 million spouses and dependents of Veterans

– Vietnam Era Veterans are the largest group (7.4 million)– Women comprise 8.1% of Veterans– About 20% of the nation's population, over 58 million people, are

potentially eligible for VA benefits and services. Veterans enrolled for VA health care

– 8.3 million– 555,984 women Veterans enrolled– 5,675,844 Veterans treated in FY11


1,512,699 encounters (+9% over FY10)

756,345 unique Veterans (+10% over FY10)

134,000 Veterans per month

3,979,345 procedures performed (+10% over FY10)

Audiology Workload (FY2011)Audiology Workload (FY2011)

Source: VHA Support Service Center


Audiology Staffing (FY2011)Audiology Staffing (FY2011)

920 clinical audiologists (6% increase over FY10)24 research audiologists284 health technicians (audiology assistants)-• 10% increase over FY10305 sites of care


Graduate Education and TrainingGraduate Education and Training For Academic Year 2012-2013, VA awarded 62 Doctoral Externships and 73 Doctoral Clinical Rotations.

― Externships are one-year advanced training experiences for 4th year students. Rotations are 350-hour training for 1st, 2nd , and 3rd year students.

Competitive training site selection based on standards of excellence criteria:

―Training to full scope of practice―Emphasis on inter-professional education

Emphasis on evidence-based practice: defining quality and outcomes of care


Leveraging Information TechnologyLeveraging Information Technology Equipment interfaces send audiometric data into the VA electronic health record and hearing aid ordering system.

Automated hearing aid and auditory device ordering and tracking system (ROES).

−Automated outcome measures (IOI-HA) −Outcomes analysis by age, degree of loss, hearing aid make/model or form factor by facility, network, or national−Ear impression scanning project (Boston Evaluation Project)

National hearing loss repository (over 1.5 million audiograms stored)― VA researchers have begun to mine the database and publish articles.


Hearing AidsHearing Aids Best technology anywhere.

Digital Hearing Aid Contract (November, 2009):– VA exercised the second option year under the contract in November.

Other national contracts:– Cochlear Implants– Assistive listening devices– Wireless devices and adaptors– Ear molds (in development)

DoD Centers use VA national contracts (2% of procurement)


FY2011 Hearing Aid StatisticsFY2011 Hearing Aid Statistics 596,443 hearing aids (+6% over FY2010)*

Net procurement: $207 million

Batteries: 59.3 million, $6.3 million

Repairs: 358,350, $14.5 million

*Reporting period: 9/25/10 to 9/24/11

Source: Commodity Sales Report, VA Denver Acquisition and Logistics Center


Hearing Aid Trends (1996-2011)Hearing Aid Trends (1996-2011)

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Contract TrendsContract TrendsDistribution of Procurement by Category:

Category Base* Option I** Group 1 (ITE) 34.52% 30.83%Group 2 (BTE) 40.83% 32.51%Group 3 (RIC) 16.82% 26.63%Group 4 (CROS/BICROS) 0.23% 0.20%

Items: 597,202 633,062Average Cost: $348.15 $344.39 Total Sales: $207,913,336 $218,020,196

*Base Year 11/1/09 to 10/31/10**Option I Year 11/1/10 to 10/31/11

Source: VA Denver Acquisition and Logistics Center


Hearing Aid Outcomes (IOI-HA) Hearing Aid Outcomes (IOI-HA) Scoring: 1=poorest outcome, 5=best outcomeQ1 Use: 4.43 Q2 Benefit: 3.99 Q3 Residual activity limitation: 3.75Q4 Satisfaction: 4.35 Q5 Residual participation restriction: 3.70 Q6 Impact on others: 3.82 Q7 Quality of life: 4.03 Veterans’ self-perceived hearing difficulty ranged from 2.53

(moderate to moderately-severe) for mild HL to 1.39 (moderately-severe to severe) for profound HL.


Hearing Aid Outcomes (IOI-HA) Hearing Aid Outcomes (IOI-HA) VA has collect over 30,000 outcomes.HL Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8Mild 2.53 4.34 4.07 3.85 4.40 3.75 3.89 4.05Mod 4.47 4.07 3.85 4.40 3.75 3.89 4.05 2.18Mod-Sev 4.67 4.10 3.59 4.45 3.54 3.61 4.06 1.71Severe 4.76 4.02 3.44 4.40 3.37 3.40 4.06 1.43Profound 1.39 4.77 3.68 3.48 4.32 3.65 3.29 3.61FY10 Average 4.43 3.99 3.75 4.35 3.70 3.82 4.03 2.34FY11 Average 4.43 4.07 3.81 4.41 3.76 3.85 4.06 2.34

Norm* 4.50 3.52 3.19 3.84 3.38 3.38 3.68Norm** 3.73 3.39 3.40 3.20 3.57 3.79 3.19*Moderately-severe to severe perceived hearing difficulty group data** Mild to moderate perceived hearing difficulty group data


Growth in Tele-RehabilitationGrowth in Tele-Rehabilitation


Distribution of Tele-Rehab ServicesDistribution of Tele-Rehab Services


Growth in Tele-AudiologyGrowth in Tele-Audiology


Audiology Telehealth Pilot ProgramAudiology Telehealth Pilot Program Community Based Outpatient Clinic (CBOC )hearing aid tele-

programming using remote control software with hearing aid fitting software at 10 pilot sites (rural locations)– Telehealth Technician staffing

All sites equipped with telehealth equipment and software− Telehealth cart (video conferencing, dual monitors, PC)− Equipment (audiometer, immittance, real-ear, video

otoscope, programming interfaces) Pilot sites will collect outcome and satisfaction data, provide

“lessons learned”, and contribute to a national toolkit to facilitate national roll-out.


VA Innovation Initiative (VAi2)VA Innovation Initiative (VAi2) VAi2 is a flagship program designed to tap the talent and expertise of

individuals both inside and outside government to contribute new ideas that produce visionary solutions to advance VA’s ability to meet the challenges of becoming a 21st-century organization.

Audiology Telehealth solutions in the FY2011 VA Innovation Initiative (VAi2) competition, announced on February 15, 2011.

VAi2 is now working with the winning innovators to refine their proposals into well-defined projects with milestones, deliverables, and a pilot phase.

http://www.va.gov/vai2/


VA Tinnitus ManagementVA Tinnitus Management Tinnitus requires a holistic, patient-centered, inter-disciplinary approach,

significant association with brain injury, noise exposure, hearing loss, ear disease, many medical conditions, and medications.

Progressive Tinnitus Management (PTM)* is a five-level progressive treatment approach:

Triage and referral־Auditory evaluation־Structured interviews־Counseling and group education־Tinnitus evaluation־Individualized management־

*Developed by the National Center for Research in Auditory Rehabilitation


Defense Hearing Center of ExcellenceDefense Hearing Center of Excellence

HCE serves as the ‘unified voice’ for the DoD, VA and other federal agencies regarding the prevention, diagnosis, mitigation, treatment, rehabilitation, and research of hearing loss and auditory system injuries.

Air Force has lead responsibility for development. Joint Hearing and Auditory System Injury Registry (JHASIR) Concept of Operations (CONOPs)

was approved. Efforts are underway to integrate existing DOD and VA audiogram data systems.

VA Audiology Program Office is collaborating closely with DOD on development of HCE.


Military Separation Health Military Separation Health AssessmentAssessment Legislation (NDAA ,2005) requires service members to receive

a physical evaluation at separation.

Audiogram is a mandatory part of the Separation Health Assessment, to be completed within 6 months of separation.

Audiograms will be stored in a DoD hearing surveillance database called DOEHRS-HC.


Auditory DisabilitiesAuditory DisabilitiesCondition Number of VeteransTinnitus 744,871Hearing loss 672,410• 1,525,066 Veterans have disabilities in the Auditory Body System,

12.1% of all disabilities• 92,260 veterans began receiving compensation benefits for tinnitus and

63,583 veterans began receiving benefits for hearing loss in FY2010.

Source: VBA Annual Benefits Report, 2010


Audiology C&P ExamsAudiology C&P ExamsAUDIO EXAM (hearing loss & tinnitus) is the second most commonly requested exam after general medical exams. Over 156,000

audiology C&P exams performed in FY2011 (12% of all C&P exams) at a cost of $42 million.

Specialty Exams VeteransGeneral Medical 473,835 390,444Audiology 156,554 141,160Psychology 71,005 65,086Orthopedics 50,516 45,859Psychiatry Consult 43,736 37,977Psychiatry Ind 38,287 35,211Mental Health Ind 34,625 32,098Neurology 22,510 20,080Optometry 19,299 18,356Ophthalmology 17,690 16,389

VA performed 1.6 million C&P exams on over 1.1 million Veterans and active duty Service members at a cost of $548 million.

Source: DSS Rehabilitation Report, VHA Support Service Center


Compensation TrendsCompensation Trends

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Hearing Loss

Tinnitus


Thanks for ListeningThanks for ListeningWith malice toward none, with charity for all, with firmness in the right as God gives us to see the right, let us strive on to finish the work we are in, to bind up the nation's wounds, to care for him who shall have borne the battle and for his widow and his orphan, to do all which may achieve and cherish a just and lasting peace among ourselves and with all nations.

Abraham Lincoln, Second Inaugural Address, March 4, 1865

meeting the challenges of va audiology care in the 21 st century lucille b. beck, ph.d. chief...

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