The 18 by 18 Movement: Common Sense and a Common Purpose for Audiology

Author: Nancy Green, Au.D.

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When Thomas Paine published Common Sense in 1776, he challenged the authority of the British government and the British monarchy, publicly and bravely on the basis of what he believed. Common Sense shouted from its pages justification for the independence for the American colonies from Britain and is still considered one of the most influential publications in American history.

As Paine exemplifies, the right outcome is often the most difficult to birth. It calls upon us to sacrifice, based on what we believe--not based on what we are certain to achieve. It requires faith, certain fear and the willingness to risk complete failure.

ADA has a rich history of challenging authorities based on its ideals and the beliefs of its members. ADA and its members commenced the 18X18 Initiative to introduce legislation that will amend Title XVIII of the Social Security Act by 2018 to provide for treatment of audiologists as physicians for purposes of furnishing audiology services under the Medicare Program, to provide for a broadened scope of audiology services available for coverage under the Medicare program and to enable Medicare beneficiaries to have their choice of qualified audiologist.

“A long habit of not thinking a thing wrong, gives it a superficial appearance of being right, and raises at first a formidable outcry in defense of custom. But the tumult soon subsides. Time makes more converts than reason.”
Thomas Paine, Common Sense

The 18X18 initiative challenges the current model of delivery for audiologic services to Medicare recipients and challenges current authorities to rethink outdated paradigms of care. We believe that this legislation will result in both higher quality and less expensive audiologic care for Medicare beneficiaries, while protecting audiologists and the public we serve.

The 18X18 Movement represents the common-sense approach to the provision of audiology services under Medicare and it considers the best interests of both the patient and the professional. There has been a tremendous amount of support and momentum for 18X18 already—by ADA members and beyond. In addition to ADA, the South Carolina Academy of Audiology, the Georgia Academy of Audiology, and the Audiological Resources Association have all formally endorsed the 18X18 draft legislation.

We concede that this 18X18 notion is revolutionary and that it will be difficult. There are those who will argue that the 18X18 legislation is too ambitious and that we should take the more measured approach of settling for direct access or expanded coverage alone.

We choose to undertake the bigger 18X18 initiative to accomplish Limited License Physician status, and direct access, and expanded coverage, not because it is more feasible, but because it is more important and more necessary. We believe that audiologists are willing to accept this difficult challenge as the best use of our passion, time, money and talent, because to settle for less would be a disservice to our patients and to our colleagues.

I was recently asked to quantify the expected financial cost savings that 18X18, if enacted, will provide to the Medicare program. There is some data already in the marketplace, and from a scientific perspective, I am looking forward to gathering and distributing new evidentiary support for the 18X18 movement. However, we must recognize that if Thomas Paine had waited to conduct a study or to survey the British to see if the idea of American autonomy would resonate well before moving forward with such a revolutionary idea, then we would still be pledging our allegiance to a Union Jack!

18X18, and the transformative changes that we seek, come from the ideals, beliefs and values that we hold—the things that cannot be quantified in facts and figures. There is nothing more important at this stage than clearly articulating WHY we believe that 18X18 is so important to our members and the patients that we serve.

The goal and the role of the audiologist have always been to provide exceptional care to our patients and to advance the profession by advancing best clinical and business practices. As we have worked tirelessly to enhance patient care and improve outcomes, we have also worked tirelessly to achieve professional autonomy. In order for us to continue to enhance patient care and to succeed as a doctoral-level profession in the future, we must be recognized by our patients, consumers, regulatory and legal authorities and indeed all constituents as the rightful entry point for audiologic care—and the autonomous entry point. 18X18 legislation will accomplish this in a way that no other initiative will. If you believe what we believe, please tell your friends and colleagues about 18X18, encourage them to join the movement, and take action by becoming an active advocate for audiology in your community. Together we have transformed this profession many times in the past—and together we will transform it today and tomorrow.