Wisconsin Act 82 – December 7, 2023
Wisconsin Act 82 – December 7, 2023
WAA opposed this legislation. In November 2023, we formed Wisconsin Audiology Advocates to have a unified voice to express our concerns about a bill that had been passed in the Wisconsin Senate and was up for a vote in the Assembly. This bill would allow Hearing Instrument Specialists to remove cerumen after taking a 6-week course and obtaining a certificate from DSPS.
Wisconsin Speech Language and Hearing Association (WSHA) had been notified about this legislation in August but did not notify or survey its members about this bill. They remained neutral, signaling to the legislators that the bill was not objectionable to WSHA and thereby O.K. with audiologists. After unsuccessful attempts to work with WSHA, requesting the WSHA Board to change their position to “oppose,” we saw the urgent needed to act.
Within two weeks in late November, a core group of audiologists were able to form Wisconsin Audiology Advocates (WAA) as a legal entity, hire our own lobbyist, and unite audiologists from around WI to present a unified voice for our professional concerns.
a) The bill poses threats to patients’ health, well-being, and access to quality care. Cerumen (earwax) management is a medically necessary treatment that is not simply “removing ear-wax.” It involves the use of metal curettes, forceps, and specula, as well as an array of irrigation and suctioning equipment. Ear irrigation can involve pressurized water and/or force.
b) Consumers are at risk of permanent harm by allowing individuals who do not have in-depth knowledge of the necessary equipment and skills to perform these procedures.
Done improperly, cerumen management can rupture not only the eardrum, but the inner ear which causes permanent, traumatic, and irreparable hearing loss. Other complications associated with improper cerumen removal include otitis externa, pain, dizziness, syncope, tinnitus, and even cardiac arrest.
c) Cerumen (earwax) removal is outside the intent and scope of the Hearing Instrument Specialists (HIS) occupational training program, which is focused on equipping individuals to fit and sell hearing aids. Wisconsin Statutes 459.06 describes the requirements for HIS: A high school degree or equivalent and passing an exam testing knowledge of key areas as they pertain to the fitting of hearing aids.
d) SB419 recognizes that at the present time, HIS are not qualified to perform cerumen management and mandates additional training. However, a short course (“at least six hours” according to the bill) in cerumen removal does not suffice to give an HIS the knowledge and expertise needed to provide cerumen management or remedy cerumen impaction.
e) There is no mention in this legislation of the need to obtain prior informed consent from the consumer and no mention of the need to explain that an HIS will charge for this procedure. Cerumen removal is considered a surgical procedure by CMS and it is covered by medical insurance including Medicare and Medicaid.
f) Getting the right care at the right time from a properly trained professional is not a barrier to care; it is a necessity to keep patients healthy, safe, and hearing well. Cerumen management requires access to and understanding of medical information regarding the consumer’s ear health to properly identify elderly (frail skin), diabetic (subject to infection – irrigation contraindicated), have underlying ear health condition such as external otitis or mycosis (fungal infection) or a history of ear trauma, perforation, or ear surgery.
h) Wisconsin would be an outlier in allowing HIS to perform cerumen management. Most states do not allow this.
Despite the tireless work of our group to inform audiologists around the state about the existence of this bill, to communicate with members of the State legislature about our concerns on behalf of public safety, it passed on December 7th.
WAA is involved in writing the legislative rules for Act 82.