J Am Acad Audiol 2020; 31(09): 666-673
DOI: 10.1055/s-0040-1717137
Research Article

Insurance Payer Status Predicts Postoperative Speech Outcomes in Adult Cochlear Implant Recipients

Sharon E. Miller
1   Department of Audiology and Speech-Language Pathology, University of North Texas, Denton, Texas
,
Chelsea Anderson*
1   Department of Audiology and Speech-Language Pathology, University of North Texas, Denton, Texas
,
Jacy Manning*
1   Department of Audiology and Speech-Language Pathology, University of North Texas, Denton, Texas
,
Erin Schafer
1   Department of Audiology and Speech-Language Pathology, University of North Texas, Denton, Texas
› Author Affiliations

Abstract

Background Cochlear implant qualifying criteria for adult patients with public insurance policies are stricter than the labeled manufacturer criteria. It remains unclear whether insurance payer status affects expedient access to implants for adult patients who could derive benefit from the devices.

Purpose This study examined whether insurance payer status affected access to cochlear implant services and longitudinal speech-perception outcomes in adult cochlear implant recipients.

Research Design Retrospective cross-sectional study.

Study Sample Sixty-eight data points were queried from the Health Insurance Portability and Accountability Act–Secure, Encrypted, Research Management and Evaluation Solution database which consists of 12,388 de-identified data points from adult and pediatric cochlear implant recipients.

Data Analysis Linear mixed-effects models were used to determine whether insurance payer status affected expedient access to cochlear implants and whether payer status predicted longitudinal postoperative speech-perception scores in quiet and noise.

Results Results from linear mixed-effects regression models indicated that insurance payer status was a significant predictor of behavioral speech-perception scores in quiet and in background noise, with patients with public insurance experiencing poorer outcomes. In addition, extended wait time to receive a cochlear implant was predicted to significantly decrease speech-perception outcomes for patients with public insurance.

Conclusion This study documented patients covered by public health insurance wait longer to receive cochlear implants and experience poorer postoperative speech-perception outcomes. These results have important clinical implications regarding the cochlear implant candidacy criteria and intervention protocols.

* Student authors.




Publication History

Article published online:
20 November 2020

© 2020. American Academy of Audiology. This article is published by Thieme.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Wilson BS, Dorman MF. Cochlear implants: a remarkable past and a brilliant future. Hear Res 2008; 242 (1-2): 3-21
  • 2 Gifford RH, Dorman MF, Shallop JK, Sydlowski SA. Evidence for the expansion of adult cochlear implant candidacy. Ear Hear 2010; 31 (02) 186-194
  • 3 Holder JT, Reynolds SM, Sunderhaus LW, Gifford RH. Current profile of adults presenting for preoperative cochlear implant evaluation. Trends Hear 2018; 22: 2331216518755288
  • 4 Sorkin DL. Access to cochlear implantation. Cochlear Implants Int 2013; 14 (Suppl. 01) S1
  • 5 Sorkin DL, Buchman CA. Cochlear implant access in six developed countries. Otol Neurotol 2016; 37 (02) e161-e164
  • 6 Dawes P, Emsley R, Cruickshanks KJ. et al. Hearing loss and cognition: the role of hearing AIDS, social isolation and depression. PLoS One 2015; 10 (03) e0119616
  • 7 Cheng AK, Niparko JK. Cost-utility of the cochlear implant in adults: a meta-analysis. Arch Otolaryngol Head Neck Surg 1999; 125 (11) 1214-1218
  • 8 Centers for Medicare and Medicaid Services. CMS Manual System, Pub 100–03, Medicare National Coverage Determination, Subject: Cochlear Implantation Transmittal 42. In: Services DoHaH. ed. Baltimore, MD: Center for Medicare and Medicaid Services; 2005
  • 9 CochlearAmericas. 2019 Cochlear implants candidacy criteria. Accessed August 8, 2020 at: http://www.cochlear.com/wps/wcm/connect/us/for-professionals/products/cochlear-implants/Candidacy
  • 10 FDA. Medical Device Record. Premarket Approval. Accessed November, 2019 at: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpma/pma.cfm?start_search=1&sortcolumn=do_desc&PAGENUM=500&pmanumber=P960058
  • 11 Gifford RH. Cochlear Implant Patient Assessment. San Diego, CA: Plural Publishing; 2013
  • 12 Gomaa NA, Rubinstein JT, Lowder MW, Tyler RS, Gantz BJ. Residual speech perception and cochlear implant performance in postlingually deafened adults. Ear Hear 2003; 24 (06) 539-544
  • 13 Rubinstein JT, Parkinson WS, Tyler RS, Gantz BJ. Residual speech recognition and cochlear implant performance: effects of implantation criteria. Am J Otol 1999; 20 (04) 445-452
  • 14 Armstrong M, Maresh A, Buxton C. et al. Barriers to early pediatric cochlear implantation. Int J Pediatr Otorhinolaryngol 2013; 77 (11) 1869-1872
  • 15 Lester EB, Dawson JD, Gantz BJ, Hansen MR. Barriers to the early cochlear implantation of deaf children. Otol Neurotol 2011; 32 (03) 406-412
  • 16 Schafer EC, Grisel JJ, de Jong A. et al. Creating a framework for data sharing in cochlear implant research. Cochlear Implants Int 2016; 17 (06) 283-292
  • 17 Peterson GE, Lehiste I. Revised CNC lists for auditory tests. J Speech Hear Disord 1962; 27: 62-70
  • 18 Spahr AJ, Dorman MF, Litvak LM. et al. Development and validation of the AzBio sentence lists. Ear Hear 2012; 33 (01) 112-117
  • 19 Dorman MF, Loizou PC. Changes in speech intelligibility as a function of time and signal processing strategy for an Ineraid patient fitted with continuous interleaved sampling (CIS) processors. Ear Hear 1997; 18 (02) 147-155
  • 20 Fabry D, Firszt JB, Gifford RH, Holden LK, Koch D. Evaluating speech perception performance benefit in adult cochlear implant recipients. Audiology Today 2009; 21: 37-42
  • 21 Sladen DP, Gifford RH, Haynes D. et al. Evaluation of a revised indication for determining adult cochlear implant candidacy. Laryngoscope 2017; 127 (10) 2368-2374
  • 22 Mosnier I, Bebear JP, Marx M. et al. Improvement of cognitive function after cochlear implantation in elderly patients. JAMA Otolaryngol Head Neck Surg 2015; 141 (05) 442-450
  • 23 Chen SY, Grisel JJ, Lam A, Golub JS. Assessing cochlear implant outcomes in older adults using HERMES: a national web-based database. Otol Neurotol 2017; 38 (10) e405-e412
  • 24 Lin FR, Chien WW, Li L, Clarrett DM, Niparko JK, Francis HW. Cochlear implantation in older adults. Medicine (Baltimore) 2012; 91 (05) 229-241
  • 25 Zwolan TA, Henion K, Segel P, Runge C. The role of age on cochlear implant performance, use, and health utility: a multicenter clinical trial. Otol Neurotol 2014; 35 (09) 1560-1568
  • 26 Wilkerson BJ, Porps SF, Babu SC. The impact of comorbidities in the aging population on cochlear implant outcomes. Otol Neurotol 2017; 38 (08) e285-e288
  • 27 Koerner TK, Zhang Y. Application of linear mixed-effects models in human neuroscience research: a comparison with Pearson correlation in two auditory electrophysiology studies. Brain Sci 2017; 7 (03) 7