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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
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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.

Keywords

cochlear implants - speech perception

* Student authors.




Publikationsverlauf

Artikel online veröffentlicht:
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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 3 Holder JT, Reynolds SM, Sunderhaus LW, Gifford RH. Current profile of adults presenting for preoperative cochlear implant evaluation. Trends Hear 2018; 22: 2331216518755288
    Google Scholar
  • 4 Sorkin DL. Access to cochlear implantation. Cochlear Implants Int 2013; 14 (Suppl. 01) S1
    CrossrefPubMedGoogle Scholar
  • 5 Sorkin DL, Buchman CA. Cochlear implant access in six developed countries. Otol Neurotol 2016; 37 (02) e161-e164
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Google Scholar
  • 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
    Google Scholar
  • 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
    Google Scholar
  • 11 Gifford RH. Cochlear Implant Patient Assessment. San Diego, CA: Plural Publishing; 2013
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Google Scholar
  • 14 Armstrong M, Maresh A, Buxton C. et al. Barriers to early pediatric cochlear implantation. Int J Pediatr Otorhinolaryngol 2013; 77 (11) 1869-1872
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 17 Peterson GE, Lehiste I. Revised CNC lists for auditory tests. J Speech Hear Disord 1962; 27: 62-70
    CrossrefPubMedGoogle Scholar
  • 18 Spahr AJ, Dorman MF, Litvak LM. et al. Development and validation of the AzBio sentence lists. Ear Hear 2012; 33 (01) 112-117
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefGoogle Scholar