Veterans Access to Cochlear Implants
As part of its mission of expanding access to cochlear implantation for individuals who may benefit, American Cochlear Implant Alliance CI clinicians are collaborating with the US Department of Veterans Affairs (VA) to increase awareness about CI candidacy in the general population as well as benefits for veterans receiving hearing services within the Veterans Health Administration (VHA).
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Veterans with Hearing Loss Lack Full Access to Cochlear Implants
ACI Alliance members include clinicians who provide cochlear implant services in a range of health plan settings including the Veterans Health Administration (VHA).
Although the VHA is diligent about selection of experienced, highly skilled clinicians to perform the surgery and needed audiology follow-up, the VHA lags dramatically behind other health care providers in referring candidates for cochlear implantation, creating a major coverage gap amongst veterans with hearing loss who do not benefit sufficiently from hearing aids (HAs). Aspects of the VA delivery system further complicate the CI process.
- Deployment to a war zone increases risk of hearing loss, with 1 in 3 returning with measurable hearing loss, which can worsen over time.
- In 2018, over 1,228,000 veterans received disability compensation for hearing loss.
- In 2019, the VA made purchases of $14 million for cochlear implant systems for first time surgeries. Utilizing a Medicare average reimbursement of $27,000 per implant system, an estimated 518 veterans received cochlear implants in the VA system (up from 477 individuals in 2016).
- A total of 812,761 hearing aids were dispensed in the VA system in 2019 (an estimated 406,380 individuals if we assume each patient was fit with two hearing aids).
- VHA audiologists are trained to fit hearing aids and provide assistive devices, but many are unfamiliar with current CI candidacy testing and outcomes. Veterans report not having been told of their CI candidacy by their VA audiologist.
- Long surgical wait times and the complexities of traveling to a VA center that performs the CI surgery remains an access issue for many.
- Cochlear implant clinicians outside of the VHA system have reported seeing veterans who were not counseled about their CI candidacy because of age or the type of hearing loss they had. Neither are valid reasons for not referring.
- Utilization of cochlear implants by individuals receiving hearing services in the VHA system in 2019 was less than that for those in the general hearing health system by a factor of one-sixth. That proportion has gotten worse since 2016 when the proportion was one-quarter.
- CI candidacy numbers were computed using a conservative 5% estimate of those using hearing aids for both the VHA and general population.
Supporting Data VHA vs US General Hearing Health System (2019)
Est adults fit with HAs
Est CI adult candidates (5% of HA users)
Est. adults implanted with CI