Objective: The aims of this study were to 1) evaluate whether remote cochlear implant (CI) programming has comparable outcomes to traditional in-person CI management, 1) determine the effects of remote programming on family burden and associated costs, and 1) demonstrate feasibility and satisfaction of remote programming by patients and families for both the adult and pediatric CI populations. Study design: Prospective study of one CI program. Patients and intervention: Adult and pediatric patients with at least one CI underwent CI programming via in-person and remote visits. Main outcome measures: CI programming parameters (impedances, neural response telemetry, upper and lower stimulation levels, datalogging), technology comfort self-report, visit burden and satisfaction, mental health and quality of life. Results: Fifteen pediatric participants (mean age: 4.17 yr; SD = 3.24) and 15 adult participants (mean age: 56.73 yr; SD = 21.11) were enrolled. In-person and remote programming sessions yielded comparable results for measuring CI programming parameters. Adult and parent participants were highly satisfied with remote programming and reported receiving excellent care. Listening effort was significantly less for the remote visit as compared to the in-person visit for adults. Burden of care to attend the in-person visit was greater for the pediatric population in terms of expenses incurred, unpaid time off work, and coordination of care for other children. Conclusions: Remote programming is a feasible and effective service delivery model for the adult and pediatric CI population. Inclusion of remote services into postoperative CI protocols should be considered as a means of reducing barriers to hearing healthcare.

Purpose: Cochlear implant (CI) sound-processing strategies are important to the overall success of a CI recipient. This study aimed to determine the effects of 2 Advanced Bionics (AB) CI-processing strategies, Optima-S and Optima-P, on speech recognition outcomes in adult CI users. Methods: A retrospective chart review was completed at a tertiary academic medical center. Seventeen post-lingually deafened adult CI users (median age = 58.6 years; age range: 23.5–78.9 years) with long-term use of a paired sound-processing strategy (Optima-P) were reprogrammed with a sequential strategy (Optima-S). Demographic data and speech recognition scores with pre- and post-intervention analyses were collected and compared with respect to the 95% confidence interval for common CI word and sentence recognition tests. Results: Using Optima-S sound-processing strategy, all patients (100%) performed equivalent or better on word and sentence testing than with Optima-P. More specifically, 17.6, 41.2, and 58.8% of the patients performed above the 95% confidence interval for speech recognition conditions of monosyllabic words, sentences in quiet, and sentences in noise, respectively. All patients (100%) selected Optima-S as their preferred strategy for future CI use. Conclusion: Speech recognition performance with Optima-S processing strategy was stable or improved compared to results with Optima-P in all tested conditions, and subjective preference of Optima-S was selected by all patients. Given these results, CI clinicians should consider programming AB CI users with Optima-S sound-processing strategy to optimize overall speech recognition performance.

Objective: To evaluate the implementation of a new streamlined service delivery model for cochlear implant (CI) patients at a mature academic CI program. Setting: Tertiary referral center. Patients: CI candidates and CI users. Interventions: Implementation of a new CI service delivery model. Main Outcome Measures: CI surgical numbers, conversion rate from CI evaluation to surgery, documentation time, number of visits for new versus established CI users, ratio of CI clinical full-time equivalency to CI surgical numbers, time from CI referral to CI evaluation, patient travel burden. Results: De-identified data from the electronic health record (EHR) were used to develop an efficiency improvement plan. With the old clinical model, audiologists' schedules were at capacity, wait for CI evaluation appointments was prolonged, and CI surgical numbers were declining. The new model implemented an interactive electronic medical record, a de-escalated postoperative programming schedule, inclusion of telehealth pre-CI surgery, and an evidence-based approach to CI programming. After a 4-year time period (2019–2022) of implementing clinical improvement strategies, the postoperative CI programming schedule in the first year after activation was reduced from 10 visits (unilateral CI user) and 16 visits (bilateral CI user) to 4 visits total. This saved the patient up to 16 hours of time at the clinic, reduced travel burden, and opened 19 weeks of appointment slots for new patients. Increased utilization of the EHR and telehealth increased the conversion rate from CI evaluation to CI surgery by 33% and decreased the no-show rate by 5%. Annual CI surgical numbers subsequently increased by 45% with the new model, which increased our program's CI utilization rate and reduced our role as a barrier to CI care. Conclusion: If CI programs wish to be instrumental in improving CI utilization rates, clinical care models need to be adapted now in preparation for the projected rise in the number of potential CI candidates. This streamlined clinical efficiency model serves as an example of patient-centered CI care that can be recreated at other institutions. Outcomes from our 4-year strategic initiative will add to the scarcity of literature in this area.

Objectives: The purpose of this study was to examine current cochlear implant (CI) billing practices across CI audiologists in the United States, to determine if CI audiologists are following the National Correct Coding Initiative (NCCI) edits, and to assess the CI audiologist’s exposure to billing education. Design: A 48-question survey was electronically distributed to and completed by audiologists who bill for CI services. Demographic data including work setting, population served, years of experience, number of CI patients managed per week, and exposure to billing education were collected. Data were analyzed to identify codes and modifiers used to bill for commonly performed CI procedures such as unilateral and bilateral CI programming, preoperative and postoperative testing, and objective measures. Results: Data were obtained from 96 audiologists. The majority (86.3%, n = 82) of respondents agreed or strongly agreed they understand billing and coding practices for cochlear implants and 94.7% (n = 89) rated themselves as somewhat to highly efficient when performing these practices. Only 16.8% (n = 16) of respondents reported receiving formal training for practice management, and half of the respondents (51.1%, n = 48) reported unfamiliarity with national billing guidelines. Those who received formal training reported higher billing efficiency. Wide variability was seen for various billing scenarios. Billing questions were presented, and answers were coded as correct or incorrect based on the NCCI edits. Respondents who reported higher agreement with understanding billing and who received formal training scored better on common billing questions related to the NCCI edits. Conclusions: Most CI audiologists rated themselves as efficient in billing; however, wide variance in billing practices was observed. Incorporating practice management and current billing education into daily practice and into audiology training programs is essential to clinic efficiency, practice management, and CI program viability. CI audiologists should be knowledgeable about appropriate billing practices to ensure long-term sustainability of programs.