FAQ - Optimum Healthcare Solutions

For your convenience, we have posted answers to some of the most frequently asked questions about our Universal Newborn Hearing Screening Program STAR System. If you cannot find an answer to your question listed below, please visit the contact page or call us at (856) 751-9660, and we will be more than happy to help you.

What’s all this recent talk about hearing loss?

Did you know that hearing loss is the most frequently occurring birth defect in the United States? It’s true. Approximately 3 out of every 1,000 healthy full-term infants are born with a significant and permanent hearing loss. That number increases to 4 out of 100 for sick or premature infants. Hearing loss has a higher incidence than cerebral palsy or Down syndrome. For comparison, the number of newborns with hearing loss present at birth far exceeds the incidence of commonly screened newborn metabolic disorders such as phenylketonuria (PKU) at 10 per 100,000 births, hypothyroidism at 25 per 100,000 births and cystic fibrosis at 50 per 100,000 births. In fact, newborn hearing loss, a screenable and treatable condition, occurs more often than all of the commonly screened newborn disorders combined.

Are there any risk factors for hearing loss in newborns?

Yes, there are certain factors in the newborn’s history that may increase the chance of hearing loss:

Severe depression at birth, which may include an Apgar score of 0-4 at 1 minute or 0-6 at 5 minutes

Birth weight less than 1500 grams

Bacterial or viral meningitis

Crainiofacial anomalies including abnormalities of the pinna and ear canal, low hairline and cleft palate

Findings associated with a syndrome known to include hearing loss, such as Down or Waardenburg

Hyperbilirubinemia requiring exchange transfusion

Ototoxic drugs given to the baby such as gentamicin, kanamycin, furosemide

ECMO (extra corporal membrane oxygenation)

Prolonged mechanical ventilation for 5 days or longer

Persistent plimonary hypertension

Congenital infections, such as toxoplasmosis, rubella, cytomegalovirus, herpes, and syphilis

Family history of hereditary childhood sensorineural hearing loss

Why must we screen all babies? Why not just screen newborns that are at risk for hearing problems?

While it is true that certain risk factors in a newborn’s history may increase the chance of hearing loss, more than 50% of newborns with hearing loss have no risk factors. Even more surprising, 90% of babies with hearing impairment are born to parents with normal hearing. Hearing loss has no visual clues. Universal Newborn Hearing Screening (UNHS) is the only method to identify babies with a hearing problem. Early identification allows treatment to begin before the irreversible consequences of unidentified hearing loss occur.

What are the consequences of unidentified hearing loss?

The most critical time for speech and language development is from birth to three years of age. If newborns are not screened shortly after birth, the average age to detect hearing defects is around 14 months of age, and ranges anywhere from 12 to 25 months. Children with mild to moderate degrees of hearing loss may go undetected even longer. This is well after the most critical period for language development has passed. By then a child can be significantly delayed in verbal skills and learning.

Left undetected, hearing loss can have a negative impact on a child’s speech and l anguage acquisition, as well as social, emotional and cognitive development. Delays in these areas, such as understanding words and using words to communicate, can have a lifelong effect on literacy and learning. These delays lead to decreased academic achievement and minimal vocational opportunities. Data indicates that the average deaf student graduates from high school with language and academic achievement levels below that of a normal-hearing fourth grade student.

Newborns with impaired hearing do much better in all of these areas if the impairment is identified by three months of age and interventions are begun before six months of age. Infants identified with hearing loss can be fitted with amplification as young as four weeks of age. With timely and appropriate medical, audiological and educational follow-up, these children can develop normal, age-appropriate auditory, speech and language skills. They can learn and progress at a rate comparable to those with normal hearing. They can be successful in school and become productive adults. They can have the opportunity to develop to their fullest potential.

Why do hospitals have to screen newborns for hearing loss prior to discharge?

The American Academy of Pediatrics supported the statement of the Joint Committee on Infant Hearing (JCIH) 1994, which endorsed the goal of identifying all newborns with hearing loss. The JCIH recommended screening all newborns in the hospital shortly after birth and prior to discharge to accomplish this goal. Since this statement was published, more and more states have mandated universal hearing screening for newborns.

Why can’t a hospital set up and manage its own Universal Newborn Hearing Screening Program?

Hospitals can and do establish and manage their own UNHS programs. However, this is a huge burden for them. Implementing a program to screen all newborns is a time consuming, labor-intensive, and very expensive endeavor. We’ve seen hospitals struggle trying to meet their state mandates, while attempting to balance existing staffing deficits, escalating costs and decreasing reimbursements.

All Universal Newborn Hearing Screening Programs have direct and indirect costs related to their operation. If the program is conducted using in-house resources, the costs must be fully absorbed by the hospital and the financial impact can be significant.

In addition to the obvious costs of the screening equipment and disposable supplies, there are other costs to consider. Staffing is a major issue. Determining who will actually perform the screening tests and then marketing to recruit them (and re-recruiting additional people for turnover), as well as interviewing, hiring and training them all take time, money and effort. Also, every program needs a Coordinator and someone to do the information tracking and reporting, follow-up and clerical work, as well as policy and protocol development and implementation and general oversight of the program.

Then there is the need for a computer and printer for the data management, plus some sort of data management software, someone to provide database administration, and a data backup and disaster recovery plan. Additionally, there are the incidental costs of office supplies, and parental educational forms and brochures. Don’t forget the costs of equipment maintenance, warranties and upgrades. And remember, any time there are changes in personnel, equipment, reporting requirements, etc., there will undoubtedly be additional costs. It is difficult to calculate or anticipate some of these costs and many hospitals that conduct in-house programs are doing so at a substantial operational loss. Most do not realize it. According to the most recent studies this loss is usually between $35,000 and $250,000 per year, every year, depending on the birthrate.

Typically, reimbursement for this service is low or nonexistent for hospitals due to their more restrictive preferred provider contracts. Historically long delays in most hospital reimbursements make matters worse.

But cost is only one issue. Our experience tells us that hospitals managing their own in-house programs use an assortment of personnel to perform the tests. We’ve seen unit secretaries, nursing assistants and various technicians doing tests, as well as staff nurses and even volunteers. No matter which of these people performs the tests, most do it as just one part of the many jobs they do in a day. And, while they understand the need for testing, most of them have other responsibilities that also require their time and attention.

A more important issue is a program’s refer rate (the number of babies that do not pass the screen and require further testing) and follow-up. While some hospitals do run their own programs, many tell us that their refer rate and ability to provide appropriate follow-up are not where they would like them to be and could be improved. Inpatient staff nurses rarely have the time to adequately conduct the follow-up for babies that refer. Unfortunately, we’ve seen that responsibility fall to the Unit Managers and Department Directors, people who don’t exactly have extra hours in their day.

While trying to juggle all of these issues, it is easy to lose sight of the goal. The reason we screen newborns is to identify the ones with a hearing loss, so we can channel them into early intervention and treatment. Without adequate follow-up, these babies can easily fall through the cracks and the window of opportunity for intervention can be lost.

As you can see, there can be many benefits in finding another way to set up and manage a UNHS Program without using in-house resources. STAR SystemSM, the OHS Universal Newborn Hearing Screening (UHNS) Program is the solution.

Why should a hospital contract with OHS to provide Universal Newborn Hearing Screening Services?

When a hospital partners with OHS, they no longer have the costs associated with running a hearing screening program. OHS presents a viable and cost-eliminating alternative for most hospital-run hearing screening programs.

Drawing on our experience, OHS has developed a comprehensive Universal Newborn Hearing Screening (UHNS) program called STAR SystemSM, which stands for Screening, Tracking And Reporting System. OHS offers this in-hospital “outsourced” Universal Newborn Hearing Screening Program to hospitals in New York, New Jersey, Pennsylvania, Ohio and Maryland, as an alternative to hospitals using their own internal resources to perform these screens.

When a hospital contracts with OHS they get a complete program which includes: state of the art equipment and all necessary supplies; highly skilled maternity nurses to perform the screens; data management and reporting of results; appropriate follow-up for babies who do not pass the screen; and policies and procedures for the administration of the program. The best part is that OHS offers this program at little or no cost to the hospital.

There are currently two acceptable methods of screening infants for hearing loss. These are evoked otoacoustic emissions (EOAE) and automated auditory brainstem response (AABR). Both tests are noninvasive, quick and easy to perform. However each test differs in its ability to detect the type of hearing loss.

OHS uses the Natus Algo 3 Automated Auditory Brainstem Response (AABR) as our preferred screening test. While it is true that EOAE’s are more common, cheaper to use and quicker to perform, we choose to use a higher standard of testing. The AABR tests the entire hearing pathway, including auditory nerve functioning. Testing is less dependent on interference from fluid and debris in the ears. Most importantly, compared to the EOAE, the AABR results in a significantly smaller number of babies who do not pass. This means fewer babies need to go on for further, more expensive diagnostic evaluations, tests and follow-up. It also results in much less anxiety for parents, who fear the worst.

This equipment, coupled with our personnel and detailed program is what makes STAR System ® so successful.

While some hospitals use a mix of personnel to perform their hearing screens, such as unit secretaries, volunteers and technicians, OHS only uses experienced Maternal Child Health nurses, experts in the handling of newborns. All screening results are communicated to the parents, hospital staff, the infant’s primary care provider and the state, in a sensitive manner. Our nurses make sure that newborns that do not pass receive appropriate and timely follow-up. Many states also require that statistics from screening programs be reported to central statewide UNHS data banks. OHS has developed a proprietary web-based data management application specially designed for the purpose of tracking UNHS data. It’s called STAR Track ®. The application was built with cutting-edge MicroSoft ASP.NET technology and is extremely stable and secure, as well as easy to use. STAR TrackTM provides tracking of patient demographics, hearing screen results and follow-up services. It allows for superior quality control of our UNHS Program and makes for easy compliance with state reporting mandates. Patient data is housed in a high security database, is accessible only by authorized personnel, and is HIPAA compliant. The application is web-based and is compatible with multiple computer platforms. It is capable of interfacing with third-party software that combines statewide tracking and follow-up patient information.

OHS policies and protocols were built from an inpatient nursing perspective and can easily be applied to any Maternity Unit. Our program is supervised by board certified Pediatricians and licensed Audiologists.

As you can see, OHS is strategically positioned to help hospitals successfully implement or improve their Universal Newborn Hearing Screening programs. We can help hospitals not only meet the state mandates, but we can help them free up their staff and save money at the same time.

What type of equipment does OHS use?

There are currently two acceptable methods of screening for hearing loss in infants. These are evoked otoacoustic emissions (EOAE) and automated auditory brainstem response (AABR). Both tests are noninvasive, quick and easy to perform. However each test differs in its ability to detect the type of hearing loss.

In the EOAE, miniature microphones are placed in the infant's ear canals. These microphones emit clicks or tone bursts and then measure the waves generated in the cochlea of the inner ear in response to the sounds. The test does not detect auditory nerve functioning and cannot detect or rule out hearing losses due to neural (nerve) dysfunction. EOAE's can usually be completed in about 5 minutes. Fluid or debris in the external and middle ear can interfere with the signals. This results in tests that do not pass, or are "referred", at rates from 5-20%. This means that up to 20% of babies who are screened with the EOAE must go on to have further, more sophisticated testing, usually the AABR.

The AABR measures auditory nerve functioning by providing information about the entire auditory pathway, from the outer ear up to the brainstem. Clicking sounds are played through soft earphones placed over the baby's ears. Three sensors placed on the baby's head and shoulder measure the electroencephalographic (brain) waves generated in response to the clicks. This is a more sophisticated test, which takes more time and effort to perform. Results are not affected by middle or external ear debris, but the baby must be in a quiet state for the AABR screening to be successful. The AABR has a much lower referral rate of < 4%.

OHS only uses the Natus Algo 3 Automated Auditory Brainstem Response (AABR) as our preferred screening test. While the EOAE’s are more common and quicker to perform, we choose to use a higher standard of testing. The reasons for this are simple. The AABR tests the entire hearing pathway, including auditory nerve functioning. It is less dependent on interference in testing from fluid and debris in the ears. The AABR results in a significantly smaller number of babies who do not pass. This results in much less anxiety for parents, who fear the worst. It also means that less babies need to go on for further, more expensive diagnostic evaluations, tests and follow-up.

A recently published prospective study evaluating the costs and performance characteristics associated with the startup and maintenance of universal newborn hearing screening programs using AABR and transient EOAE found that the “AABR appears to be the preferred method for universal newborn hearing screening. AABR was associated with the lowest cost, achieved the lowest referral rates at hospital discharge and had the quickest learning curve to achieve those rates”. (Lemons, J., et al. Newborn Hearing Screening: Costs of Establishing a Program. Journal of Perinatology 2002; 22:120-124.)

Who performs the hearing screens?

While some hospitals are forced to use a mix of personnel to perform their newborn hearing screens, such as unit secretaries, volunteers and various technicians, OHS only uses nurses. Our highly skilled Maternal Child Health nurses are experts in the handling of newborns. They are comfortable working in an inpatient setting and know how to collaborate with all members of the healthcare team. They understand the importance of adhering to infection control and safety practices according to established hospital policies and protocols. Our nurses go through an extensive orientation program and their performance is monitored for competency and quality. They are responsible for maintaining all professional licenses, certifications, immunizations and other testing necessary to work in a hospital setting; adhering to all OHS policies, procedures and protocols, as well as the hospital specific policies, procedures and standards that apply when providing OHS Services; and maintaining compliance with all applicable state and federal laws pertaining to the confidentiality of patient information, including the Health Insurance Portability and Accountability Act (HIPPA) regulations. Most importantly, these experienced professionals are aware of the anxiety parents experience when having their newborns tested and know how to educate and interact with these families.

What happens if a baby passes the hearing screen?

It's important to remember that most babies do pass the hearing screen. If there are no risk factors for hearing loss, the baby’s primary care provider will assess hearing as well as speech and language development at the baby’s regular office visits.

If there are risk factors present, the baby’s primary care provider will arrange for formal hearing tests as the child grows.

If a baby passes the screen does this mean that he/she will not have a hearing loss?

No. While congenital hearing loss is present at birth, some forms of hearing loss can develop or progress as the child grows. For example, recurrent otitis media (ear infections), head trauma, meningitis or the use of certain medications can all lead to hearing loss later in childhood.

What happens if a baby does not pass the hearing screen?

A baby may not pass the initial hearing screen for several reasons. When a baby does not pass, it is called a “refer”. When a baby refers for the first time, it is the policy of OHS to repeat the test either immediately or at another time prior to discharge.

If the baby refers for the second time, the baby is then referred for further testing by an Audiologist or an ENT. An Audiologist is a licensed healthcare professional who specializes in the diagnosis, evaluation, and treatment of hearing disorders and communication problems. An ENT is a physician that specializes in disorders of the ears, nose and throat. It is recommended that infants who are referred from their initial newborn hearing screen receive a medical evaluation and a follow-up diagnostic audiological evaluation before 3 months of age. Infants with confirmed hearing loss should receive appropriate intervention by 6 months of age from professionals with expertise in treating hearing loss in infants and children.

What can be done if a hearing loss is identified?

Many communication options and technologies are available to a family of an infant with a hearing loss. Several different types of hearing aids are now available and infants as young as 4 weeks old can be fitted with these units. Cochlear implants, electronic devices that stimulate the auditory nerve, are also available. Treatments plans also include auditory, speech and language therapy sessions. For your convenience OHS has provided healthcare links to some leading resources.

What if a baby is not screened prior to discharge?

Whenever possible, hearing screening should be performed before discharge from the hospital. In the event an infant is discharged for whatever reason before a hearing screen is done, OHS will arrange for outpatient screening services.

How can an outside company care about patient satisfaction the way we do?

At OHS, we understand the importance of patient satisfaction. We know the healthcare market is very competitive. We know how hard hospitals work to improve and maintain their images in their communities. We know how this effects the bottom line. We know because the Executive Vice President and Director of Clinical Affairs is a former Director of Maternal Child Health. She had first hand experience with a nationally recognized patient satisfaction organization and her department consistently ran in the 99th percentile for patient satisfaction every week.

You can be sure that the staff at OHS works hard to uphold each hospital’s patient care philosophy and protects their image in the community.

Patient satisfaction is important to us too. In fact, customer and employee satisfaction are important to us as well. We strive to not only meet expectations, but to surpass them.

We received grant money for our UNHS program. Does that affect our ability to contract with OHS?

No. Several states offered grant money to help hospitals set up UNHS programs. While the specifics are best dealt with in person, hospitals can still partner with OHS without violating their grants.

What happens if my hospital already purchased a hearing screening machine?

Our experience is that many hospitals have purchased some type of hearing screening equipment. OHS is in the business of finding solutions for hospitals. We want to save you money. Give us a call and let's find a way to make this program work for your particular situation.

am concerned that if my hospital contracts for this service, OHS will come in and steal my nurses to work for them. Will this happen?

This is a very real concern, since everyone is aware of the nursing shortage and its impact on a hospital’s ability to provide inpatient care. No one knows this better than Cathy Lipton, the OHS Executive Vice President and Director of Clinical Affairs. Cathy has over 25 years of healthcare experience in Maternal Child Health and has worked in various settings throughout her career, from hospital inpatient units, to private practice, to professional corporations. Cathy has held such titles as Clinical Nurse Specialist, Nurse Practitioner, Nursing Instructor, and Director of Nursing. She knows how difficult it is to attract and retain nurses at the bedside. For this reason, OHS states in its contractual agreements that OHS will not actively recruit for employment any of the nurses used by the hospital during the term of the contract and for a period of one year thereafter. Rest assured, you will not be letting the proverbial “fox in the henhouse”.

Does insurance pay for the test?

Many insurance companies cover part or all of the cost of the hearing screening and follow-up services. Some state and local resources are also available for those babies with no health insurance coverage. For billing purposes, we treat the patients in the same manner as the hospitals. In other words, those patients that qualify for Medicaid or Charity Care also qualify for these same programs with OHS.

This sounds too good to be true. How does OHS do it? What are you not telling me?

We hear this all the time. Many people believe that if something sounds too good to be true, it probably is.

We understand your concern. However, in this case, it is true, there is nothing hidden! OHS is able to provide this service because, unlike hospitals, we are not restricted by preferred provider and managed care contracts, with their delayed reimbursements and capitated rates. We offer this program as a private practice.