“I was withdrawing more and more, becoming more and more frustrated from social events,” she said. “I didn’t want to go anywhere anymore because I couldn’t hear anything. It was impossible to stand there just smiling when I didn’t know what was being said.”
Three years ago, Welter got a cochlear implant and started living again.
“It enabled me to live life, literally,” she said. “Now, I don’t hesitate to go anywhere. I don’t even mind talking to salespeople. … I am forever grateful to Dr. (Brian) McKinnon and MCG for providing me the opportunity to get one.”
Welter was 66 years old when she received the implant in her left ear, which was paid for by Medicare. But had she been a child, the opportunity would not have been readily available.
Georgia has one of the lowest reimbursement rates in the nation for pediatric cochlear implant surgery. The standard surgical cost for an implant is around $35,000 at the Medical College of Georgia Hospital and the state reimburses $26,000 for an adult to have the implant. But the state pays only $5,400 for a child’s surgery making Georgia “one of the worst reimbursements in the country,” according to McKinnon, an assistant professor of otology/neurotology at the Medical College of Georgia Hospital.
In South Carolina, Medicaid reimburses $33,000 for the same pediatric implant surgery and Ohio reimburses 100 percent of the costs, McKinnon said.
“I am learning an awful lot doing this. It’s extraordinarily rewarding to turn a deaf child into a hearing child,” he added. “But I know there are some very real economic pressures on the state. … It’s just reality that (there’s not enough money). And they just don’t understand the benefits of a well-funded program.”
The state of Georgia would reap benefits in the long run that vastly outweigh the costs of the surgery, mostly through reduced educational costs and increased earnings, according to recent studies. Several published in the Journal of the American Medical Association in the past 10 years cite savings of $53,000 to $1 million over the lifetime of a child from special education and remedial classes, transportation to special schools, classroom sign linguists, and reduced work productivity among adults.
Georgia has two publicly funded schools for children in pre-K through 12th grade with hearing loss: The Georgia School for the Deaf in Cave Spring is a residential school with 96 students, and the Atlanta Area School for the Deaf is a day school with 206 students. A spokesperson with the Georgia Department of Education said it costs approximately $63,000 to educate each student at the Cave Springs school this year and $38,000 at the Atlanta school.
Children and adults who receive cochlear implants must learn to translate the new sounds they hear and take speech therapy. Welter said the first person she heard speak after her implant was hooked up was the audiologist.
“I heard an ‘s’ sound that I’d never heard before and it sounded like Donald Duck. The sound is mechanical so it takes getting used to,” she said. “But since I’ve got the implant, I have heard the timer on my stove, birds singing and the turn signal in my car – things I’d never, ever heard before.”
Children younger than age 2 who receive the implants require no special therapy and are on the same developmental level as their hearing peers in terms of speech, communication and understanding.
“It’s impressive that these children are mainstreaming in their schools and mirroring peers in terms of academic achievement and are quite successful,” McKinnon said.
Because every child with a disability is enrolled in Medicaid regardless of their parents’ insurance status, the children are missing out on technology that could change their lives, McKinnon said. Fewer than five hospitals in Georgia perform cochlear implants because of the low reimbursement rate, he said.
When McKinnon went to MCG in 2006, the previous cochlear implant program had closed because it lost $900,000. McKinnon has worked to reinstate the program by finding ways to reduce expenses so the program breaks even for adult surgeries. The pediatric surgery program is slowly starting back up with the assistance of federal funds. He did five pediatric implants last fall, and is evaluating more children for the surgery.
“The challenge now is how to keep it economically viable for the hospital,” McKinnon said, adding that it would be easier to cut costs if they were able to perform more surgeries.
“The cost of the device would decrease because we would be buying in volume,” he said. “If you saved thousands to educate that child, then you just saved their college tuition.”