At the end of January, the Academy released two statements regarding the accessibility and affordability of hearing care in the United States. These statements were driven by the considerable attention hearing care services and devices have received over the past 18 months in Washington, DC. Of particular interest is the outcome of a December meeting at the National Academies of Science, Engineering, and Medicine (NASEM), where the role of the audiology community in hearing care was readily apparent. While feeling chastised, to some degree, for our roles in creating some of the perceptions that have led to concerns regarding the high cost of hearing aids, the participants at the NASEM also opened the door for audiology to take a lead role in improving access and affordability to hearing care for adults with mild hearing loss or communicative impairment.
With much of the focus on the issue of over-the-counter (OTC) devices, the concepts of accessibility and affordability are much broader than the devices available to consumers. Accessibility and affordability includes the consumer’s access to a hearing evaluation, their financial status with regard to obtaining treatment or devices, the geographical distribution of audiologists in the United States, and obstacles such as the need for a physician referral for Medicare patients.
In general, the challenge to the audiology community is to optimize care while minimizing obstacles to access. The Academy recommends a hearing care delivery model that includes (1) determination of appropriate management options based on a comprehensive audiological evaluation and individual needs assessment as performed by an audiologist; (2) consideration of a spectrum of hearing management options that may include hearing aids, assistive listening devices, implantable technologies, communication strategies, and auditory-based therapies; (3) recommendations for medical assessment when appropriate; and (4) counseling and recommendations that are consistent with the individual needs of the patient, including geographical constraints and financial limitations.
We support minimizing obstacles, including the removal of statutory or regulatory rules that impede access (e.g., physician referral for Medicare patients), the need to clearly differentiate the cost of services from the cost of products (unbundling), and consumer access to low-cost alternatives for treatment. This last issue is different than support (or opposition) of OTC devices. Our statement was explicit in the need for audiologists to offer a broad range of treatment options that take into account both the communicative requirements and financial status of the patient.
OTC devices are, and will continue to be, controversial and have elicited a wide range of responses within the audiology community. At this time, the impact of OTC devices is unknown, and we can only speculate as to their effect on the delivery of hearing care in general, or on audiology practices specifically. Currently, there is little scientific evidence regarding the impact of OTC devices on patients, their safety, the economic impact on audiologists, or the uptake by consumers. In this regard, the Academy continues to communicate with other stakeholders, and to monitor the statutory and regulatory environment in Washington, DC, as well as to encourage more research and understanding of the effectiveness, or lack thereof, of OTC devices as a method to manage communicative impairments.
Now, the Federal Trade Commission (FTC) is looking into the issues associated with access and cost of hearing care. While the focus of the Food and Drug Administration is safety, the FTC’s focus is consumer protection. The FTC will be holding a meeting in April to examine “competition, innovation, and consumer protection issues raised by hearing health and technology, particularly hearing aids and devices with similar functions and features.” In some regards, the outcome of the FTC’s investigation may have a greater impact on the delivery of hearing care than the OTC issue. The FTC could look at areas such as bundling versus unbundling, the relationship of audiology practices to manufacturers (e.g., manufacturer-owned practices, discounted purchasing structures, etc.), or at alternative delivery models.
So, a very interesting 18 months for the audiology community—and we aren’t done yet. Aside from the impact of changes to the Affordable Care Act, the specific focus on hearing aids and hearing care delivery will continue to play itself out over the next year. Stay tuned for updates and calls for action! More updates will be coming at AudiologyNOW!® 2017 in Indianapolis!