Audiology services and provisions are changing following the passage of the over-the-counter (OTC) hearing aid legislation. In the end, what that will actually mean is still unclear. Likely, we will see a device that can manage mild hearing loss for patients and give them some options for their hearing health care. Those of us who have practiced for many years are still trying to decide how that will fit into our current practice model and whether to incorporate an OTC product in the clinic.
In an article in Health Affairs, Nicholas R. Reed, AuD, a faculty member at the Johns Hopkins Bloomberg School of Public Health and the Johns Hopkins University School of Medicine, discussed what may occur after the Over-the-Counter Hearing Aid Act of 2017 will allow people to buy hearing aids directly from FDA-approved manufacturers (Willink et al, 2019).
“Probably that will make hearing aids more affordable,” Reed said in a statement about the article. “But it won't affect the barriers to accessing hearing-care services, which generally need to optimize the function of these devices. Most people, if you put two hearing aids in their hand, will have little idea of what to do with them.”
Looking Toward the Future
This change in the hearing health-care landscape has launched a significant number of articles, information, and editorials on what the future of audiology services can and should be. For those whose primary source of practice income is focused on hearing aid dispensation, there is a need to review expanding services and options. For some, this may mean earning a certificate in a new area of specialty, such as tinnitus, to provide more services for patients. For others, it may mean expanding diagnostic services such as auditory-processing testing or electrophysiology.
“Audiologists now have the unique opportunity to place a value on the service component of amplification, regardless of where products are purchased,” Alicia Spoor, AuD, wrote in an October 2018 editorial in The Hearing Journal. “The introduction of
OTC hearing devices may promote hearing health care across the country in a more meaningful way” (Spoor, 2018).
Earlier this year, CVS announced that it is closing down its hearing centers.
“Next year, the FDA will introduce regulations to allow hearing aids to be sold OTC, eliminating the need for CVS to dedicate space in stores for audiologists to conduct hearing tests and fit people for the devices,” according to a report in Drug Store News (Levy, 2019). “The company is experimenting with new store formats as its core drugstore business faces pressure from online companies such as Amazon. It’s piloting HealthHUBs, which offer more health services, such as blood pressure testing and yoga classes.”
What is most interesting about this announcement is that CVS recognizes the need to diversify and expand other services. The company is recognizing the need to change what it provides in order to grow.
The Role of the Audiologist
This is the same concept we need to adopt in our practice. Audiologists have extensive training and can provide a well-rounded diagnostic and rehabilitative experience.
As experts in hearing, balance, tinnitus, cochlear implants, and so much more, we have a unique opportunity to redesign how we provide our services to patients and to strengthen those areas that make our profession unique.
What do patients value that will help us to excel in our services? In a survey completed on HealthyHearing.com, contributors Brande Plotnick, MS, MBA, and Paul Dybala, PhD, noted that consumers reported significant belief that the hearing-care professional is essential to appropriate amplification selection, fitting, and follow up (Plotnick and Dybala, 2017).
In fact, 93.82 percent ranked the hearing health-care professional as very or absolutely important for the fitting and selection, and 83.14 percent ranked them absolutely important for follow-up-care visits. Patients felt these factors contributed to a successful hearing aid fitting and long-term-benefit solution.
This indicates the importance of the professional fitting, assistance, and follow-up, or the service end of what we do and why we do it. Providing high-quality, professional hearing health care that translates to happy and successful patients is the art of audiology.
Despite survey results that indicate that audiology professionals are a valuable piece of the overall success, why have we failed to be more successful at reaching the populations that need our assistance? Of the 28.8 million Americans (ages 20 to 69) who could benefit from wearing hearing aids, fewer than 16 percent have ever used them (HLAA, 2017).
Beyond the need for devices are the concerns of patients who have taken the steps but fail to be successful with amplification. How do we provide help to all of the populations that need audiology specialty services?
The emerging audiology practices need to diversify and provide a resource for patients who need good hearing health care for new or existing amplification. Through better public education, referral relationships, and creating the best initial diagnosis and treatment paths, we must reach out to those patients who need amplification but have not committed to that change.
Improving the Clinic
Clinicians must provide the type of clinic environment that promotes professionalism and value for their time and needs. Evidence-based practices for diagnosis and treatment must be firmly established and up to date.
A good clinic should do a routine assessment of the practice from a patient perspective on a regular basis. Is the office warm and inviting? Was the appointment scheduling and check in/check out as efficient and friendly as possible? Were the appropriate diagnostic tests completed, and if appropriate, billed to the correct insurance?
Were patients given adequate time to ask questions and receive information? Did they have the chance to view and listen to the most current hearing aid technologies and accessories?
Hearing aid pricing and services must be clearly defined and transparent to the patient. There must be a charge for services, with or without insurance coverage, for patients to understand the value of the professional.
A practice can establish pricing based on a variety of factors such as reimbursement rates, competitive review, and hourly break-even totals. There are some great articles on how to accomplish this goal, as well as many trained consultants who can help to define what pricing and service packages should look like in a practice appropriate to the size and location of the office.
Working with Patients
Those patients who have hearing aids or amplification of some type, but are not succeeding as desired, create a great opportunity for audiologists to provide a second-opinion clinic. This clinic can provide thorough diagnostic assessments beyond just the basic test battery.
Patients may need a more significant case history, tinnitus assessment, speech-in-noise testing, real-ear measures, cognitive screenings, electrophysiologic assessments, and even cochlear implant candidacy review. A patient’s medical insurance can be billed where appropriate.
For those services that are not covered, patients can be offered a fee-for-service option. This approach highlights the benefit of good audiology professional involvement to assess the patient, determine the appropriateness of the amplification selection and fitting, and examine counseling discussions resulting in the greatest successes.
This type of clinic should be open to any and all hearing aid and amplification users to assess a true baseline hearing status, with recommendations for advanced testing as needed, and to guide the patient on whether what they have is appropriate for their hearing loss and communication needs. There will be devices a clinician cannot program, but they certainly will be able to do various performance checks and real-ear verification to provide feedback to patients and make recommendations.
There is an opportunity to provide information on services, referrals, accessories, current technology, and medical conditions. These are the skills that make audiologists truly unique, and these are the skills that we have trained and honed in our clinical experiences. In the end, the goal of the visit should be to advise the patient on the hearing aid, the programming, or the patient’s overall ability to succeed while taking into account other factors, including potential cognitive, visual, and dexterity changes.
Conversely, the appointment might examine or validate the patient’s success with your recommendations. Either way, audiologists can provide a level of expertise and professionalism through good counseling and honesty that likely will keep a patient returning.
Technology and Improved Outcomes
Hearing health care is more than the ear and balance system. Patients must be aware of medical conditions that have a link to hearing loss, and audiologists must address the patient from a whole-health perspective.
Counseling patients on the comorbid conditions that can have a deteriorating effect on the hearing and balance system is a standard of care that, as clinicians, we are responsible to review and provide.
Technology is changing rapidly, providing many options to assist our patients.
Hearing aids today can
- Stream audio for music and phone calls directly to cell phones.
- Connect to a wide array of streaming accessories through Bluetooth.
- Provide biometric-sensor feedback for heart-rate and activity-level tracking.
- Track social and cognitive engagement through hearing aid use.
- Provide a user tap-control for those with dexterity issues.
- Provide translation features.
- Provide voice-to-text transcription.
- Integrate with mobile apps for more features and use.
- Provide hearing aid self-check tests.
- Provide remote programming.
In addition, today’s hearing aids have
- Tinnitus solutions
- Fall alerts for patient-chosen friends or family
- Voice assistants for knowledge-based questions
- Rechargeable batteries
- Geotag locations for sound preference
With all of these technological abilities, fitting a hearing aid is far more than providing hearing-amplification assistance. Today, audiologists have more tools than ever before in their toolbox to help patients succeed with their overall health goals.
The support and follow-up care that patients find necessary and valuable can be enhanced by providing solutions with a multifunction hearing device that addresses multiple health issues and includes convenience features.
Research is providing links to positive outcomes. The “self-reported use of hearing aids was associated with reducing any visits to the emergency department and hospitalizations,” according to a 2018 report on the association between hearing aid use and health care use and cost among older adults with hearing loss (Mahmoudi et al, 2018).
Telehealth and Remote Programming
Among the rewards associated with new hearing technologies, remote hearing aid programming provides a helpful platform to provide services for patients with mobility, transportation, and time-availability issues.
Telehealth is emerging as a preferred method of care for patients. State and local licensure laws are incorporating this practice and insurance is beginning to provide coverage. When a patient has the potential to self-check their hearing devices prior to an office visit and launch a request for programming remotely, both the patient and the caregiver save time in their daily lives.
This convenience is combined with the ability to geotag locations to create custom fits for specific locations. Clinicians can increase hearing benefit in the locations where a patient struggles the most. This remote programming provides a mutual benefit and value to in-office patients who may need more time and attention.
The Road Ahead
The outcome of the OTC legislation will soon be defined and will create wonderful opportunities for audiologists to validate and reaffirm their skills and value to patients. This is a chance to expand services; redesign the way a practice can look, feel, and perform; and welcome new and existing users with a vast array of new technology.
There is much work to be done to increase our reach to the substantial number of prospective patients who need our services, to provide hearing and health-care benefits to new patients, and to get all of them to accept and receive intervention earlier.
Perhaps American Academy of Audiology President-Elect Catherine Palmer said it best, during her General Assembly Speech at the Academy’s 2019 Annual Conference:
We do not do hearing and balance tests.
We do not sell devices.
Change the course of cognitive decline for patients.
Reduce the risk of patients falling.
Start a chain of events for a child that will promote reading, education, and employment.
Prevent social isolation.
In fact, we ensure social participation, which increases life expectancy.
Decrease medical adverse events.
Decrease hospitalizations and readmissions.
And we can save the health-care system over $3.3 billion per year (Palmer, 2019).