Unscheduled Changes in Audiology, Internet Sales, and Direct Mail: Interview with Kim Cavitt, AuD
Douglas L. Beck, AuD, spoke with Dr. Cavitt about over-the-counter hearing aids, multiple revenue streams, bundling and un-bundling, and more.
Academy: Good morning, Kim. I thoroughly enjoyed your presentation at the January 2014 Illinois Academy of Audiology (IAA) meeting.
Cavitt: Thanks, Doug. The IAA is always a powerful meeting, and I was honored to share my thoughts and ideas with the participants.
Academy: And for the readers who may not be familiar with you, I’ll just say you’ve been an audiologist for almost 25 years and you’ve been very active in the audiology-political landscape, and the “business” side of practice. You started Audiology Resources in 2001, specializing in billing, reimbursement, and practice protocols and you consult all over the United States. And finally, you’re currently president-elect of the Academy of Doctors of Audiology (ADA). What I’d like to do today is cover some of the key points from your IAA presentation, and feel free to add in more current developments.
Cavitt: Thanks, Doug. Audiology and hearing aid dispensing are changing very quickly, and it’s not going to go backward. A good reference for the reader is the new abstract you authored for the Academy, reviewing Sergei Kochkin’s recent findings based on more than 2,000 people who purchased their hearing aids online and received them through direct mail.
Academy: I have to say it seems apparent to me that very few dispensers or audiologists have any idea how successful direct mail has been. The Internet has changed everything, there’s no going back. It’s the same with the rest of the world, one must either change with the times or be left behind, and I really fear for the professionals who say they won’t see patients who purchased their hearing aids online. That is, to me, it seems the acquisition stream is already the 800-pound gorilla, and it will likely get bigger and stronger, and we need to address it, or perhaps be left behind.
Cavitt: I agree. I think the change has been occurring for more than a decade, and it includes so many aspects. In your talks you note there are 36 million people with hearing loss and we only see some 20 or 25 percent, so the vast quantity of people with hearing loss are either getting by, or their acquiring amplification and other tools via alternative routes. And of course, in 2014, we have better technologies, better distribution, manufacturer consolidation, easy access and lower prices and many third party organizations and administrators…all of whom are ready and willing to serve the vast un-met needs of the boomers.
Academy: That reminds me of my “personalization” talk, in which I speak about personalization as solving the problem the patient perceives…and that’s an entirely different protocol than what we generally do!
Cavitt: Exactly. Even the Hearing Loss Association of America (HLAA) is calling for better access, more transparency, unbundling, and more. And when I think about our profession, I think it’s become high-end product-driven. Our practices have become all about product, rather than skill, or doctoring, knowledge, diagnostics, and aural rehabilitation…and so while we’ve been focused on high-end products, a “perfect storm” was being created outside the sound booth! In fact, I’d say Hi Health Innovation really jump-started the wholesale change…it was a shot across the bow…and it all occurred because we set it up to happen by losing sight of what made audiology the amazing profession it is. We’ve lost sight of diagnostics and aural rehabilitation and we’ve become retail stores selling widgets…and you cannot beat the Internet for low pricing. That’s not going to be a sustainable plan!
Academy: Well, I have to admit I hate shopping and I buy almost everything online. Truly, I buy clothes, electronics, computers, phones, guitars, lights, beds, cat litter (yes indeed…delivered to my house via Amazon Prime at no charge, next day service)…all online. I am so guilty of using Best Buy as the showroom for Amazon! And frankly, if I need it sooner than tomorrow, I’ll go to Costco…and I believe most of our colleagues do the same! The fact of the matter is the 10,000 boomers are turning 65 years of age daily, and the vast majority (I’ll wager 90 percent) use the Internet daily. That is, they are just like you and me, and this is the way they shop and acquire stuff!
Cavitt: I agree entirely. I even buy shampoo online! I tell people all the time, if you grew up with the Internet, your social consciousness and knowledge of the world is very different from the pre-Internet consumer and shopper. I never go anywhere without my phone and when I need things, I click and buy it and move on and the product meets me at home!
Academy: Right, and so maybe the thing about audiology is to realize we have highly specialized skills which cannot be replicated online, and perhaps those skills are what we need to focus on, rather than the product, itself?
Cavitt: Sure. In fact I recently had the best optometry exam I ever had. I actually went to an independent licensed optometrist at Costco, and I paid the doctor himself for his work and then he gave me the prescription. I took the prescription and that enabled me to buy my prescription reading glasses elsewhere! And frankly, he really didn’t care where I bought the product, as his career and knowledge were all about the diagnostics and recommendations; that was his value within the system. I can buy glasses anywhere in the world with his prescription and that gave me freedom, choice and the ability to buy what I want, personally, it allows me to make decisions and to take responsibility for my choices!
Academy: And I should note, by law, optometrists are required to give the patient/consumer their prescription. I learned that in the recent March/April, 2014 edition of AudiologyToday, in Barry Freeman’s article titled “The Future of Hearing Care….” (page 32).
Cavitt: And it seems to me that’s the future for us. We have an enormous opportunity to provide excellent and comprehensive diagnostic and aural rehabilitation and vestibular and tinnitus services, and of course we can sell hearing aids and ALDs and such, but we need to focus on the practice of audiology itself, more so than the products!
In fact, at the large ENT practice I used to work in, we paid all salaries and costs of doing business through our diagnostic fees. We billed for everything we were entitled to bill for, we collected co-pays, and we focused on our professional activities more than our retail sales. I believe that if you provide a very high level of care and the highest quality service, you’ll do fine and you can (and should) still sell hearing aids, but you can sell them inexpensively and unbundled, which might actually make you surprisingly competitive with the Internet. And, for those patients who want the very best, you can still sell premium units but do so while charging for your professional time, programming, aural rehabilitation, hearing aid testing, real-ear measures, speech-in-noise evaluations, hearing aid evaluations, tinnitus evaluations and counseling. Maybe we should sell PSAPs in the office for the people who want them; as selling PSAPs allows us to meet that person and highlight the difference between the best hearing aids with remote microphones and spatial sound ability and top notch noise reduction and adaptive directionality!
Academy: And so it seems to me like you’re advocating for unbundling, to remain competitive?
Cavitt: Yes. I encourage it. I don’t think everyone has to do it, but if you’re going to be future-oriented and you want to be competitive in the weeks, months and years to come, it’s clearly worth thinking it through. All of us need to explore the pros and cons and make decisions for ourselves and our practices based on where we are and where we want to be, because again, it’s either be part of the change or fall behind, we’re not going to be heading back to the 1990s, there’s no third option!
Academy: So basically, it’s “back to our roots.”
Cavitt: Yes, and so in many respects it’s about “going back to the basics.” It’s about taking care of patients and providing aural rehabilitation for people with hearing loss and it’s about going back to Carhart’s vision!
Think about this, Doug, you’ve written and lectured a lot on tinnitus, and most of our patients complain about tinnitus, but very few audiologists perform a full scale tinnitus assessment, which they were trained to perform! They may write something like “patient complains of tinnitus….” But if the audiologist is not doing a full-scale evaluation, or if he or she is not using the excellent screening tools and questionnaires, how does he or she know the magnitude of the problem and how will he or she know exactly what to recommend to maximally manage the patient’s tinnitus?
What about when the patient tells us they’ve had noise exposure? Does everyone do OAEs? No, they don’t! And the most common complaint of all time is speech-in-noise, which clearly we can measure and evaluate and often improve significantly, but most of us don’t do it, and we really ought to! To me, these are tremendous opportunities that slide through our fingers! Simply, we need to practice the full scale of audiology!
Academy: Thanks so much, Kim. I’m sure this interview will introduce some new thoughts, ideas and options to our colleagues, and I am very appreciative for your straight-forward thoughts and analysis!
Cavitt: Thanks, Doug. I appreciate your time, too!
Kim Cavitt, AuD, is the owner of Audiology Resources Inc., in the Chicago area. She is also the president-elect for the Academy of Doctors of Audiology.
Douglas L. Beck, AuD, Board Certified in Audiology, is the Web content editor for the American Academy of Audiology.