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Audiology Assistants: The Key to Efficiency in the Audiology Practice

Audiology Assistants: The Key to Efficiency in the Audiology Practice
Nichole Kingham, AuD
October 4, 2021

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Editor's note: This text-based course is an edited transcript of the webinar, Audiology Assistants: The Key to Efficiency in the Audiology Practice, presented by Nichole Kingham, AuD.

Learning Outcomes

After this course, learners will be able to:

  • Identify the key job duties for an Audiology Assistant.
  • Identify the inefficiencies in a busy clinic.
  • Describe how to create a plan for hiring and training an Audiology Assistant.

Introduction

As a business owner or a leader in a clinic, efficiency is a primary focus. Audiology assistants, in my opinion, is one of the easiest ways to create efficiency in an audiology practice. In this course, we will show you taking the time upfront to create a plan for training and implementing an audiology assistant will lead to successful integration into your practice.

Make A Plan with SMART Goals

What gets planned gets done. Adding an audiology assistant without a training plan is not going to be successful.  We need to have a plan to incorporate an audiology assistant correctly into a practice. Let's begin by discussing the use of SMART goals for an audiology assistant. SMART goals are very specific. You're going to start at the beginning with what we want that role to look like. You want to be able to measure what they're doing and how they're performing. You want to make sure that your goals are attainable and relevant to the role and time-bound. We want to have a workable or relavent plan so that you know, after even as short as ten weeks, that you have an excellent working person in the role doing the role that you need for your practice. A time-based plan is a successful plan. 

SMART Goals

  • Specific
  • Measurable
  • Attainable
  • Relevant
  • Time-Based

Defining the Role of Audiology Assistant

Let's define the assistant's role and think about creating clinical protocols.  AAA defines the role of the audiology assistant as one that is prescribed, directed, and supervised by an audiologist. This is not an autonomous position. Audiology assistants should not be seeing patients without your direction. It also means that when they're being trained, they need you to help with the training. You need to be involved from day one. Their goal is to support the audiologists, to make the audiologist more efficient, to help the audiologist do the job they were trained to do.  In other words, to operate at the top of their license.  As audiologists, we are trained to be clinicians, but we also have work to do in the back office to keep the clinic going. These tasks range from billing/coding, filling out paperwork for repairs, calling back patients and all that extra work also has to be done. The audiology assistant can help you perform the essential tasks not necessary for you to do but essential for the function of the practice. The role of the audiology assistant is to increase the bandwidth and capacity of the provider and create better customer service.

What Do Audiology Assistants Do?

It depends. It is up to you to define the role, as long as this abides by the rules of your state. Audiology assistants are doing instrumental tasks to the practice's success, but they don't require specialized training. If it doesn't require licensure for you as an audiologist or as a hearing instrument specialist, but it's required to make your practice run smoothly, it's probably an audiology assistant job or task. The goal is to create a role that allows audiologists to see more patients and spend time with patients because we know that relationship building is what keeps our patients in our practices. Your audiology assistant creates that bandwidth so that they can do that.

Non-Revenue Generating Tasks

Generally speaking, an audiology assistant is going to work with tasks that are non-revenue generating, but that's not completely true. Our audiology assistant is on a bonus structure based on several things he can do to create a bonus for himself. One of them has to do with recalls. Getting patients back in practice is very important. If you have your front desk person doing that, it takes them away from the phones. Having an audiology assistant who can do recalls for you is a great way to increase appointments that are coming in and also revenue. 

Hearing Instrument Related Tasks

There is a lot that goes into hearing aids. Tasks like ordering devices, performing repairs, selling point-of-sale items, and coordinating accessories can take time away from an audiologist serving patients. These are perfect tasks for your audiology assistant. Remember, it is vital to check with your state regulations to ensure that all tasks are permitted. At our clinic, a six-month check is probably the most important task that an audiology assistant performs. This is what I lovingly call an oil change. Essentially this is a clean and check. They are there to ensure they have all of their supplies, ear canals get checked, make sure they don't have a wax buildup. At that point, the audiology assistant can check to ensure that your patient doesn't need any further testing. We like to see our patients for an annual audiogram, and it works much better when someone is looking the patient in the eye and telling them that they need to have a hearing test at their next appointment.  We find this delivers a better outcome than sending emails or postcards or trying to catch them on the phone. Our patients are always set for an appointment every six months. They see an audiologist every other time. In between these appointments, they will be scheduled with the audiology assistant. 

Equipment Maintenance

Who loves to do biologic checks? Who does biologic checks? If you don't do one purposely, then you do it on your first patient. We all do biologic checks somehow, but it works better for you if you just have it part of your routine. Make sure that you're doing biologic checks. How often does it happen to you that you get to your first patient on Monday morning and have forgotten to do your calibration, and now you have to calibrate before you can do real-ear measures? Having it built into our protocol, then on Monday morning, the AudioScan gets calibrated period before 8:00 a.m, before the first patient is scheduled, that is a great time saver. It's an efficiency marker.

Patient Education and Training

Hearing instrument orientation is crucial for practice. Our hearing aid deliveries are about 90 minutes because we're doing first fit real-ear measures, and then we're going over how to put them in and take them out and expectations and cleaning and paperwork and payment. 90 minutes is a lot for a hearing instrument orientation. It was great to take that and make it 45 minutes for the audiologist and 45 minutes for the audiology assistant.  Our audiology assistants set up the Bluetooth features for our patients and teach our patients how to work their instruments with their Bluetooth.

Testing Support

When presenting about audiology assistants, I am often asked if assistants can provide support for testing. Well, yes and no is the answer. Really, the answer is no diagnostics. You don't want audiology assistants doing diagnostics. What they can do is protocol immittance testing without interpretation. They can perform tympanograms and OAEs and bring you the results for interpretation. Your job is to review that result with the patient. Our audiology assistants perform otoscopic checks on patients, collecting and score self-assessment forms and perform speech in noise testing. Most people don't bill for QuickSIN unless it's connected to a cochlear implant evaluation. You can have an audiology assistant help with QuickSIN, and they can perform hearing screenings. 

Other Support Functions

They can prepare materials for impression taking. In some states, audiology assistants can perform impressions. Most states can't. What it comes down to impressions is what you're comfortable with because, ultimately, the audiology assistant is underneath your licensure. Again, audiology assistants, they're not independent practitioners. They are not autonomous at all, so they are underneath your licensure. If something goes wrong with something that your audiology assistant has done, that ultimately is your responsibility. If you're comfortable having someone make impressions, you've trained them to make the impression, and it's not restricted by licensure in your state, or whether it's licensure or certification, then there's no reason why they can't. Should they? That's another question. Again, that's something that you'll have to answer for yourself. 

Life Cycle of a Hearing Aid Purchase

How can an audiology assistant save you money? If you take a hearing aid purchase over the life span of about four years, your cost as an audiologist is about $1,500 to see that patient. That comes from looking at work that Brian Taylor has done that shows that the typical cost per billable hour for a provider is about $150 in the typical clinic. It could be higher than that. If it's higher than that, then your time for the life cycle of a hearing aid purchase is much more expensive long term. You're going to pay $1,500 for each patient that enters your practice, just in time.

What if we take those things that the audiologists would generally do and we split it up, and then we create some time where the audiology assistant takes on some of those duties. If we can split it up, it's going to look more like this. Instead of costing $1,500, you're going to spend $800 to $950 per provider roughly. The rest of that time only costs you about $200 for the audiology assistant. The billable hour for audiology assistants is approximately $35. If you can break it down here, then you've got five and three-quarter hours, but the audiology assistant costs $201.

Suppose you take the saved time, five and a half hours or five and a quarter hours per patient. Say we're going to take that, and we're going to use half of those hours, just half of them for hearing aid evaluations that we couldn't have done without an audiology assistant because there's not enough bandwidth, there's not enough room in the schedule. We're going to take half of them and do hearing aid evals. That means 262 more hours to see consults in four years. Say your close rate is 60%, which is what is typical. You're going to have 157 more binaural hearing aid sales. If your ASP is $2,200, that's $693,000. People will say, I can't afford to hire an audiology assistant, but you can. If you are going to make an extra $173,000 a year just by being more efficient in your practice, does that make it easier for you to hire somebody and maybe even hire another audiologist? Possibly. It takes about six months to get an audiology assistant to work within their role sufficiently. But it's six months that is well worth the expenditure, what you have to do for a time. The cost of training is well worth it because, in the end, you're going to have extra cash. That's definitely what we've seen in our practice.

Tasks Audiology Assistants Cannot Perform

Audiology assistants cannot do diagnostic testing.  If you're in an ENT practice, an audiology assistant could do testing because it goes underneath the NPI number of the physician. However, if the ENT group are Medicare providers, Medicare very specifically says that if you're going to provide services through Medicare, diagnostics have to be completed by an audiologist. Even in the ENT practice, audiology assistants should not be performing diagnostic testing.

Audiology assistants should not be interpreting test findings. They could do fixed immittance testing and then bring the test to the audiology provider and review the results. They can't provide counseling. They cannot recommend hearing instruments. This one's hard, too, because many patients come to see the audiology assistant as one of their providers. Our patients will ask the audiology assistant if there is any new technology out there, and your audiology assistant should be trained to say yes. To get more information about that, I'm going to have the audiologist talk with you. Audiology assistants should not be giving specific details on recommendations for hearing aids.

They can't make referrals for further testing. How do you make a referral if they come in and they need a new hearing test? If you, as the audiologist has said, I want you to have your hearing test in a year and the audiology assistant is just taking your directive; the audiology assistant is going to schedule that appointment. But they can't refer out, for balance evaluations, can't refer out to an ENT, that should be handled by the provider.

Audiology assistants cannot modify a hearing aid if it changes the function of the hearing of the gain of the instrument at the eardrum. For instance, you see a patient and you changed the domes because they've complained something is uncomfortable or what have you. Then two days later, they call back and say my ear domes are not very comfortable. I'd like to get in and have that changed back. Technically your audiology assistants should not be doing that because it can change the output of the hearing aid at the eardrum. This task can be performed under the direction of the Audiologist, but the assistant cannot do this without your expressed direction.

Here's the disclaimer. All things that your audiology assistant can and cannot do need to be checked against what your state says.

Ensuring Excellence in Patient Care

Let's remember the main goals of adding an audiology assistant, (1) creating bandwidth,  (2) creating value for the practice, and (3) creating excellent patient care. To do that, you have to hire the right person. You have to know what the job functions look like. You have to discuss your business goals. They have to know exactly what your plans are long-term for patients in your clinic and then constant and consistent training. Let's talk about each of those.

Hire the Right Person

How do you find the right person? Where do you find the right person? In our clinic, of all the audiology assistants I've hired, the majority of them using mainstream hiring sites.  The great news is that there are lots of different people looking for new adventures. I have been quite lucky, and I think every audiology assistant I've hired has had a hearing and speech background. 

How do you know it's the right person? One of the first things you want to do is go to audiologyacademy.com, and the underneath FAQ is a free audiology assistant job description builder. You have to know what the role looks like before you decide what the right person is. Take this opportunity to go and create a job description. It will give you a way to narrow down what you want that role to look like. 

In the interview process, I would highly recommend that you use some sort of a personality or traits test so that you can see how they will fit into your clan. The DiSC is the one that we use. It's inexpensive. It's easy to use, and it's sort of fun. This profile puts you as a person into a quadrant. D people are the drivers, and a lot of audiology assistants are Cs. They are very accurate and cautious. They also are very concerned about patients and patient care. If you have a very large organization, I think what most experts would tell you is that you probably need to have a mixture of people in all of these four quadrants. However, if you have a small practice, you want everybody to be closely matched in the quadrants. The reason why is because you don't have an outlier that doesn't seem to belong. Using something like DiSC training or DiSC questionnaire really can help you decide if you've got the right person coming on board.

Understanding of Business Goals

With any new employee, it is critical that you sit and write down what your actual goals are for business. It is a good discussion for your entire staff, but being able to talk through with your audiology assistant so that they understand what is acceptable in order to keep the business profitable, that's an important conversation to have upfront. For example, you need to discuss things like: What services do you give away for free? What services do you not? What type of warranties do you provide? How often should your patients be seen? Are you seeing them every six months? Or are you seeing them every three months? How often are hearing tests done? Is it once every year? Is it every other year? What can employees do to ensure patients are satisfied? For instance, say you're running late and the audiology assistant recognizes that the patient's been sitting for a while, can the audiology assistant take on part of that care so that they're not sitting? Can they offer them a coffee card to apologize for the wait? What are your processes? Those business goals being discussed up front are very helpful. You have to know what those business goals are and you have to write them down and make that part of your SMART goals. 

Constant and Consistent Training

In order to maximize the potential for the audiology assistant, you need constant training and consistent training. Consistent training means that you have some sort of path. You have mapped out the journey.  ou know what you're going to do on day one, you know what they should be doing by week one, you should know what they should be doing in week six.  Audiology assistants require work and supervision. You can't just bring them in and let them go. You have to have a plan, writing it down is the best way to do that.

Training is available and Audiology Academy has a program, so does Nova Southeastern. Both are great programs. Audiology Academy covers customer service training, lab management, and the audiology basics. It includes weekly reading, videos, and flashcards. The student must pass the quiz at the end of each module in order to finish the entire training. The goal is to support the supervisor so they don't have to recreate the wheel. There is something already put together for you so you know exactly what the training should look like every week. You can walk through that with your audiology assistant and the best practices protocols have things like, what should your daily routines look like? What are lab responsibilities? How do you clean a hearing aid? How do you communicate that you've cleaned that hearing aid efficiently and sufficiently with the provider? These are just some ideas of things that we include so that you don't have to create them.

Good training includes hands-on. Hands-on training means you're going to have the patient in front of you. You're going to have the audiology assistant next to you, and then you're going to let them do part of the task. I hear from people, oh, that takes too long. Yes, it takes a long time. In our experience, it takes about six months for an audiology assistant to be trained well. For six months, you have to do some sacrificing of your time in order to create time later. You have to be willing to take some extra time upfront with the audiology assistant, knowing that by doing so you will have more time on your hands down the road. 

Training Support is Available

In Audiology Academy, we have compiled all the videos in one place so you don't have to find them. If you say, let's change tubing, you're going to demonstrate it, making it hands-on, but then you want them to go and solidify that by watching someone else do it as well. Then reading materials with case studies. How do you handle a patient who is angry? Just talking about it is probably not going to stick very well. Instead of waiting for an angry patient to come in and hoping they handle it, having something where they can walk through the process and troubleshoot and give you their idea of how they would solve it, it's actually a very good idea.

The Audiology Academy program includes two courses, one has 10 modules, one has 15. It has a step-by-step instruction for what you should be training for and it builds on each week. Week one leads to the type of tasks they'll be completing in week two and et cetera.  The supervisor's guide also has their homework. You know exactly what they're training for in the training and then the homework that's required in-house. And you get a detailed list of the things that they are learning in the modules.

Tracking Training

What gets tracked gets accomplished! What gets planned gets done.  For instance, if you only show them how to change a battery door one time, they're not going to be efficient at changing battery doors. If you have a tracker that lists all the things that you want your audiology assistant to do, and you want them to do it 10 times before you're comfortable with them doing it on their own. Well, you've got a tracker that says, this person has done a battery change three times in the last month, then you can work to make sure that they get more experience, that they have more hands-on, they've got the experience inside your clinic to do that function. Then we actually send emails every two weeks just to keep you on track so you know what you should be doing during the 10 modules or 15 module training.

I hear people say, what if I train them well and they leave? Well, what if you train them poorly and then they stay? Or what if you don't train them at all and they stay? I think that training people well, and if they leave, great, you know that you have trained a really good person who's going to do a great job of customer service at another practice. It speaks volumes for our industry in general, we want to have well-trained people.

Also hear I trained an assistant in the past with my own training, worked out just fine. If that's the case, great. What tends to happen is if you don't have a plan, you'll miss something. You're going to miss something and it will be six months down the road, a year down the road, and something's going to happen and you go, oh gosh, yeah, we have not talked about that. having a plan of the things that you want your audiology assistant to know is the best way to make sure you're filling all gaps that you know that when they are working as an audiology assistant, without your direct supervision, 100% of the time, that they are representing you and your clinic well.

Make that plan upfront and you're going to create a more efficient practice. You're going to create more customer service, you're going to be better at customer service. You're going to see more patients, you're going to have happier patients and it will all be worth it.  t takes about six months to get them from day one to efficient part of your team. Our suggestion is that you set time on the schedule for focus training.  Focused training means that you're not with a patient, you're actually sitting with them one-on-one to answer questions and to focus on a certain task. In the beginning, weeks one through four, spend about 30 minutes in the morning when you're both fresh, three to five days a week doing something, some sort of training. In the weeks five to eight, do two days a week instead of three to five. Then weeks eight to 10, do a 30-minute training once a week. You can obviously change that depending on how well they're doing and how quickly they're picking things up. 

Practice Makes Permanent

You want them to be able to practice in your clinic and not have to do that on their own time. So set the time to do that and give them the flexibility to get those homework skills done while they're on the clock. Let your other staff members help. For instance, you want them to practice doing fixed immittance testing, then have one of your staff members available for them to do that testing.  But if you can take the time, especially for a hearing aid delivery, which I think is really one of the most key functions of an audiology assistant is helping with the hearing aid delivery. If you can take the time to have your audiology assistant first listening in so that they know exactly how you want information presented to the patient, and then you're basically walking through exactly how you want things said. Then you switch to you present some, and then the audiology assistant present some, and then you present some, an audiology assistant. And what that does is it allows them to practice with you sitting there, instead of just saying, all right, it's all on your own, do it yourself. I think patients also love to be involved with that learning process and they understand and appreciate what you're trying to do and tend to be willing and able to help with that.   

The key to efficiency in the audiology practice is, defining the role of all of your team members, but your audiology assistant in particular, hire the right person, use protocols, create a plan, and then make sure that you are the supervisor and you're doing the training. 

Citation

Kingham, N. (2021). Audiology assistants: the key to efficiency in the audiology practice. AudiologyOnline, Article 27829. Retrieved from http://www.audiologyonline.com

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nichole kingham

Nichole Kingham, AuD

Dr. Kingham currently works with Clinic Owners and Practice Development Groups to help implement an Audiology Assistant or Technician into private practice Audiology and medical Ear, Nose and Throat clinics. She is a current member of the AAA Audiology Assistant Subcommittee. Dr. Kingham has worked in private practice since 2003, where she hired the first Audiology Assistant in Washington State and has trained and promoted Audiology Assistants since 2009. 

Dr. Kingham was awarded a master’s degree in Audiology at the University of Washington and obtained her clinical doctorate from A.T. Still University. She was awarded the Future Leaders in Audiology Award in 2012 and is the Past President of Washington State Academy of Audiology. 



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