Many people complain about the high cost of hearing aids. For the average person, digital hearing aids represent a significant financial investment.
Nonetheless, one advantage of expensive hearing aids is they offer enough financial incentive and profit to allow and inspire audiologists to provide a wealth of useful and efficient services which patients need and desire. Audiology-based services are often cost prohibitive based on time constraints, and of course, the lack of willing and able participants to pay for the audiologist's time.
By virtue of their academic and clinical training, their licenses, the many years spent earning their undergraduate degrees in communication disorders and multiple graduate degrees in audiology (master's and doctorates), audiologists are uniquely interested in, capable of, and qualified to provide these products and services. Yet most audiologists realize their financial situation is based on very few CPT codes for diagnostic testing and the sale of products.
Of course, audiologists can do much more than CPT codes reflect - but nobody wants to pay for it! Audiologists cannot typically bill for 'E and M' (evaluation and management) services as physicians do. Audiologists cannot typically bill for their time, their counseling, their aural rehabilitation work, or their non-diagnostic test administration, interpretation and management related to hearing aid amplification.
In our opinion, 'successful' management of hearing loss and hearing aid users - from the viewpoint of the patient (Ross, 1999) - pivots on one critical issue: Time.
Digital hearing aids, with their high price tags, allow audiologists to spend time providing all (or most) of the clinical services they are capable of providing, and importantly, these services are needed by our patients.
Hearing aid users, new ones in particular, require a lot of professional, consultative time. Unfortunately, many current dispensing models do not allow enough time to provide necessary, time-intensive services. Despite best intentions, it is difficult to maximally address and manage issues associated with hearing loss and hearing aids in the typical two to three hours devoted to the selection and fitting of amplification.
Let's consider some of the essential services and products we'd provide in an ideal, theoretical situation where time considerations did not apply. Again, keep in mind the following is not an exhaustive listing of the services and products we provide, but is a realistic listing of some of the things we do (or should do) after we invite the patient and their significant other into our office We would spend the appropriate time to:
Do patients need all of these services? Yes. Some need a little less and some need a little more! Perhaps the fact that these services are not provided as often as they should be helps explain high return rates and low market penetration?
We believe the effect of hearing loss in general, and adult-onset-hearing-loss (AOHL) specifically, is a grossly underestimated condition. The impact of AOHL was clearly illustrated by the National Council on the Aging study (Kochkin and Rogin, 2000). The study clearly demonstrates not only the personal and familial implications of hearing loss, but the positive effect of hearing aid 'treatment' as well.
As a society, we often deal with hearing loss as if it were a trivial condition. We (as a society) assume that communication problems, secondary to hearing loss, can be 'solved' by simply applying hearing aids to the impaired ears. Indeed, it is because our society underestimates the overall impact of hearing loss that hearing aids can be purchased through mail order catalogues and the internet, without benefit of clinical expertise or professional intervention.
This (the status quo) would not be the case if there were a proper and well-founded appreciation of the all-encompassing impact hearing loss has on a person's life. Given this appreciation, our society would be more receptive to private and public funding of aural rehabilitation and other treatment-based activities associated with hearing loss and the acquisition of hearing aids.
There is no higher priority for our profession than making the public aware of the full implications of hearing loss upon the individual and his/her significant others, and the many excellent options available to facilitate successful management of hearing loss with personal amplification systems (hearing aids, FM systems and ALDs) and with professional management and consultation.
Nonetheless, given the realities and limitations of the present system, we believe we can provide more extensive aural rehabilitation and treatment- based services for people with hearing loss -- funded by the cost of the aids themselves (Ross, 1999b; 2000).
We propose that 'unbundling' services is probably not in the patient's best interest, as it will likely reduce the professional time and services associated with common hearing aid dispensing practices.
Consider: When hearing aids cost $2000.00 or more per unit, patients are paying for more than just the product and directly related 'fitting' services; they are also paying for the audiologist's professional time.
Unfortunately, it is probable that the converse is also true -- When patients are provided 'low end hearing aids,' necessary professional time will probably not be available.
If more time was dedicated to consistent, professional, high quality counseling, aural rehabilitative and treatment- based issues, within the hearing aid selection and fitting process, we would certainly ensure a higher percentage of satisfied patients. With more satisfied patients we would anticipate a greater impact on society and greater 'market penetration' for our professional services and products.
In summary, the services we provide our patients must be based on their needs. To maximally address their needs, lots and lots of professional time is required.
Simply stated, the economic realities should ideally be shaped to fit the needs of the patient, not the other way around! Expensive hearing aids may offer one very important, previously non-addressed benefit - more time spent with the audiologist.
REFERENCES:
Kochkin, S. & Rogin, C. (2000). Quantifying the Obvious: The Impact of Hearing Instruments on Quality of Life, The Hearing Review, 7(1), 6-35.
Ross, M. (l999a). Great Expectations...Regarding the Performance of Hearing Aids, Hearing Loss, 20(5) 29-31.
Ross, M. (1999b). Redefining the Hearing Aid Selection Process. Aural Rehabilitation and Its Instrumentation, ASHA Special Interest Division ##7, 7(1), 3-7.
Ross, M. (2000). When a Hearing Aid is not Enough. The Hearing Review, 7(9), 26-33
BIOGRAPHICAL INFORMATION:
Mark Ross received his B.A. and M.A. from Brooklyn college and
his Ph.D. from Stanford University. He is a Professor Emeritus in
Audiology from the University of Connecticut and is currently a
principal investigator of the Rehabilitation Engineering Research
Center (RERC) located at the Lexington School for the Deaf.
Douglas L. Beck received his B.A. and his M.A. from the State University of
New York at Buffalo. He received his Au.D. from the University of Florida at
Gainesville. He is the Editor-In-Chief of Audiology Online, San Antonio, Texas.
