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Interview with Cindy Beyer, Au.D., Senior Vice President of Professional Services, HearUSA

Cindy Beyer, AuD

September 19, 2005

Topic: Aural Rebabilitation and Dispensing
Beck: Hi Cindy. Thanks for meeting with me today.

Beyer: Hi Doug. Thanks for inviting me.

Beck: If you don't mind Cindy, let's review a little of your professional education and history, and then we'll get into today's topic. Please tell me about your education?

Beyer: I earned my master's in 1981 from West Virginia University, and I recently completed my Au.D. program (2004) from the Pennsylvania College of Optometry.

Beck: Congratulations on your Au.D. - that's fantastic! You've been with HearUSA for quite a while, right?

Beyer: Yes. I started in 1987, so it's been 18 years, and of course back then, we were HEARx. I started as a clinical audiologist, became a center manager, then a regional manager taking care of 8 to 10 centers, and then I became the Director of Contracting. After that, I was the Director of Quality Assurance, and now I am the Senior Vice President of Professional Services.

Beck: Cindy, when did you first see the value of offering AR classes?

Beyer: Actually, back in 1987, we started with the "HELP" classes, which stood for
Hearing, Education and Listening Program. We had input from Drs. Bob Sandlin and Donna Wayner. We developed a comprehensive curriculum and it has evolved a bit over the last two decades, in fact, it was originally a four-class program, and it's been redesigned into a three-class program.

Beck: Would you please work me through the three classes?

Beyer: Sure. But I should explain that the HELP program doesn't start until after the patient has been fit with their hearing aids, then had the 24-48 hour phone call follow-up, and then they're brought back to the office for their two week check-up, and then they start the HELP program, which is one hour per week for three weeks. The first class is the basic orientation, and by the time the AR program starts, many of the acoustic and other issues are solved, and so we can focus on strategies for maximal hearing and listening...and less on how to turn the hearing aid on/off, or how to place it in/out of the ear.

Beck: I agree. I was chatting with a colleague the other day and I came up with "Hearing aids help hearing, but AR helps listening!" I love that line and I hope I haven't stolen it from someone...we'll see what e-mail I get about that! Another very important component of the AR process is the family and spouse...are they involved?

Beyer: Absolutely. Everything from the initial diagnostic meeting to the AR classes are family friendly, and we encourage the spouse or significant other to participate.

Beck: Very good. Please tell me about class one?

Beyer: OK, by class one, the patient is functioning with hearing aids and the audiologist is viewed at this time as the AR expert, not so much as the person from whom they are purchasing, so the dynamics change. Class one covers; general facts about hearing loss, understanding hearing loss, the goals of amplification, realistic expectations, limits of hearing aids, binaural advantages and a group question/answer period, how to use T-coils, and we provide a hands-on opportunity to use the phone, clean the hearing aids and change the batteries.

Beck: OK, and class two?

Beyer: Class two is the fun one -- from my perspective! In class two we cover the psycho-social issues related to hearing loss, overcoming hearing loss through amplification and a better understanding of communication dynamics and sound. We talk about why it takes 5 to 7 years for patients with hearing loss to acquire hearing aids, objections and obstacles, and we discuss, acknowledge and accept each of them, working through and uncovering objections that could be lingering in their minds. Interestingly, if we don't discuss, acknowledge and accept, we may unintentionally overlook the in-the-drawer issue...and that is not an acceptable outcome! So we focus class two on interaction, listening strategies, psychological issues and communication dynamics, and again, this is really my favorite class as it has the potential for such wonderful revelations and insight, and the sharing of personal experiences. It's cathartic for many of them - and the experienced users help the newly aided patients to embrace their hearing aids.

Beck: And class three?

Beyer: Class three is the Total Communication Approach class. We help patients learn to anticipate upcoming problems, in order to better manage their communication opportunities. We look at what to anticipate in restaurants and meetings, where to sit to maximize sound and visual cues, for example by examining floor tiles versus carpeting, high ceilings versus low ceilings, where the speaking person is relative to where you choose to sit and other important resources too. We talk about assistive listening devices and alerting devices and how to make use of products that can make them comfortable and safe. We also have a nice manual that guides them through each class and serves to remind them of tips, stories and how to manage potentially difficult communication situations.

Beck: Wow. Great program! How to you measure success in the AR program?

Beyer: In terms of dollars and cents, we find that when patients participate in AR, the return rate for their hearing aids goes down dramatically. In fact, for participants, the return rate is about 3 percent, which varies over time, but it's always about 1/3 to ½ the return rate of patients that don't participate in AR. And that doesn't include the "apostle effect" - patients that participate in the program learn to advocate for hearing aids and refer their friends and family members. There are significant revenue opportunities that result from this program.

Beck: Lowering the return-for-credit (RFC) certainly justifies the time and energy. I'll bet another important factor is patient satisfaction goes up for AR participants.

Beyer: Yes, it really does. We survey the patients after their AR class, and we get a lot of positive feedback from the AR patients, and as you noted, any one of these outcomes is worthwhile, but when you add higher satisfaction, less returns and more informed patients, it makes a lot of sense. In fact we also survey the staff, and about 95 percent of the staff think AR is worthwhile and appropriate.

Beck: What percentage of your patients participate in AR?

Beyer: Well, it varies by office and region, but in general it is about 20%. Some offices recruit about 50% of their patients, but the average attendance is somewhat lower.

Beck: Do you "incentivize" the patients?

Beyer: Well, that's a tough one, and we've gone around and around on that. We offer the patients an additional 30 day trial period if they attend the AR class, and that's really been a great incentive, although you could argue that it's got potential negative baggage with it...Some offices offer raffles for battery testers and other accessories. We offer discounts and battery clubs with attendance. We try different things from time to time, but the most important issue is that the audiologist promotes the importance of participation and makes the classes fun and interactive.

Beck: Cindy, thanks so much for your time today, and for sharing the AR program with us.

Beyer: My pleasure, Doug.

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cindy beyer

Cindy Beyer, AuD

Senior Vice President of Professional Services, HearUSA, Inc.

Cindy Beyer, Au.D., is currently the Senior Vice President of HearUSA Inc. Her areas of expertise include  quality and accreditation programs, professional development, and hearing benefit administration.   Dr. Beyer has published several articles in Audiology Today, Advance for Audiologist, Seminars in Hearing and The Hearing Journal on such topics as managed hearing care, hearing aid outcomes and reducing hearing aid returns through patient education.

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