“Peeling the Onion” is a monthly column by Harvey Abrams, PhD.
As you have likely heard, the President’s Council of Advisors on Science and Technology (PCAST) has issued a report that, if its recommendations are put into effect, will likely have a significant impact on the consumer electronics and hearing health care industries in general, and audiologists in particular.
PCAST in Review
The recommendations are largely the result of an industry review performed by the PCAST Aging and Technology Study Full Working Group chaired by Christine Cassel, M.D. The slide deck briefing of Dr. Cassel’s presentation to the PCAST can be found here, but it will be worth your while to view the entire webcast of her presentation.
Aside from several unfortunate factual errors and misrepresentations, what struck me in viewing the webcast was the complete absence of any discussion describing the professional services associated with selecting and fitting hearing aids.
Bundling Bites Back
After viewing the webcast, many of you will likely react with dismay and outrage. Once I got over my own initial disbelief, I took a step back and asked myself this question:
“How does Dr. Cassel, a distinguished physician and health care policy expert, a senior advisor to the President of the United States no less, arrive at a world view of hearing health care as simply the purchase of a product completely devoid of any professional component?”
After a few moments, I answered my own question as I considered that what I had just observed was a completely logical and inevitable consequence of the decision to bundle the hearing aid with the professional services we provide.
One could argue that if Dr. Cassel had simply performed her due diligence, she would have discovered the range and value of professional services that are critical for successful hearing aid fitting outcomes. In fact, one of Dr. Cassel’s working group staff members communicated with several members of our profession who impressed upon her the importance of the professional services that hearing health care providers perform.
In the end, however, this critical talking point was never included in the presentation to the PCAST nor considered as part of the subsequent recommendations of the working group. I will not presume to understand the reasons why. I would suggest, however, that the seeds of what we are observing here were sown at an important turning point in our professional history.
There Was a Time…
As most of you know, there was a time when audiologists were prohibited (per ASHA’s Code of Ethics) from profiting on the sale of hearing aids. An outstanding review of this fascinating era of our professional history is provided by Wayne Staab in a 3-part series of HHTM posts (part 1, part 2, and part 3). Following a Supreme Court ruling that found that a professional society (in this case, the National Society of Professional Engineers) was in violation of federal antitrust laws when they prohibited their members from submitting competitive bids and thereby suppressing competition, it became clear that ASHA could no longer legally sustain its own policy of restraining trade and competition among its members.
Overnight, everything changed for our profession. This was a critical decision point in our history. We could have created a hearing health care model unique to the profession of audiology. Instead, we simply adopted the prevailing and, at the time, successful bundling model used by the hearing instrument specialists.
The inevitable result of over 35 years of incorporating a bundling model is that, from the perspective of the hearing impaired community (and apparently from the perspective of senior health care policy experts) hearing health care is, and only is, the hearing aid and hearing aids cost too much. Their cost is beyond the ability of many to afford; the average cost is approximately $2400 with some hearing aids costing up to $10,000.
How many times have you witnessed sticker shock from your patients or heard them exclaim that they didn’t realize that hearing aids “cost so much” or ask, “Why do they cost so much”? The conversation is exclusively about the cost of the product, not the value of our services. We have, in essence, commoditized the rehabilitative component of our profession.
Resources and Recommendations from Membership Organizations
Our professional organizations have attempted to address the bundling/unbundling issue. ASHA created a white paper as part of its Practice Portal titled “Unbundling Hearing Aid Sales” (full disclosure: I was one of the contributors to this Practice Portal topic). The paper provides an excellent summary of the pros and cons of each model and provides valuable resources for those considering an unbundling model but does not recommend any particular approach.
Likewise, a AAA task force published two articles in Audiology Today, describing current hearing aid delivery models but made no recommendation relating to bundling or unbundling. Instead, the task force recommended that “the Academy should reinforce the concept that a clear fee structure should be presented, or at least be made available, to the public whether bundling or unbundling is selected, so that consumers and other stakeholders might understand what the fitting of amplification entails.”
What To Do?
I would like to think that the AAA task force’s recommendations will be universally followed and that:
- all audiologists who sell hearing aids will provide a “clear fee structure” to their patients which identifies the value of the professional services they are providing
- our patients and health care policy folks will understand and appreciate that the cost of hearing health care is more than just the device.
I’m afraid, though, that after 35 years of conflating the service with the product, we have created a perception of hearing health care as a product and this perception will be very difficult to overcome. And for that, we have no one to blame but ourselves.
Harvey Abrams, PhD, is a principal research audiologist in the hearing aid industry. Dr. Abrams has served in various clinical, research, and administrative capacities in the industry, the Department of Veterans Affairs and the Department of Defense. Dr. Abrams received his master’s and doctoral degrees from the University of Florida. His research has focused on treatment efficacy and improved quality of life associated with audiologic intervention. He has authored and co-authored several recent papers and book chapters and frequently lectures on post-fitting audiologic rehabilitation, outcome measures, health-related quality of life, and evidence-based audiologic practice. Dr. Abrams can be reached at firstname.lastname@example.org