Meagan Lewis, AuD

by Meagan Lewis, AuD

 

Change is difficult: it’s uncomfortable and it’s challenging. When you’ve counseled patients about hearing aid pricing in a bundled way for years, it takes practice to feel confident in presenting the itemized options- maybe a bit like patting your head and rubbing your belly. 

However, in representing yourself as the expert on hearing healthcare, it is critical to instill confidence in your patient and know of what you are speaking. Otherwise your ability will be questioned by all parties.

 

New Hearing Aid Pricing Structure: Acting Out the Changes

 

Prior to seeing our first patients under the new pricing structure, we chose to role play with multiple different scenarios. Let me say that we have some excellent actors on our team which helped to lighten the conversation but also helped to delve deep into some potential pitfalls.

 We developed a letter which notified patients that there were changes coming to the pricing structure. Hearing aids would be less costly in order to provide more flexible options for payment to our patients. The letter also described the addition of financing options. 

As you might imagine, I got a few phone calls.  Surprisingly, there were only a few.  One lady called in angry, saying she would not be getting her next set of devices through our clinic.  I asked why. She felt that we were “nickel and diming” her.  I explained that the process actually lowered the cost of the product and allowed us to fairly charge for the time spent seeing her. As a long-time patient, she didn’t come in all that often, so the new system could save her money over time.  She made a consult appointment to investigate new devices.

 

Leadership and Team Effort

 

The entire team has to be on board for this model to work.   Leadership guides describe all the players that you need on your team:  the early adopters, the reluctant person who will help identify problems, the cheerleader etc. We are lucky to have all the players on our team.  However, there are some players that may not immediately come to mind. 

We have a centralized call center. These folks answer the phones and make appointments for our otologists and audiologists. As the first voice of our program, they are as important as having the audiologists on board. I created scripting and scenarios for them to follow when they received calls for a consult.  They also participated in role play with our scheduling coordinator. 

Our otologists are also a key piece of the puzzle.  At our clinic, we collaborate to promote patient care.  We started the conversation with them 2 years ago about patients who had been seen from surrounding areas that maybe didn’t need surgical intervention, but rather evidence based audiologic care to improve their functionality and communication ability.  I presented the case for charging for our services, the proposed costs, etc.  I am sure that many of you have had similar wide-ranging conversations with your otolaryngology colleagues in which you had an opportunity to educate them about the cost and value of audiologic services. Our conversations ran the gamut, ranging from explanations of the high cost of devices, to whether someone just needed a low cost amplifier, why not just provide an “MD hearing aid”, etc. 

It bears reminding those reading this post, as we explained to the otologists and other team members, that with our new pricing, PSAPS and entry level hearing aids are similar in cost, but the hearing aid can be adjusted more easily. 

 

Time for Beta Testing

 

Clearly, the “alpha phase” of this project was time consuming. And, when I thought we had considered every scenario, a new one popped up. Personally, I wondered how the charge for hearing aid consults was going to be received.  I knew that the assessments that we were going to provide were going to drive recommendations, felt strongly that our time was worth what we proposed, but I didn’t know how our clients would perceive it. 

This is where we were August 1…stay tuned for more data and case reports.

 

This is part 3 of the Unbundling series by Dr. Lewis. Click for part 1 and part 2.

 

Meagan Lewis, AuD is the manager of the audiology department at Wake Forest Baptist Medical Center, a large university and medical school based health care system in North Carolina. Wake Forest, under Meagan’s lead, is an early adopter in breaking away from a ‘bundled “price for hearing instruments. There is much interest in this topic, and Meagan has agreed to share her experiences to date, with periodic updates as the new approach settles in.

feature image from contract express

Meagan Lewis, AuD

by Meagan Lewis, AuD

 

The world is changing, will we?

 

Hearing Aids: The Social Policy View

 

Recent changes at a national level are opening the door for consumers to gain more direct access to hearing technology. 

  • The FDA announced that people over the age of 18 no longer need medical clearance to purchase hearing aids.  
  • PCAST (Presidential Council of Advisors on Science and Technology) released statements that hearing aids were too expensive and not easily obtained by the general public, paving the way for the FDA to make an over-the- counter class of hearing aids. 

In many ways, it’s a whole new world for audiologists. 

 

Personal Views

 

From a personal perspective, I have to agree with the changing perspectives and changes they are bringing. Please don’t throw stones yet!

My twin brother has mild to moderate, sensorineural hearing loss and functions well with his devices.  However, he is the world’s worst hearing aid patient.  He ran over “daddy’s earrings” (as my nieces call them) with the car. They now function only intermittently, but he will not own up to it because he doesn’t want to have to pay for new devices.  They are expensive and his health insurance will not cover them.

 I want- need- my brother to hear and I don’t want cost to deter him from hearing.

Alternatively, take the case of a staff member’s sister who has not been able to afford hearing aids for years.  She was interested in a PSAP and I agreed to fit her and verify the fitting.  We looked at them together and I was surprised to find that in an itemized model the cost of the PSAP plus associated services was comparable to an entry level hearing aid. 

I can provide appropriate audibility, verification, and options and cover my time while helping her. 

That’s the goal and it’s realizable.

 

First Steps Toward the Goal

 

I have to say that this project began with a best practice initiative. Our team of dispensers poured over articles to create a guideline.  What evidence-based procedures are going to provide our patients with the best outcomes over the least visits?  With only a little gnashing of teeth, several assessments were decided upon in addition to LDLs, real ear measures, EAA, and speech-in-noise testing.  After the completion of the protocol, the group was proud- but concerned.

Together with our resident spreadsheet wizard, we began looking at several items:

  • what exactly is our overhead, salaries
  • how many days a year are taken for conferences or vacation
  • how many average visits does a patient have during the life of his/her hearing aid. 

Then we looked at all the procedures that are involved in fitting the device:

  • the consult
  • the electroacoustic analysis
  • fitting and orientation
  • conformity, etc.

We assigned a charge based on the amount of time required and our cost per hour.  Because we thought there may be a subset of our patient population that prefers to pay for all their services up front, we also created service packages based on the average number of visits that may occur over the period of 1 year, 3 years, or 5 years.

In the next post, we discuss our first steps in implementing our “unbundling” efforts.

 

Meagan Lewis, AuD is the manager of the audiology department at Wake Forest Baptist Medical Center, a large university and medical school based health care system in North Carolina. Wake Forest, under Meagan’s lead, is an early adopter in breaking away from a ‘bundled “price for hearing instruments. There is much interest in this topic, and Meagan has agreed to share her experiences to date, with periodic updates as the new approach settles in.

feature image from contract express