That response is attributed to Willie Sutton, a famous bank robber of the 1940s and 1950s, when asked why he robbed banks.  I have quoted it a couple of times during my career, not because I robbed banks, but because it is, in essence, brash and logical. 


The Logic of Efficiency


It also has some vague application to the hearing aid field—not the robbing aspect, but rather the underlying logic of efficiency.  This efficiency thing is also at the heart of directed mailings, advertising, and appeal to people who have an obvious need. It’s also at the center of ads for cars, dishwashing detergent, and even medicine.

For quite some time I have harbored the thought that, were I still in the audiology business, I would look closely at what I had to offer to those people who fail in their attempt to use amplification.  Imagine what kind of consumer response you would get if you placed an ad that said something like:

There is no lack of data about the real “market penetration” of hearing aids, the instrument return rate for “lack of benefit”, and attempts to explain why a significant number of patients fail in their attempts to hear better.  There are also indications that support the lack of proper testing and the setting of instruments as an explanation.  One thing is abundantly clear:  people fail despite their output of time and money.  And, while that’s where the desire is, it’s not very efficient when it comes to providing help.


Try Again With Those Who Try


Perhaps it might prove fruitful and efficient if some clinicians attempted to “fix” those patients who have shown that they were willing to try hearing instruments but failed, for some reason, to gain sufficient benefit.  After all, they took the first step. 

Maybe there are methods or procedures that would suit them better.  Maybe there are simple solutions to help them benefit from their outlay in time and money.  Perhaps if some of these “failed” patients were “rescued,” this would demonstrate that appropriate audiologic care does indeed make a difference.

Many studies that have shown “first fit,” faulty, or absent probe measurements; inappropriately programmed instruments; and the like have proven unsatisfactory to many with hearing loss.  We should also not have to be reminded that many clinics that follow “best protocols” have a very high degree of success with their amplified patients. 

Those “best protocol” clinics and clinicians could provide a great benefit if they were to solicit “difficult” patients who failed with their hearing aids.  Proving that adding astute clinicians to data-driven procedures solves a lot of problems may go a long way towards demonstrating the skills and advantages of good audiology.


That’s Where the Money Problem Is


In contrast to Willie Sutton’s statement, money should not be the principle driver of any approach to helping people use hearing devices.  While there must be a consideration of reimbursement, patients who have tried and failed using amplification would seem to have pursued hearing aids despite the cost.  And, their failures reflect on all of us.  There is another saying that roughly translates “rumors of failure travel faster than rumors of success.” 

For Audiology, perhaps the appropriate rephrasing of Sutton’s statement could be something like:  “That’s where a greater need is.”  Proving the value of generating data and realistic expectations, then applying the best practice protocols to patients who have failed in their attempts at amplification, may be a good first steps.  We already know that these patients have taken a first step toward help, and they deserve an explanation of what happened.  We seem to be training new clinicians to follow correct protocols, but there also seems to be a lot of sellers out there who are not following these “rules.”

If audiologists provide value, shouldn’t they try harder to prove it to those who have failed?  The worst outcome of such a program would be that some of these patients would know why they failed.  The best outcome would be successful patients who understand the benefits of data, protocols, and knowledgeable professionals.  Either way, audiology wins.

You guys are smart—you figure out what such an approach is worth in terms of reimbursements, advertising, and good will.  And efficiency.


feature image courtesy of the FBI

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