Two weeks ago I finished writing what I thought was my last blog on ethics. I mean, “Who wants to read my thoughts on ethics, week after week?” So I was surprised to get several comments about my comments and then I received the following response from Mike Metz. (See below.) Mike was in private practice for 30 years and has taught, on and off at the university level for about 40 years. For six years he was on the AAA Ethical Practices Board and has been involved with the subject of ethics for a number of years. As he said in his response to me, “I have been yelled at, called dirty names, and quietly cursed in many public and private forums for expressing the ethical views of the Academy and the federal government…”
My views on this subject are available for one and all to read in my prior blogs. Suffice it to say, as a Dispenser, I have a very different view of the subject than does Mr. Metz. I come from a commercial background while he comes from an academic/allied medical profession background. When it comes to client care we have the same goals but view differently some of the business aspects of hearing health care. As I said in my previous blog, “Who wants to read another person’s thoughts when they are the same as your own”? Boring!!! So – Vive la difference!
Here is Mike’s comment, unedited:
Hi Ray.
I am sorry that I missed this post as it first came out as I could have offered a comment in a more timely manner. Volume discounts are, in and of themselves, not an ethical issue. However, the lack of “transparency” in dealing with patients and these wholesale volume discounts is the issue. If you read up on such topics as “conflict of interest” and “apparent” conflict of interest, you will see that a volume discount that serves only the dispenser and is not passed on to the patient/customer is patently unethical for audiologists, unless that discount is passed on to the patient. This is true even if an audiologist only participates in dispensing. Further, if any audiologist or dispenser deals with any government reimbursing agency (think MedicAid, Children’s Services, etc.), this action of not passing on the discount to the payer may also be illegal.
These are not easily managed concepts and the AAA has dealt for a long time with audiologists not understanding them. The ethical restrictions on volume discounts (as you discussed in this posting) do not apply to dispensers who participate only in sales of hearing aids. They do, however, apply to audiologists, even if these audiologists do not belong to a national professional organization. (See my blog under David’s column.)
I suggest that anyone interested in the topics of conflict of interest, Anti-kickback laws, or other ethical constructs, get a copy of the AAA “Green Book” and do a little reading.
Thanks Mike – More opinions are welcome from anyone with a responsible view.
