Metz’s Medicine and Audiology – Part 2

Gael Hannan
November 22, 2016

by Mike Metz


Getting back to our roots, James Jerger’s editorial in a recent trade publication (Jerger, J, Audiology Today, Is It Time to Panic?  Sep/Oct, 2016), raises some issues that may prove pivotal to the field.  And impending changes to the scope and practice of audiology may get some help from a peculiar source, especially in light of the recently proposed OTC hearing aid regulation.

What does the public expect from audiologists?  Do they require and get professional care?  And, is this care of high clinical value to the patient’s ear and hearing symptoms?  If we were to sample the public at large, asking for opinions about audiologists, ear physicians, hearing aid dispensers, and the care rendered by each, I suspect that many of their answers would not be what we would wish, but also may not surprise us.


The observations offered by critics of the present hearing device system include the lack of success in some patients, pricing of devices, and access to various levels of ear care, to name a few.  The predominant public criticism would appear to be pricing and there has been lots of input into the rationalization of costs.  But, interestingly, there has been little criticism surrounding access and technology—except in professional circles.


It seems that the government and the public reasonably assume that technology will offer higher quality than in the past, and this quality will be offered at reduced costs.  Further, since the improved technology devices will be offered over-the-counter, access will no longer be an issue.  These assumptions are probably true.

What seems to not be considered by anyone but clinicians is the success rate of PSAPs or other DIY devices.  Technology, price, and access will not necessarily equate with patient success.  If you successfully predicted the recent presidential election, perhaps you could also take a shot at the failure rate that will be associated with these PSAP/DIY devices. 

Perhaps these recommendations and proposed laws allowing for the PSAP/DIY sales directly to the public may provide a new path for audiology—one that is more in line with clinical training and audiology’s roots. 


  1. New laws or regulations increase the adoption rate of PSAPs, at least to some degree. Making PSAP/DIY devices available to mild and moderately hearing impaired patients would certainly enable more people to find some help with decreased hearing.  That could mean more traffic into offices to investigate, quantify, and qualify their degree of hearing loss.  Clinicians can bill for such services.


  1. If the patient visits a clinical office for “reimbursable investigative” information they may be more likely to revisit that office if things don’t turn out as they planned. This puts audiologists in any office a step ahead in clinical follow-up.  (Astute) Clinicians can bill for follow-up services.


  1. Offering only services surrounding rehabilitative devices renews the reimbursement game with third parties. Existing codes can be used for rehabilitative care.  Again, the clinician has to be knowledgeable—getting money from insurers is never easy.  But there are reasonable, rationale methods for rendering and obtaining reimbursement: 
    1. The device is separate from follow-up rehabilitative therapy.
    2. Therapy is billable under existing codes.
    3. Therapy many times involves investigative testing to find and fix problems and arrive at solutions.
    4. How else does a clinician get paid for treatment involving a therapeutic device?
    5. Rehabilitation encourages investigation into needed meaningful protocols that provide for the best predictive directions and final outcomes.


  1. Direct sales to the hearing impaired public places clinical services in perspective.
    1. Services are provided by clinicians licensed to do so.
    2. Dealing with hearing loss in this manner expands potential for audiologists in both stand-alone and medical offices.
    3. Offering services reduces the competition from non-clinical sources.
    4. Audiology services become transparent in that the patient can bring almost any device to any clinician in search of additional hearing benefit.


The moves towards PSAPs and OTC devices may at least partially solve many government and public concerns as well as address our “stand alone” business problems. 

While it may seem that the financial rewards of such an open and transparent approach are not what they are under the present situation, the choices we face may not include the status quo.  It is a good bet that this proposed legislation would pass in some form similar to what has been proposed.  Even if it involves a “Plan B” for audiology, it is worthwhile to consider this approach in returning to our roots.


mike metzMike Metz, PhD, has been a practicing audiologist for over 45 years, having taught in several university settings and,  in partnership with Bob Sandlin, providing continuing education for audiology and dispensing in California for over 3 decades.  Mike owned and operated a private practice in Southern California for over 30 years.  He has been professionally active in such areas as electric response testing, hearing conservation, hearing aid dispensing, and legal/ethical issues.  He continues to practice in a limited manner in Irvine, California.


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