Developing a Viable Best Practice Model for Online and OTC Hearing Aid Distribution

Holly Hosford-Dunn
March 25, 2014
Ryan Kalef, Canadian Audiologist and Intrepid Reporter

Ryan Kalef, Canadian Audiologist, Intrepid Reporter, Worthy Competitor

Hearing Economics  welcomes back Ryan Kalef as Guest Editor for the next few weeks.  His previous posts have given readers the Canadian perspective with An Earful From CanadaCall of the Wild, and Different Views on Selling.  Today he jumps in the bare-knuckled Price ring, joining the Pricing Series to the effort started last week by Terry Ross to find rational and professional means of competing against new challengers.


The burgeoning question on my mind lately is this:

Can Internet sales of hearing aids executed to achieve lower prices for the consumer/patient/client, be a sustainable business model and follow best practice principles?

Following a few days of reading up on the Internet and over-the-counter sales market for hearing aids,{{1}}[[1]] By reading about upstart young entrepreneurs with business degrees (e.g., embrace hearing), rather interesting and/or out of date ENTs (e.g., MD hearing aid), various patient based hearing forums and a slew of audiologists/hearing instrument dispensers condemning the market as a knock against  their time and expertise.[[1]] I started thinking to myself that “there can be a viable best practice model for online/over the counter hearing aid distribution.”

Surely if a number of well-educated and business-savvy folks see the potential, and there is a consumer demand for lower prices, a highly educated individual in the field of audiology and hearing aid dispensing (such as myself) with  dreams of financial grandeur could see the potential too.


Best Practice OTC Hearing Aid Distribution Model: Could it Work?


I do see the potential and, theoretically, I think there is a model that could work. But is it a more economical system? Instead of joining the critics who fight over average follow-up rates, time value, and the value of expertise, I decided to explore the structure that would actually satisfy my criteria for operating such a practice.

  • First, the model needs to meet best practice hearing healthcare standards.
  • Second, it needs to offer lower prices to the consumer/patient/client.
  • Third, it needs to be a viable, sustainable business model.


Model 1:  Best Practices for Ideal Patients in Current Dispensing Settings

Has Mr Ideal Visited Your Office Lately?

As an Audiologist first and business person second, my modeling effort is in stark opposition to the business minds working from the business idea outward and bashing the world of hearing health care in the process.  I’ll explore and develop the model through step-by-step examples, much like writing a computer program (or body building).  The model is best started with the simplest case — one with no problems.  I’ll start with my ideal clinical patient, whom we will name Mr. Ideal.

Mr. Ideal is an active, well-educated 70-year-old patient who lives an active and social lifestyle. His dexterity is excellent, he does not wear glasses as his vision does not require it, and he describes himself as tech savvy. Mr. Ideal has noticed a gradual decline in his hearing ability, particularly in group situations over the past 5 years, and is now motivated to correct his problem through the use of hearing aids. And, oh yes, he does not have a wax problem, and he has a “standard” mild to moderate sloping bilateral sensory-neural hearing loss (SNHL).

In the clinic Mr. Ideal’s best practice process goes as follows:

  1. A complete assessment.  Time length is 1 hour because he is Mr. Ideal.
    • case/medical history ( I had to learn those qualities about Mr. Ideal from somewhere)
    • otoscopy ( to ensure the ears are, in fact, healthy)
    • tympanometry (verifying again the health of the middle ear)
    • air conduction (AC) pure-tone assessment
    • bone conduction (BC) pure-tone assessment
    • Word Recognition Score (WRS)
    • Speech Reception Thresholds  (SRT)
    • speech assessments, perhaps including a quick Speech in Noise Test (quick SIN) to look at speech in noise performance
    • review findings and agree on a treatment plan
      • affirm with Mr. Ideal the nature of his hearing loss
      • complete hearing aid candidacy review with Mr. Ideal
      • confirm that Mr. Ideal agrees with the recommendation for bilateral open-fit hearing aids, with the option for Bluetooth technology
      • measurements for tubing length and dome size are made
      • color selected
  2. The appropriate paperwork is filled in and the order is made to the HA manufacturer.  Time required:  10 minutes.
  3. Upon receipt of the hearing aids, correct paper work is filed and double-checked to be sure hearing aids are accurate and electro-acoustic performance is to specification.  Time:  10 minutes.
  4. Mr. Ideal returns to the clinic for his fitting appointment.  Time length is 1 hour because he is Mr. Ideal.
    • He is counseled as to expectations and adaptation with his new hearig aids and he fully understands on all fronts.
    • Hearing aids are programmed to target in the manufacturer’s software.
    • The output of the hearing aids is verified to target using real-ear measures (objective verification).
    • Mr. Ideal is very pleased in the clinic with his target fitting and no other adjustments are required.
    • Insertion and removal of the battery is reviewed and Mr. Ideal gets it on his first try.
    • Insertion and removal of his hearing aids are reviewed and Mr. Ideal is able to demonstrate insertion ability after a few short moments of practice.
    • He is very pleased and is on his way.
  5. Mr. Ideal returns for his first scheduled follow-up after two weeks.  Time required is 30 minutes because he is Mr. Ideal.
    • He reports no difficulty changing the battery.
    • He happily wears his hearing aids 8 hours a day.
    • A listening questionnaire (COSI) is filled to step two.
    • Basic maintenance and care of the hearing aids are reviewed (changing domes, wax guards etc…) and he demonstrates no difficulty performing these himself.
  6. Mr. Ideal returns for follow-up one month later.  Time required:  15 minutes.  
    • He reports no concerns.
    • He is performing maintenance correctly, as confirmed by observation and a clean and check of the hearing aids.
    • COSI is completed.
    • Mr. Ideal accepts the hearing aids formally and is advised to return for 6-month follow-ups and/or on an as needed basis.

Thus ends the fitting and follow up process for Mr. Ideal, fit within best practice principles.  Total time for his fitting process is 3 hrs and 5 min over 6 -7 weeks. Additional time for follow ups down the road is not included because he is Mr. Ideal and will return happily in 5 years time ready to purchase new HAs.

With the groundwork for Mr. Ideal  laid, the next step is to substitute a mode that integrates an Internet/over-the-counter sale of the hearing aids themselves without precluding best practice.  Hold that thought till the next post, when Mr. Ideal meets his hearing aid online in Model 2.

(Editor’s note:  This is Part 16 in the multi-year Hearing Aid Pricing series.  Click here for Part 15 or Part 17).


Ryan Kalef is a clinical audiologist and clinic manager with Hearing Life Canada.  He holds an Msc in Audiology degree from UBC as well as a Bsc in Integrated Sciences (Physics and Psychology) also from UBC.  He  recently was  the conference co-chair for the 2012 BCASLPA conference in Richmond, BC and is the private practice audiology representative for BCASLPA. Ryan enjoys the active lifestyle Vancouver has to offer including the many scenic hikes, golf courses, and ski hills in the surrounding area. And, oh yes, a healthy interest in economics.  

feature image courtesy of longer encounters; photo of Mr Ideal from prime cut body building

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