As members of AAA debate the merits of direct access legislation, a new study, published online April 26 at JAMA-Otolaryngology is apt to capture the attention of Medicare policymakers. Elham Mahmoudi and colleagues at the University of Michigan, using data from the 2013-2014 Medical Expenditure Panel Survey, evaluated hearing aid use among 1336 adults, aged 65 and older.
The researchers addressed two main questions: 1) Is the use of hearing aids in older adults associated with an increase in hospitalizations and emergency room visits? 2) How does hearing aid use effect health care utilization and spending among older adults?
Hearing Aid Use and Healthcare Costs
Elham Mahmoudi, PhD
To address these questions they conducted a retrospective study of data collected from a representative sample of noninstitutionalized adults in the U.S. Individuals aged 65 and older with self-reported hearing loss were part of their statistical analysis. Among the group of 1336 individuals who were part of the study, 602 were self-reported hearing aid users. This group of self-reported hearing aid users was compared to a group of similar non-hearing aid users. The mean age of the population studied was 77 years with 45.1% self-reporting as hearing aid users.
Using complex statistical analysis to account for confounding factors, such as physical limitations, educational level, income and region of the country, the researchers determined that hearing aid users spent, on average, $1125 more on total annual hearing care expenses, and, on average, $325 more on annual out-of-pocket medical expenses. However, they also found that hearing aid users had slightly lower ($71) Medicare expenditures, a lower probability of both emergency room & hospital visits, but a higher probability of visiting the doctor for routine office appointments.
According to the authors’ conclusion in the JAMA paper, “Our study shows positive results of hearing aid use on increasing the number of office visits and reducing hospitalization and any emergency department (ED) visits among patients with self-reported hearing loss. However, we did not examine the causes of these visits and whether they might differ between individuals with and without hearing aids. It may be that reductions in the use of this type of service reflect fewer critical incidents, such as falls, that require urgent and immediate intervention. Alternatively, because ED visits and unplanned hospitalizations have been associated with less access to a regular source of primary care, it may be that the differences in ED visits and hospitalization between older adults with self-reported hearing loss who do or do not use hearing aids reflect variations in patterns of health care use. It is also plausible that individuals who use hearing aids are willing to spend more on preventable health care services.”
“Our results indicate that patients who reported using hearing aids had higher numbers of office visits and lower probability of ED visits or hospitalizations. People who use hearing aids need to be tested by a specialist, and their hearing devices need to be fitted regularly. Perhaps owing to better communication, patients with hearing aids are more aware of their well-being and health conditions and are more likely to request primary or specialty care visits as needed…… improvement in physician-patient communication, better understanding of and adherence to recommended treatments, and therefore better awareness of preventive care may explain the outcomes of hearing aid use on the differing use of health care services”
Disparities in Hearing Aid Use
In an accompanying commentary, Margaret Wallhagen from the Department of Physiological Nursing at the University of California, San Francisco, pointed out the disparities in hearing aid use across geographic regions and minority groups, suggesting that hearing aid use is less common in people with fewer resources. These are well-known disparities that also were brought to the fore in the June 2, 2016 NASEM report on hearing healthcare access and affordability.
Among the considerations proposed by Wallhagen to address these disparities in hearing aid use for vulnerable and underserved populations are the clinical adoption of short questionnaires or brief objective hearing assessments by primary care providers, the use of simple educational brochures to encourage follow-up with hearing healthcare providers, and finally, the consideration of high quality over-the-counter hearing aids and other vetted non-custom alternative amplification systems.
Given the relationship between hearing aid use and the increased cost associated with hospitalization and emergency room visits revealed in this study, Medicare policymakers would be wise to take these findings into consideration as it examines ways to lower its total per person costs and expand its overall coverage to an aging American population. Concurrently, these findings should be a clarion call to hearing healthcare professionals to embrace quality, lower cost alternative amplification solutions to better meet the needs of underserved populations.
*featured image courtesy pixnio
I can vouch for wearing hearing aids as a senior who is 80 plus years. Wearing one in each ear if both ears have a hearing loss. I am around many seniors and they refrain from using hearing aids because to them it is a sign of aging. This is so sad and they remain at home with their disability by turning up the TV so loud their children do not want to visit them. Today the hearing aids have so many programs that help one hear in a quiet or noisy environment. However you must visit a licensed audiologist whose purpose is to help you hear. Some hearing health providers promote tiny hearing aids that have batteries too small for arthritic fingers.
I have a neighbor who has hearing loss, but not very bad I would say. He got his hearing aids from the VA. They sit in a drawer. I have to conclude that either he doesn’t really need them or because they were free that to him that he is not invested in them. I know from doing beta testing for product concepts that those who pay nothing to participate are the least likely to provide meaningful feedback. Hearing Aids should be reasonably priced, but if they are free then that’
s just another reason for the wearing to consider them worthless.
OTC is presented as some sort of panacea to get people to use hearing aids, as if the professional services that make them work well and keep them working are not an essential part of the equation. Consumers are incapable of looking in their own ear, and they are also incapable of keeping clean the tiny parts and pieces that are essential to keep clean so they actually work. Hearing aids are HIGH MAINTENANCE medical devices, and in our office, we see our clients a minimum of 4x per year for routine cleanings and checkups, wax removals, repairs and more. Those who have to pay for their services through 3rd parties like TruHearing, which provide reduced prices on hearing aids by separating the cost of the device and the services, tend to skip the appointments to “save money”. We don’t see them until a year or so after the purchase, grudgingly and upset because “these things stopped working 4 mos after I got them and were a waste of money! What are you going to do about it!” Well, let’s look with the video otoscope on the big screen TV. Oh! There’s debris in the microphone, debris in the speaker, and wax in your ear. Clean clean clean. Presto! Works like new! I can tell them all day long that they have to come in every 3 mos for maintenance to keep them working, but when they have to pay for it, they’d rather “save the money.” If the product doesn’t work because it’s clogged up, ANY amount spent is a waste of money! OTCs quickly end up in the drawer because of simple cleaning issues consumers can’t take care of themselves without specialized magnification and cleaning equipment that is both expensive and not provided with their purchase. It is not going to be a panacea. It will simply convince more hearing impaired people that “I tried hearing aids and they didn’t work”.
It’s like your car, people. You can run it for a while, sometimes a good long while without any kind of service or maintenance, but without the service, repairs and maintenance required to keep it working, it will eventually become a large and expensive paperweight in the garage.