Counseling and PSAPs

cochlear implant single sided deafness med-el
Mike Metz
July 17, 2018

by Mike Metz

Mike Metz, Hearing ViewsAs PSAPs come into the marketplace, and as clinicians decide how to deal with them, there arises an issue of the need to addressing patient counselling.  Most hearing aid fittings come with recommendations for follow-up.  Most new cars sales also come with recommendations for follow-up.  What do PSAPs come with?

Automobile sales typically consist of following up with a phone call to the buyer, an invitation to visit the sales office for clarification of the vehicle’s operations, or to get the car washed or serviced.  Many hearing aid sales provide similar follow-up.  If the operation of the hearing device is the main reason for following up, there is little reason to call these office visits anything other than a sales follow-up.  To call such visits “therapy” is not only misleading, it also lessens the impact of “real” therapy, not only in the eyes of a patient, but also in the reimbursement columns of third party payers.

Recently, in trade publications as well as professional journals, there have been a number of articles regarding “follow-up counseling and/or follow-up therapy”.  It would seem that many of the return visits to the office that fit the hearing aid(s) involve teaching the patient to use the devices.  Conceding the necessity for such training, do those visits constitute therapy or are they just plain “fitting follow-up”?

I bet that most audiologists do not provide “therapy” following a hearing aid fitting.  They confuse and mis-label the concepts of “sales follow-through” and “therapeutic follow-up”.  This is partially a remnant of audiology’s adoption of the retailer’s business model back in the 1970s.  If there is doubt that this is the case, consider what non-clinical hearing device dispensers do.  Are their “orientation” tasks similar to the tasks performed by an audiologist?  Does this similarity transform the salesperson’s tasks into therapy?  Do the same sales tasks constitute therapy when performed by a clinician? What about an “audiologist aide”?  If an “aide” can provide therapy, can a non-audiologist dispenser?

Professional therapy involves at least a couple of aspects:

  1. Diagnostic information outlining the problem
    1. An appropriate history
    2. An audiogram
    3. A conclusion
  2. Discussion with the patient about the DATA and offering an outline of the therapeutic goals and tasks
  3. Fitting the devices and documentation of benefits
  4. A therapeutic plan for recommended treatment beyond the device fitting
  5. Notes in the patient’s file about progress: goals, methods, milestones, problems, etc.
  6. Time spent, and money paid/collected—invoices, accessories, insurance information and payments, etc.
  7. Most importantly, a licensed and knowledgeable therapist!

But, most clinicians already know the elements of therapy, right?  Are some clinicians trying to make follow-up sales tasks into “therapy sessions”?  Are they billing third party payers for such sessions?  Could such billings be in violation of laws or ethical standards?

Stating this in a more simplistic manner, if your billing methods were audited, would your clinical tasks and notes support a definition of therapy in the minds of the auditors?  This, of course is an essential element of “unbundling”.  But, just because services are “bundled” into the sale of the device doesn’t excuse the clinician from providing what is being called “follow-up clinical services” and documenting visits in a true “clinical” manner.

As a patient, I have been served by some good clinicians.  As a consumer, I have had “follow-up” in several sales offices.  As a clinician, I can make some sort of judgement about the value of these office visits.  One can wonder at how other patients, third party payers, government agencies and others place value in some “follow-up” offers. 

When it comes to PSAPs, the skills of a good clinician will many times make a huge difference in the ability of these devices to provide benefit to the hearing impaired.  Goals, established in large part by the accumulation of clinical hearing data, can be set in a realistic manner.  Progress towards goals can be demonstrated with data.  Impossible situational solutions can be explained.  Technology applications or algorithms can be justified.  Data replaces a “sales pitch”.  Data replaces “follow-up.”

Patients and third parties can understand these logical and data-driven methods.


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