… the hearing industry has been … loosely organized … lacking defined standards of quality in both the provision of testing services and in product performance. Consumers…have not developed a confidence about audiology in general as being a serious aspect of health care and concern.{{1}}[[1]]HEARx Marketing Plan, internal document, 1986. Unless otherwise noted, all quotes in this post come from the internal HEARx Marketing Plan.[[1]]
HEARx was a hearing healthcare company created in 1986 by Paul Brown, MD, to medicalize audiology and hearing aid dispensing. “Medicalize” is the right term, but “legitimize” was the actual term used in the HEARx Marketing Plan to describe the vision. As a physician who had created a successful clinical laboratory services company while still in training and ended up selling it for $140 million, Dr. Brown was accustomed to success and turned his attention to hearing, which he characterized as an under-utilized “part of (consumers) health care screening.” The internal HEARx Marketing Plan developed the medical model in detail as follows:
1. A Medical Advisory Group of 7 prestigious professionals in the hearing field was at the crux of the organization. This group of luminaries was to attend 2 company meetings at the central office each year as well as provide individual consulting services to the company. Each Advisor directed a specialty area “To assure HEARx credibility within the medical community and to create … credibility in the eyes of consumers.” The 7 Areas and Advisors were{{2}}[[2]]HEARx brochure from mid-80s[[2]]:
a. Hearing Diseases — Harold Schuknecht, MD
b. Hearing Testing; — James Jerger, PhD
c. Hearing Aids & De.vices — Charles Berlin, PhD
d. Hearing Rehabilitation — Jerome Goldstein, MD
e. Product & Service Quality Assurance — Jerry Northern, PhD
f. Hearing Research & Development — David Lim, MD
g. Professional & Government Relations — Derald Brackman, MD
2. Mandatory training courses in the Educational Center of the company’s central office were specified for all audiologists and “audiologists in training” (taken to mean CFY audiologists, given the date of the document). The purpose of the training was to achieve a “quantifiable level of competence both in the technical aspects of audiology and in interpersonal skills.” Training was under the auspices of the Medical Advisory Group. Graduates were awarded a HEARx Training Certificate and required to “participate in annual update training programs.”
It seems that Dr. Brown and company may have been unimpressed with existing audiology university graduate programs and maintenance of ASHA CCCs. That view was likely shared by the audiology types on the Advisory Group, each of whom was involved to some degree with the profession’s historical moves toward the AuD, elimination of the CCCs as the audiology gold standard, and development of the American Academy of Audiology (AAA)(ADA). Charitably, then, HEARx’s efforts may be viewed as an early test ground for future AuD programs and membership organizations, sans medical directors and physician control.
3. A Quality Review Board made up of “retired otolaryngologists and audiologists” and monitored by (guess who) the Medical Advisory Board, was tasked with “anonymously visit(ing) each center at least 3 times a year to evaluate the quality of service rendered, the cleanliness and appearance of the centers, the competence of the audiologist and the effectiveness of all employees’ interpersonal skills.” The idea of retired ENTs skulking anonymously in an audiology practice, checking waste baskets and bathrooms for cleanliness is beyond my imagination, but not that of the HEARx vision.
4. Each practice was to have an ENT Medical Director on staff “in case of a medical emergency.” The medical director was also required to “review all audiology reports in order to insure (sic) that no tumors or infections are missed.” Not cost-effective on the surface, but an added benefit was the creation of “mutual referral patterns” in which the ENT referred “to HEARx for testing and products, and from HEARx to the physician when testing suggests the presence of pathology.” Oh, pre-Stark amendment — those were the days!
The 38 page document goes on in this vein. It offers a fascinating historical view of audiology when it was truly the hand maiden of otolaryngology, ripe for the picking. The vision of autonomous audiology, which is so much a part of our political and education discussions nowadays, would have found no footing in the HEARx vision of Dr. Brown. And yet, the yearning for consistency, quality, standards of excellence, and coalescence in the market is shared by both visions, not to mention the move toward a revenue-based business model.
The next post in this series will look at the financial assumptions and structures set up to support the HEARx vision.
