Harvey Abrams PhD
Today’s post comes from Guest Editor Harvey Abrams, PhD, back with another compelling read. He was last heard explaining away the $100 hearing aid myth. Readers can find his bio at the end of the post.
Today’s post picks up the Pricing issue from the service side of the equation: Not only do products cost more than you’d think, but services are worth more than some think. Dr. Abrams takes it to the street, making his pitch directly and compellingly to consumers.
Starkey Hearing Blogs ran Dr Abram’s post on February 4, 2014 and graciously gave us permission to reformat and rephrase it for publication at at Hearing Economics.
What’s the Consumer’s Smart Move?
There’s no getting around the fact that investing in better hearing can be expensive. Given the ubiquitous nature of online shopping, you might be asking yourself if it’s a smart move to bypass the hearing professional and save money by purchasing your hearing aids online. The problem with this approach is that it assumes that all you need to do is put those purchased hearing aids in your ears and your hearing problems will be solved! That’s like buying an orthodontic appliance online and expecting your teeth to straighten out by simply putting it in your mouth.
If you’re considering purchasing hearing aids online, you need to ask yourself a few questions.
- How will you determine which hearing aid is best for you? There are literally tens of thousands of possible combinations of manufacturers, styles, features, and levels of technology to consider.
- You also have to ask yourself what you are going to do with those hearing aids once they arrive in your mailbox. The many parameters, or settings, of your hearing aids need to be properly adjusted in order for you to achieve the best results in terms of speech understanding and listening comfort. Even if your hearing aids come “pre-programmed,” the sound coming out of the device interacts with the unique acoustic properties of your ear. These ear-specific acoustics differ from person to person and even from the right ear to the left ear for the same person. In fact, two people with the same hearing loss, fit with the same hearing aids, programmed to the same settings can experience very different results.
- What are you going to do if your hearing aids need to be adjusted or repaired?
- What if your online hearing aids don’t provide you with the help you were expecting?
- How will you know if it’s because the hearing aids are not functioning properly, are not appropriate for you, aren’t adjusted properly, or, more importantly, that you require something more than just hearing aids, such as assistive technology or auditory training?
You Need a Guide to Make the Smart Move
In fact, you won’t be able to answer any of these questions (nor should you be expected to). The management of individuals with hearing loss, which includes the appropriate selection and fitting of today’s complex hearing instruments, requires extensive education and training. Hearing care professionals are required to be licensed in the state in which they practice. Their training and experience are designed to ensure that the treatment plan they propose for you is based on a comprehensive evaluation of your hearing system and your communication needs.
Here’s another question: What should you expect from an Audiologist that you won’t be able to get through an online purchase? I’ll answer that one in 8 steps:
- A patient-focused “income” measure: Audiologists have a number of well-validated and researched questionnaires to help determine your unique treatment needs.
- Meaningful clinical tests: The majority of patients with hearing loss complain of problems understanding conversations in background noise. Audiologists can test your ability to understand speech in noisy backgrounds in addition to other measures of your hearing system.
- Patient-specific treatment goals: You and your Audiologist should identify what you want to achieve at the conclusion of treatment. That is, what do you want to be able to do that you can’t do now?
- Selection of hearing aid style and features based on the treatment goals: Two patients with the same hearing test can have dramatically different auditory processing abilities, communication requirements, and, consequently, treatment goals.
- Verification of hearing aid settings: Your Audiologist should use probe-microphone measures to ensure that you can hear those sounds that contribute most to speech understanding while also ensuring that loud sounds are not uncomfortable for you.
- Validation of the hearing aid fitting: In the end, the success of your treatment will be determined by the extent to which your expectations and goals have been achieved. You and your Audiologist should assess this.
- Consideration of hearing assistive technology: Despite best efforts, one or more of your goals might not have been satisfactorily achieved. Your Audiologist will consider other technology such as remote microphones to achieve those goals.
- Rehabilitation services: You may continue to experience communication problems despite being provided with the latest hearing aid technology fit by expert clinicians. Your Audiologist can provide you with rehabilitation tools that can optimize the benefits of your hearing aids, similar to how physical therapy improves the healing process following knee surgery.
Consumers, Think On
Does your online hearing aid purchase come with these 8 additional services? If so, shop away; if not, you may want to think twice about purchasing your hearing aids online.
(Editor’s note: This is Part 14 in the multi-year Hearing Aid Pricing series. Click here for Part 13 or Part 15).
Harvey Abrams, PhD, is the Director of Audiology Research at Starkey Laboratories. Previously, Dr. Abrams served in clinical, research, and administrative capacities with the Department of Veterans Affairs and the Department of Defense. He also teaches distance-learning courses for the University of South Florida and the University of Florida. Dr. Abrams received his master’s and doctoral degrees from the University of Florida. His research has focused on treatment efficacy and improved quality of life associated with audiologic intervention. He has authored and co-authored several recent papers and book chapters and frequently lectures on outcome measures, health-related quality of life, and evidence-based audiologic practice.
title image courtesy of hear at home
To begin with, you are advocating purchasing hearing aids online.
I am reliably aware that when manufacturers offer a new product, we are not the first purchasers. The manufacturer does an IPO type of offering, with information leaked out Hearing Planet, and other unscrouplous agencies. These groups buy the new product by the 1000’s . Manufacturer makes his money and keeps quiet. No one knows how Hearing Planet got the aids because its confidential. Then the manufacturers put up great dramas to tell us that they are not selling “directly” to such agencies.
My contact at a major manufacturer provided this info. Its confidential. Starkey is also named. The sale always takes place before the IPO. A very corrupt technique. Please tell Brandon about this info. If you really want to maintain good ethics, The Hrg Aid Man. Association needs to act. NOW !
Thank you for outlining the services a great audiologist would provide. I wish more audiologist provided the services you outlined. Unfortunately very few audiologist do. To the best of my knowledge only one audiologist in my county does real ear testing and very few test your ability to understand speech in noisy backgrounds.
I dream of the day when your guidelines are the reality everywhere.
This brings home that it’s not the Internet that is the real topic – it’s the supplier, be it audiologist or retailer.
Blamey Saunders (in Australia) run a fully supported tele-health model on line, for people with mild to moderate loss, and follow high standards of care. Not many single practice audiologists could boast to work directly with clients within 24 hours, and have a team of 25 experts in hearing, audiology and hearing aid technology in attendance so quickly. Our haring aid system is designed end to end to support this
Elaine
@ Ann: In Oregon, since 2006, probe microphone measurements and/or sound field testing is required within 30 days by the state. The practitioner has the choice of either, but at least one must be completed in the first 30 days, preferably at fitting.
Audiologists or dispensers who do not complete this within the time frame without just cause (i.e. patient refusing to come back for the testing) are subject to fines or, if a significant pattern of repeated behavior is demonstrated, possible removal of license.
This was a consumer-driven change to our law. The Oregon chapter of the NHLA pushed for this and got it. It wasn’t a problem for me since we were already routinely doing both procedures.
Despite this, I find it common for either group–Auds and HIS alike–to not bother with these procedures. IMO, this is voodoo audiology, particularly when it comes to probe mic measures; assuming the manufacturer’s software is doing what their software says it is, is going on faith rather than science. While the patient may not like the target volume, at least you know where they are at.
I fit to patient preference, which may have them underfit initially but does create an acceptable level for them to start with. I then use the probe mic results to counsel them on how they could potentially do better when they are ready for more volume.
But your statement is completely valid. How can we as professionals claim we’re so much better than the internet because we perform these procedures, when in reality 60% of our colleagues don’t? A bit of hypocrisy for anyone who complains about internet sales but doesn’t follow what our industry considers to be best practices.
And don’t forget the value of sound field testing for validation as well…
My concern is that clients are provided with a hearing aid without an audiologist assessing their hearing loss and needs,
e.g. as was reported to me by a client who walked through my door, he said that he had bought aids from your own company but that had he had never had a hearing test – can you explain your step by step process when dealing with clients, and what information etc you are willing to provide the audiologist on the ground who is left to try and sort things out for these clients.
I have an aid adjusted by an audiologist. As far as getting any useful information through it goes, it’s a dead loss.
I have a home phone that, as a person with a hearing disability, was provided for me by the state. All it does is boost volume. I can hear and understand with that.
I read up on different cell phones and chose one that can have the volume turned WAY up. If you’re standing in front of me, I can hear you better if you call me on my cell than I can with my aid.
Explain to me again WHY I should have an audiologist work hard to make it difficult to hear.
I am thinking this must be a set-up question, but I will answer it seriously in case you really are asking WHY. You have picked the wrong audiologist, just as people pick the wrong physician, accountant, realtor, or other professional on occasion; ditto for picking the wrong friends and partners on eharmony.com. Interviewing, reading up on, and observing people — professional or personal — is an essential step if one entertains hope of success in any relationship, including “doctor-patient” relationships. The days of “doctor knows best” are long gone, thank goodness. We all have access to information that enables us to make economically wise decision about how we spend our resources (time AND money). We all have sunk costs that we cannot recoup except to improve our knowledge and experience so we can do better next time.
WHY? Because you picked the wrong Audiologist and incurred a sunk cost. Inferring that all Audiologists are bad is not a valid conclusion, though it does allow you to not learn from your past experience. Better idea: read up (as I believe you’re doing as evidenced by your Comment), chose wisely, do it again and benefit from what you learned from your first experience. Insist on useful information, an Audiologist who listens, amplification that does better than just “boost volume,” hearing aids that enlarge your social sphere rather than relegating you to your cell phone, and consistent, careful follow-up. Trust me, you’re gonna like the way you hear!
The reality is that convenience and cost are the major players here. Purchasing hearing aids at one third of the price and the ability to adjust them yourself from the comfort of your home for people with mild to moderate loss is gaining popularity by the truck load.
As technology improves and is refined the need for audiologist’s will diminish overtime.
Ann hit the nail on the head. If our profession, as a whole, practiced standardized best practices, then consumers’ receptive communication needs would be placed front and center. These needs would be systematically evaluated using speech-in-noise testing and formal/informal questioning to determine their needs within the framework of their lifestyle and other factors. Then and only then would a RANGE of technologies and training be recommended. And, of course, any recommendations would be verified and validated. Unfortunately, because the standard of care varies widely, consumers are not guaranteed a reliable guide. Left to navigate the hearing health care maze on their own, they may or may not reach their hoped for destination.
You’ve convinced me I should look into buying hearing aids over the internet.
When I have problems hearing with my hearing aid, the audiologist doesn’t help me. She explains how it’s MY fault that I can’t understand anything I hear because I’ve forgotten what things sound like. In reality, she has them adjusted so they boost the sound in a very narrow band only. So, if I can hear a sound at all, it sounds like every other sound that I can hear. I can usually tell there’s a sound, but have no clue what it is.
The only clue I have is duration. A siren tends to go on and on, whereas a car backfire has a very short duration, and a car horn is usually more of a medium length. And speech is usually a series of sounds, but then, so is music. But otherwise, they all sound alike.
I asked for a different audiologist last time, and that one was determined to prove that the first one hadn’t done anything wrong. She wouldn’t test my hearing or adjust the aid, just turned it a little louder.
I also can’t hear ANYTHING in my right ear, which she said has moderate to severe loss, and my left ear, when the TV is turned as loud as it will go, makes me wonder if there’s a sound in my apartment or if I’m imagining it, and she called that mild hearing loss. I went out the other day with my aid in and the battery ran out. I didn’t hear the beep and didn’t notice a difference.
If you buy an aid over the internet, can you adjust it yourself in any way other than volume? Are there any quality aids you’d recommend?
Ms Mitchell–I just came across your post and I hope you will find my reply– many months later. Please seek another opinion, because a good audiologist can provide better service than you describe! You may need an updated test. Yes, hearing aids can be adjusted for more than volume. It may be that the hearing loss is to the point of you needing more help than a hearing aid can provide. Your description of your difficulty makes me think you might need extra technology–such as a remote microphone, or –you might be a cochlear implant candidate. A good audiologist should be able to perform a thorough evaluation and let you know when it it time to consider options other than hearing aids, and they should be equipped and willing to refer you to the appropriate place so that you can have the best care. Keep looking! I wish you the best!
Thank you for outlining the services a great audiologist would provide.
online hearing test
Thank you for an informative article. The issue here is cost that most people can’t afford. It doesn’t matter how much I would love to purchase a top of the line hearing aid through a certified Audiologist, I can’t afford it. The insurance companies doesn’t cover the cost neither Medicare. So I, like millions of other consumers, just suffer and are shut out from the world of hearing because we can’t afford the cost of H.A. To qualify for any program, you practically have to be homeless, I spent months contacting all the resources that are mentioned in numerous blogs without success.
I have two relatives that used to work for a hearing aid company and they told me of their cost and what they sold them for to audiologist and considering the suffering of so many people, I would say, the mark up is almost criminal. The audiologist are all over the net trying to explain away their mark up, but that is not going to do any good to the people who can’t afford to buy. I think that more people would buy hearing aids if they could afford them. I’m not buying over the net because, I think that their prices are still high without the support and I’m afraid of what I be getting. Thanks again for the information. 4-16-14
I have only just come across this article in my recent search on the internet for information to help me resolve my hearing impairment and although my contribution may be a little late I feel compelled to post a reply to the author’s assumptions, assertions and less than objective statements. I am certainly not an academic and I don’t pretend to know a great deal about hearing loss and the use of hearing instruments to compensate for hearing deficiencies but by the same token I have enough commonsense to make myself aware of the things I need know, do and who to seek help from if needed along with the vast majority who have hearing difficulties and access to the internet.
Mr Abrams initial questions are presented as being answerable only by consultation with an audiologist.
I cannot give wholly encompassing answers to his questions but I can, with my brief foray into the vast amount of information available on the net put them into context.
Q1 states that there are ‘tens of thousand of possible combinations of manufacturers, types, styles etc of hearing aids to choose from.” Plainly this is an exaggeration. why does he feel the need to exaggerate? And after consulting with a doctor to ensure the health of your ears, having a hearing test documented and considering your personal needs the choice soon becomes an obvious. In any case most audiologists are affiliated with specific suppliers which narrows the choices if you take the traditional path.
Q2. 3. 4.What is the difference with getting pre programmed aids of the net and getting them preprogrammed from an audiologist? In both cases it becomes a case of trial and error for further adjustments and either returning the aids to the net supplier or losing more time out of one of your working weekdays returning to the audiologist for further adjustment guesswork.
The most disturbing aspects of the comments within these questions is the implication that you will not be able to have the aids you buy on the net adjusted to your needs because you were silly enough to buy from an internet supplier about whom you did not do enough research to ensure that your interests and needs would be fulfilled.
And the availability of the hardware and software for adjusting hearing aids is purposely restricted by the supplier to ensure that the retailers [audiologists] can retain an income stream after the sale of aids or refuse to assist a person who has bought the identical model off the net.
And certainly anyone should be able to consult with an audiologist for any problem they have with their hearing but the sad fact is they cant. And the reason for this is because most players in the hearing services providers community are more concerned about protecting their income than providing effective solutions to hearing impaired persons at a reasonable cost.
But times are a changing! the internet is here. Knowledge, albeit general in most instances is available to anyone who is determined to find it and the days of being able to charge more than 12 times the manufacturing cost for hearing aids are limited.
Large discount retailers are now being supplied with high end hearing aids which they can sell at a fraction of the prices that traditional hearing clinics charge and are dispensed by the audiologists they employ.
Other inventive and enterprising professionals are and have developed aids that match or exceed the performances of the six major cartels products and are selling them at a third or less to persons who otherwise would continue to suffer the disabling effects of hearing loss.
So even the manufacturers who supply the industry are bypassing their traditional distributors [audiologists] and are tapping into the huge numbers of people who simply cannot afford the expensive elitist service that Mr Abrams promotes.
The main thing that I and I am sure most other concerned people have an issue with is the nexus of a section of the medical fraternity with the suppliers of devices to cure suffering people’s condition and the fact that this partnership allows audiologists to greatly enhance their income at their patient’s expense.
Of course people will risk buying hearing aids off the internet irrespective of the dubious arguments against it. Even if the aids do not work perfectly and they cannot get them corrected its still vast improvement on the circumstances they were in.
The restriction of cure for suffering in any form to the well off is immoral and any means to make that cure available to the general community should be supported not discouraged.