By David H. Kirkwood
MINNETONKA, MN—Hearing care providers have long believed that a recommendation from a primary-care physician (PCP) is one of the most compelling factors in motivating people to get help for their hearing loss.
That’s why for years the Hearing Industries Association (HIA) marketed to GPs, family practitioners, and internal medicine physicians, urging them to add a hearing screening to their routine physical exam protocol.
It’s also why many audiologists work assiduously to cultivate relationships with local PCPs (and their nurses) who might refer patients their way.
The evidence that PCPs play a crucial gatekeeper’s role in putting patients on a path to addressing their hearing loss continues to mount.
In 2012, Sergei Kochkin, then executive director of the Better Hearing Institute (BHI), reported that consumers selected the family physician as “the most important social influencer” in their decision to get hearing aids. (The consumers chose that answer from a list of potential influencers suggested by the MarkeTrak 8 survey.)
Jus last month, BHI’s report on the MarkeTrak 9 survey revealed that 20% of survey respondents who did not have a hearing aid despite an acknowledged hearing loss said “a positive recommendation from my doctor” would motivate them to purchase one. As the figure below shows, among the nine possible motivators listed in the survey, a doctor’s recommendation was the third most selected, behind having insurance coverage for a hearing aid and taking a hearing test “that makes it clear that I need” a hearing aid.
NEW HEARING TEST KIT
hi HealthInnovations, part of UnitedHealthcare, America’s largest single health carrier, touts its kit, which became available in 2012, as “an innovative way for primary-care physicians to test for hearing loss, making it easier and more affordable to diagnose the condition.” The kit is priced at $179, but is available free to many UnitedHealthcare in-network physicians.
According to hi HealthInnovations, the kit’s air-conduction threshold testing produces calibrated, controlled tones at different frequencies and intensities, resulting in accurate hearing test, or audiogram, results. Compliant with ANSI S3.6-1996 standards for audiometers, the kit can be used by physicians, nurse practitioners, and physician assistants.
WHAT WILL IT MEAN FOR HEARING PROFESSIONALS?
Audiologists and hearing aid specialists have their own, more sophisticated equipment for testing their patients’ hearing. However, they still have reason to be interested in the low-cost kit designed for PCPs.
As Lisa Tseng, MD, the CEO of hi HealthInnovations, pointed out in her company’s announcement of the patent, “People wait an average of seven years to obtain treatment for hearing loss, so making testing equipment more widely available is helping enable earlier detection and treatment of this condition.”
Earlier treatment of hearing loss is exactly what hearing professionals want to provide, so they may look for ways to encourage use of the test kits—possibly even giving them to primary-care physicians in their community in hopes of generating referrals of patients with hearing loss to their office.
On the other hand, there is no love lost between hearing care providers and hi HealthInnovations. Ever since that company arrived on the scene in fall 2011, organizations of hearing professionals have strongly criticized its sales model, which enabled it to sell online what it described as “high-tech, custom-programmed hearing aids” for the unusually low price of $749 to $999 (now $799-$999).
The International Hearing Society, American Speech-Language-Hearing Association, American Academy of Audiology, Academy of Doctors of Audiology, and American Academy of Otolaryngology–Head and Neck Surgery all decried the sale of hearing aids directly to consumers without their ever being seen by a licensed professional.
The Better Hearing Institute, part of the Hearing Industries Association, issued a warning to consumers about “do-it-yourself hearing care” and advised of “the inherent risks associated with purchasing over-the-counter, one-size-fits-all hearing aids instead of consulting a hearing healthcare professional.”
hi HealthInnovations also drew criticism for its novel online hearing test. Originally, the company planned to use the results of that test to program customers’ hearing aids. However, it was forced to give that up after the Food and Drug Administration (FDA) sent it a warning letter on March 28, 2012, stating that it “has learned that your firm is marketing the hi HealthInnovations Online Hearing Test in the United States without marketing clearance or approval, in violation of the Federal Food, Drug, and Cosmetic Act.”
Since then, consumers have been required to get an audiogram before ordering hearing aids from hi HealthInnovations, but they can still obtain and use the hearing aids without an in-person fitting.
BYPASSING THE HEARING HEALTH PROVIDER?
In view of hi HealthInnovations’ record to date and hearing care providers’ criticism of its methods, there is speculation among hearing professionals now that the company’s outreach to physicians is essentially a way to bypass them altogether.
The company says any licensed medical professional in a physician’s office can use the kit, and that it produces “calibrated, controlled tones at different frequencies and intensities, enabling accurate hearing test, or audiogram results.” Therefore, it appears that patients might end up ordering hearing aids through their family physician’s office without ever visiting an audiologist or hearing aid specialist.
Indeed, in an e-mail exchange with this blog, Will Shanley, director of public relations for hi HealthInnovations’ parent company, UnitedHealthcare, confirmed that this can happen and defended the approach. He wrote, “Many Americans with hearing loss want to obtain care for their hearing loss from a primary-care physician, so the test kit helps enable that. A 2011 AARP-ASHA survey showed that 70% of people prefer to address their hearing loss with their primary care provider.”
Noting that Medicare requires providers to screen for hearing loss as part of the Initial Preventive Physical Exam, Shanley continued, “Having this test available in the physician’s office increases the likelihood of detection and treatment of hearing loss, including appropriate referrals to ENTs, audiologists, or hearing aid dispensers.”
He also pointed out that after obtaining an audiogram from their doctor, patients can choose to go to any hearing professional to get hearing aids.
However, audiologists, hearing aid dispensers, and, for that matter, ENTs may wonder how many patients who are identified with hearing loss by their family physician will choose to go elsewhere for hearing aids if their doctor suggests buying them through him or her.