By now everyone in the hearing healthcare industry is familiar with the facts, but they bear some repeating: There are millions of Americans with mild to moderate age-related hearing loss, and a mere 15 to 30% of this group use hearing aids, which are expensive, rife with stigma, and rarely covered by insurance. The consequences of untreated age-related hearing aids are significant, as research indicates it accelerates cognitive decline, social isolation, increases in hospitalization and depression. Further, there are plenty of technological breakthroughs that could open the market for throngs of people in need of better hearing — if only governmental barriers could be lessened to ease access to technology and innovation. It is that final key point which appears to be a large focus of PCASTs{{1}}[[1]]President’s Council of Advisors on Science and Technology (PCAST)[[1]] public airing of their recommendations in Washington DC on November 20. You can watch the 27 minute presentation here.
PCASTs co-chair, Dr. Christine Cassel’s presentation appeared to be preoccupied with accelerating technology solutions to address this public health situation; at least that was the perception of one industry expert in attendance.
Given the stakes, it is a legitimate question to ask why PCAST chose to focus primarily on patient-driven technological solutions to fix a major public health problem, given that other solutions, like direct access to audiologists and hearing instrument specialists for routine hearing screenings could potentially lower costs and improve quality of care.
Does the recommendation of “accelerating technology solutions” as a priority over other possible solutions suggest PCAST bends to the interests of lobbyists or other powerful influences?
A brief look into Dr. Cassel’s past might provide some insight.
Taking a Closer Look
In 2009, Dr. Cassel co-authored an editorial in Journal of the American Medical Association decrying exactly these sorts of recommendations for patient-driven care.
“Both patients and physicians should exercise caution before moving headlong into a strategy that attempts to make health care more efficient and effective by further increasing the pressure of competitive market forces.” p. 323{{2}}[[2]]Berenson RA, Cassel CK. Consumer-Driven Health Care May Not Be What Patients Need—Caveat Emptor. JAMA. 2009;301(3):321-323. doi:10.1001/jama.2008.994.[[2]]
Although Dr. Cassel called for a cautious approach to consumer-driven healthcare within her own field of medicine nearly seven years ago, her presentation at the last PCAST meeting was to accelerate this same type of consumer-driven care for the hearing care industry.
This seems to be a direct juxtaposition of the approach she so strongly endorsed in 2009 when she stated in that same JAMA editorial:
“The consumer-directed health care goals of information sharing and involving patients in care decisions and in the societal need to manage scarce health care resources should be endorsed. But the notion that the way to achieve these goals is to further pit physicians and patients against one another as market suppliers and customers who aim to foster efficiency out of a competitive drive cannot be accepted. These goals can be achieved more effectively by building on and strengthening the base of the professional relationship and supporting the therapeutic alliance of physicians and patients at the micro and macro levels of the health care system, which better serves both patients and society.” p. 323
In the past she advocated for improved relationships and alliances between physicians and patients, and now it would appear she is supporting more of a consumer do-it-yourself approach.
Why the Change?
Why the change of heart? Image courtesy sentinel
This begs the question, why a change in mind with respect to consumer-driven care? Dr. Cassel is a physician, who is currently president and CEO of the National Quality Forum.{{3}}[[3]]The National Quality Forum (NQF) is a US non-profit that promotes patient protections and healthcare quality through measurement and public reporting. It was established in 1999 based on recommendations by the President’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry. NQF’s membership comprises over 400 organizations, representing consumers, health plans, medical professionals, employers, government and other public health agencies, pharmaceutical and medical device companies, and other quality improvement organizations.NQF has helped develop guidelines on palliative care.[[3]] She is a leading expert in geriatric medicine with several peer reviewed publications to her credit, but an HHTM examination into her past reveals that she is not beyond reproach. She has had recent conflict of interest issues, according to this report.
Dr. Cassel is the former president and CEO of American Board of Internal Medicine (ABIM), a non-profit firm that certifies new physicians as meeting standards of practice. ABIM has been accused of showering millions of dollars of compensation on executives, many of whom have been accused of conflicts of interest, including Dr. Cassel. In 2014 Dr. Cassel resigned from two large healthcare organization board positions amidst allegations of conflicts of interest.{{4}}[[4]]Citing ‘Distraction,’ Quality Forum CEO Resigns Board Seats. ProPublica, February 27, 2014.[[4]]
Raising questions about the apparent change in her stance toward consumer-drive care is not a suggestion of incompetence or dishonesty. Rather, given the recent allegations of conflicts of interest, it is completely reasonable for her to be scrutinized about an apparent change in thinking on direct-to-consumer health care.
Raising Questions
An evidence-based case can be made that the unmet need of millions of Americans with age-related hearing loss would actually benefit from a re-regulation of the market, more innovation and cheaper technology. But in the face of other urgent healthcare issues in the U.S, it is fair to ask why the hearing care market was chosen and why PCAST wanted to accelerate their report?
Has a powerful interest group influenced the priorities of PCAST?
Past allegations of conflicts of interest and a significant change of mind with respect to consumer-driven healthcare by Dr. Cassel are reasons to question PCAST on this matter.
HHTM will continue to monitor and report on further developments.
Great reporting. Audiologists have been pushing for re-regulation for years, but rather than allocating appropriate funding (to make audiological care more affordable via Medicare, etc) it looks like the government will opt for the cheaper option.