WASHINGTON, DC — The key message during Friday’s (9/18) public meeting of the President’s Council of Advisors on Science and Technology (PCAST) was that 30 million Americans do not have access to hearing care.
The PCAST, originally chartered in 2001, has a broad mandate to advise the President in areas of science and technology. One of the main goals of the council is the use of science-based principles to raise awareness of public health issues.
Christine Cassel, MD
Dr. Christine Cassel, a geriatrician and member of the PCAST council, reviewed several issues surrounding the impact of age-related hearing loss–including the disconnect between the cost of hearing technologies and their access to the majority of Americans with hearing loss. In addition, she reviewed many of the medical and social consequences associated with age-related hearing loss.
Dr. Cassel stated during her 20 minute presentation archived on the web that the current situation involving the cost and under-utilization of hearing aids is one “ripe for a technological solution helped by federal action.”
Prices High & Access Complex
One of the main topics of discussion during the September 18th meeting was the barriers to adoption due to the cost of technology presents many Americans.
Panel members shared with the audience that the average cost is $2400/instrument, and $4000-$8000 is a typical price range; costs which are often not covered by insurance.
Another consumer barrier discussed during the meeting was achieving access to hearing aids and the many complexities associated with it. As the panel indicated, aging adults who suspect hearing loss often must seek out an audiologist without the help of their primary care physician.
The consequences of individuals with age-related hearing loss waiting too long also were reviewed by the panel.
Path Forward
Although the panel has yet to make a formal recommendation, three stated goals with the intended purpose of improving access to hearing care were stated:
1) Reduce the overall costs of hearing technologies
2) Stimulate innovation and technological development
3) Increase the number of people with hearing loss who use this technology
To achieve these goals it is widely speculated that the group’s final recommendation will include technology-based changes in federal regulation to promote innovation in order to improve access. Toward that end, specific items mentioned in the meeting to foster more “consumer shopping” included, allowing consumers to shop for the best value, making internet shopping for hearing technology more accessible, and allowing new entrants into the market more easily.
Possible Longterm Implications
PCAST makes policy recommendations in areas such as understanding of science, technology, and innovation to the President and the Executive Office of the President on pertinent issues of the day related to public health and science. Recent PCAST reports have addressed antibiotic resistance, online education technology, cybersecurity and climate change.
Although President Obama was not in attendance during the meeting on hearing loss, historically, presidents often follow recommendations of the council when establishing new policies and initiatives.
A random sampling of audiologists and other prominent industry leaders knowledgeable of the PCAST findings suggest many hearing care professionals are bracing for some significant changes in the hearing instrument marketplace. Several speculated these changes are likely to occur in the near future.
Some possible changes mentioned by professionals, who were queried, include changes to the FDA hearing aid regulations, greater consumer access to PSAPs and other hearables for the mild to moderately impaired and possible Medicare coverage of low cost hearing devices.
Given the recent announcement of the IntriCon/ADA partnership, earVenture, the industry may be already adapting to some of these possible forthcoming changes.
I hope President Obama is listening.
As a Brit. who wears free NHS hearing aids I find the USA position appalling.
Hearing is a right not a privilege!
Also (on a purely selfish note) if The USA government and health insurers start providing help with hearing aid purchasing, freeing up Web sales and making hearing aids what they should be, clever, but afordable tech. With data sheets and end user reviews, not ridiculously over priced, over regulated ‘medical’ devices. That benifits the HOH all over the world!
Bunny, hearing healthcare in the US is a veritable bargain, but it costs the federal government 4.3 times as much to fit a hearing aid as it does the private market, and renders no aftercare and very limited range of technology. Yes, some people need that help, but certainly not the majority of hearing impaired individuals. I am deaf and you should see the difference in care I received in my 67 years on this planet between the government agencies and the private clinics–the difference is astounding.
What about the hearing aid tax credit bill that has languished in Congress for many many years? That seems to be a reasonable starting point.
After all of this talk is distilled down to the bottom of the vessel the question is “Who will deliver and fit these affordable, clever, high tech hear devices?” Let’s say as I private provider I could buy these devices for $1, and sell them for $500. After pulling out all of the expenses for rent, office staff, parts, compensation to the professional fitter, etc. I will loose money on each one of them if we spend the amount of time with each patient that we do now. If I dare to spend anything on marketing my losses will only get worse. So them my choices are, A. Spend less time with each patient and try to sell three times the number of units, as in “Okay, we’ve fitted your devices. Call us if you have any problems.” or B. Bill for each office visit and procedure, which for the elderly who need extensive follow up and aural therapy, which could run into hundreds of dollars.
The only way to make cheaper devices work for a for-profit dispenser, be it a hospital, medical practice, audiologist, or HIS, is to greatly increase the numbers of willing buyers so the volume can justify the minimal margins, and getting people to seek help when they are younger. The majority of buyers in our practice have waited until they are past 70 and suffer from multiple health issues – arthritis, poor cognition, diabetes, coronary disease, stroke, etc. They are not good candidates for self-fitting hearing aids that require them to download software and use a dongle to program their aids.
Stating that the over-worked primary care doctors need to do more to educate their patients is, while true to extent, is not realistic. The PCP’s I know would love to have that luxury, but they don’t.
Thanks, Mr. Jones, for one more argument in favor of affordable health care for ALL people. Our $$$$ driven system and mentality continues to obscure and thwart attempts to make basic health rights affordable for everyone, from the developers of the technology, through the manufacture of the devices all the way up to the people such as yourself who dispense and deliver them. Lots of people who develop, manufacture and deliver the devices are more interested in “driving their Mercedes” than in solving a real problem with affordabity. And don’t tell me you “have to make a living too.” Like any other part of the heath care industry, it’s about the almighty $$$$. Trying to do the right thing comes in second. Seems that the human malady will work against this forever, thus a nigh impossible problem to solve.
Jeepers, Mr. Trotter! I won’t tell you that I have to make a living, nor will I tell you that my employees need to make a living. Nor will I tell you that patients will get good outcomes if a $12 per hour fitter delivers their devices. If the delivery of hearing care requires me to make little, or nothing for what I do I will shut down my offices, fire the employees, and go work at McDonalds.
Went over your head, did it Mr. Jones? Certainly, people deserve to make a living. That’s not the issue here. You apparently entirely missed the point.
btw, try this book by Robert Reich: “Saving Capitalism: For the Many, Not the Few.” See if it does anything for you. You want the last word? Have at it. That’s all from me.
Jim, you are correct. There is much offered in the private market that is nearly totally absent in the public programs. From cost efficiencies, time expended per patient, quality of instrumentation, counseling and aftercare, hearing healthcare on the private market is a veritable bargain compared to anything in healthcare today. Again, it cost the government 4.3 times as much to fit a hearing aid as the private market, and there is no comparison between instrumentation and service and care between the two.
Once again, a health care access issue is falsely blamed to further a big government agenda. There is absolutely NO problem with ACCESS to hearing care in America. Hearing aid dispensers across this country scream FREE hearing tests, otoscopy, counseling, repairs, etc, from every form of media every single day. At Miracle Ear, we have 1200 locations across the U.S. that are ALL screening people from all walks of life every day in almost every market. As for the cost of hearing aids, everyone but the laziest of socialists has seen ads for aids as low as $495. If that’s not affodable, there is the VA, medicade, in New Jersey we have a state program that I use regularly that supplies top quality aids to the working poor and unemployed. At Miracle Ear we have a foundation that treats every child of need with FREE quality aids and we have expanded that in to all adults under the poverty line. I encourage you all to check out the Miracle Ear Foundation and our “Gift Of Sound” program. As for my fellow capitalists, we have positioned our practice to specialize in high tech personally customized hearing solutions and the overwhelming majority of our very busy practice are in top tech at about $3000 per aid and appreciate a superior customer experience. I firmly believe, and have put into practice, that we can help everyone that wants help without going out of business. In fact, our numbers have increased every year since we’ve adopted this strategy post 2008 recession.
What a load of crap. Anything the federal government gets involved in is worse after. ACA is a prime example. We now pay 150% more for our health insurance, have less coverage, less choices of doctors. less choices of insurance and higher rates.
If the government gets involved, what you will see is mass exodus of hearing professionals. As far as the Brits, they do not have any better usage percentage as the US. Studies have proven it. People don’t want to wear hearing aids. Period. We are selling a product people don’t want, but end up needing. Bill, Jim and Brent are all right on there statements.
Dan, I agree. If you want to run up the costs, and kill the service, just put the politicians and bureaucrats in charge. We need more government hearing aids like a hole in the head. Just came from UK where almost half of all hearing aids are paid for out of pocket even though they can get them “free” from the NHS—if you wonder why, visit an NHS facility–you’ll feel like you stepped back into the 1940s, take a number and get almost no aftercare for instrumentation that is far inferior to the wonders available on the private market. That is why almost half of all hearing aids are bought on the private market there–the service, the expertise, the instrumentation, and minimal cost leave the government programs in the proverbial dust.
It is utterly wrong to say that hearing impaired individuals in the US do not have access to hearing healthcare. About third of all hearing aids are given to recipients in the US through a number of government programs, but a high percentage of these end up as dresser drawer hearing aids. Government programs cannot provide the needed up close and personal and time-consuming care that the vast private distribution network provides. Plus, there is the little detail what it costs to collect the tax dollars that are spent on the free programs. The last time we analyzed the costs of public vs private, the costs of publicly administered hearing aids is about 4.3 times as high per hearing aid as the private system. Plus, in the private system you have competition, endless service, and the best hearing care professionals in the world–all for the lowest cost of any health expenditure in healthcare today. It is pure balderdash that we need more government in hearing healthcare and will dramatically increase the cost to society far higher than the low cost and efficiencies afforded in the private system.
The PCAST is simply wrong. It has been proven time and time again that lowering the price of hearing devices does NOT result in more people using them. Look at the VA system where some patients come in for their free hearing aids and actually try to cheat their hearing test so they will qualify for aids they don’t need. Look at patients who own multiple homes/cars/business but claim that “I can’t afford these prices.” In my office we did an experiment for a month where we lowered the prices of our best premium hearing devices (Normally $7500/pair) down to $1000/pair. The adoption rate of patients that month did not change. We saw just as many patients as every other month and just as many of them had aidable loss. Our testing is always free, and we did just as many free trials. The fact is that it is a psychological problem. The patients HAVE access to care. The patients DO have money (now granted, there are exceptions, but there are also organizations to help those who truly don’t have the money). But unless their hearing loss is severe enough to get past their initial denial, they don’t do anything about it. Its like the old adage about the guy who didn’t have cancer until he went to see the oncologist. Hearing loss is real and millions of people have it, but they don’t want to admit it to themselves even after they have been tested and diagnosed. I had a friend who is an administrator of a physical therapy practice. He asked me why hearing aids are so expensive. This from a guy whose industry charges between $100-$350 per visit and on AVERAGE requires 9-10 visits over 3-4 months. Thats $1000-$3500 for a few months treatment for a single problem with no guarantee of successful outcome. I charge between $3500-$7500; I typically have an ongoing relationship with my patients for 4-5 years or longer with no limit on how many visits or how much work I will do for them, and I CAN give a pretty accurate prediction of what we can realistically accomplish through our efforts (before we ever collect a penny). The only reason it SEEMS cheaper is because insurance helps with the cost of physical therapy but not generally with hearing aids. So wouldn’t it make sense that instead of lowering costs, we should simply get insurance companies to pull their heads out?
As a senior myself burdened with the high cost of medication it seems disingenuous that Dr Cassel is going after the “high cost” of hearing health care while her boss president Obama has saddled us with an unworkable so called affordable health plan that is bankrupting America