As members of AAA debate the merits of direct access legislation, a new study, published online April 26 at JAMA-Otolaryngology is apt to capture the attention of Medicare policymakers. Elham Mahmoudi and colleagues at the University of Michigan, using data from the 2013-2014 Medical Expenditure Panel Survey, evaluated hearing aid use among 1336 adults, aged 65 and older.
The researchers addressed two main questions: 1) Is the use of hearing aids in older adults associated with an increase in hospitalizations and emergency room visits? 2) How does hearing aid use effect health care utilization and spending among older adults?
Hearing Aid Use and Healthcare Costs
To address these questions they conducted a retrospective study of data collected from a representative sample of noninstitutionalized adults in the U.S. Individuals aged 65 and older with self-reported hearing loss were part of their statistical analysis. Among the group of 1336 individuals who were part of the study, 602 were self-reported hearing aid users. This group of self-reported hearing aid users was compared to a group of similar non-hearing aid users. The mean age of the population studied was 77 years with 45.1% self-reporting as hearing aid users.
Using complex statistical analysis to account for confounding factors, such as physical limitations, educational level, income and region of the country, the researchers determined that hearing aid users spent, on average, $1125 more on total annual hearing care expenses, and, on average, $325 more on annual out-of-pocket medical expenses. However, they also found that hearing aid users had slightly lower ($71) Medicare expenditures, a lower probability of both emergency room & hospital visits, but a higher probability of visiting the doctor for routine office appointments.
According to the authors’ conclusion in the JAMA paper, “Our study shows positive results of hearing aid use on increasing the number of office visits and reducing hospitalization and any emergency department (ED) visits among patients with self-reported hearing loss. However, we did not examine the causes of these visits and whether they might differ between individuals with and without hearing aids. It may be that reductions in the use of this type of service reflect fewer critical incidents, such as falls, that require urgent and immediate intervention. Alternatively, because ED visits and unplanned hospitalizations have been associated with less access to a regular source of primary care, it may be that the differences in ED visits and hospitalization between older adults with self-reported hearing loss who do or do not use hearing aids reflect variations in patterns of health care use. It is also plausible that individuals who use hearing aids are willing to spend more on preventable health care services.”
“Our results indicate that patients who reported using hearing aids had higher numbers of office visits and lower probability of ED visits or hospitalizations. People who use hearing aids need to be tested by a specialist, and their hearing devices need to be fitted regularly. Perhaps owing to better communication, patients with hearing aids are more aware of their well-being and health conditions and are more likely to request primary or specialty care visits as needed…… improvement in physician-patient communication, better understanding of and adherence to recommended treatments, and therefore better awareness of preventive care may explain the outcomes of hearing aid use on the differing use of health care services”
Disparities in Hearing Aid Use
In an accompanying commentary, Margaret Wallhagen from the Department of Physiological Nursing at the University of California, San Francisco, pointed out the disparities in hearing aid use across geographic regions and minority groups, suggesting that hearing aid use is less common in people with fewer resources. These are well-known disparities that also were brought to the fore in the June 2, 2016 NASEM report on hearing healthcare access and affordability.
Among the considerations proposed by Wallhagen to address these disparities in hearing aid use for vulnerable and underserved populations are the clinical adoption of short questionnaires or brief objective hearing assessments by primary care providers, the use of simple educational brochures to encourage follow-up with hearing healthcare providers, and finally, the consideration of high quality over-the-counter hearing aids and other vetted non-custom alternative amplification systems.
Given the relationship between hearing aid use and the increased cost associated with hospitalization and emergency room visits revealed in this study, Medicare policymakers would be wise to take these findings into consideration as it examines ways to lower its total per person costs and expand its overall coverage to an aging American population. Concurrently, these findings should be a clarion call to hearing healthcare professionals to embrace quality, lower cost alternative amplification solutions to better meet the needs of underserved populations.
*featured image courtesy pixnio