Like all healthcare professions, those involved in the delivery of hearing-related services must serve the needs of the consumer. For the past fifty or more years, professional organizations and other institutions have been created to serve the interests of those qualified to provide care to persons with hearing loss. However, new consumer demands and needs may be triggered by advances in technology. When the demands of consumers evolve, those who serve them must be flexible enough to change with them. While it is the responsibility of the licensed professional to provide ethical, evidence-based care – to above all, do no harm – ultimately, it is the consumer who gauges the value of the products and service provided.
Recently, HHTM sat down with Paul Martin of Blue Ocean Advisors to collect his insights on proposed changes to the Florida hearing aid dispensing regulations.
Q: There seems to be some legislative activity happening in Florida right now. Can you update our readers on what the hot button issue is there?
A: In 2019, the Florida Legislature overhauled many state regulations to support greater access to telehealth services. Coming out of this past year’s COVID-19 pandemic, Florida was looking to make additional improvements to a wide range of healthcare regulations. As part of this effort several pieces of legislation have been introduced. This presented an important opportunity to modernize the state’s audiology rules, which have not been updated since 1995. The purpose of the changes proposed by the Florida Legislature is to align the state regulations with the current FDA regulations and recognize that people want greater access to and choice in how they can purchase hearing aids and receive professional support.
Q: Based on many of the postings at various listservs, it’s safe to assume the majority of audiologists oppose this legislation. Could you help our readers understand why there is strong opposition to this bill?
A: I believe the negative perception is mostly driven by misinformation. The immediate response sent out by opponents of this bill did not accurately reflect the purpose, language, or intent of the legislation. I believe that if our community is presented full and accurate information, many more would be supportive. Importantly, this bill still requires a licensed audiologist to be a part of the care process and make determinations about a patient. The goal is to increase access to hearing care, under the authority of a licensed professional.
Q: In the face of so much unmet need, a more prudent position might be to support such legislation. Tell us why support of this legislation would be benefit persons with hearing loss?
A: We believe this would benefit both persons with hearing loss and the community of licensed professionals who treat them. This addresses the two main barriers to care that were identified by PCAST and NASEM – access and affordability. It accomplishes this while not cutting out the licensed professional who is treating a Floridian with hearing loss. There is considerable research that supports the effectiveness of hearing aids delivered and supported in a remote model, all the more so when professional care is delivered as part of that model. This is why we’re committed to maintaining a viable hearing aid business model for hearing care professionals through telehealth, particularly as an important and valuable alternative to hearables, PSAPs, self-fitting devices, and, shortly, OTCs where no hearing professional is involved in the selection and fitting process.
Q: How would this legislation benefit the profession?
A: As an audiologist who has dedicated decades to this field I, like most of my colleagues, know that our profession does not reach millions of people with hearing loss. We all want to treat more people who need care and to reach communities that have historically been underserved. To accomplish this goal we need to incorporate modern modalities and technologies. Remote care needs to be made accessible while still allowing for a licensed professional to play a central role, and this legislation accomplishes that in Florida.
Q: Your position seems logistical, data-driven and realistic. What are your thoughts on why so many providers continue to oppose it?
A: I think 90% of this is driven by misinformation, which is why I appreciate you giving me the time to answer these questions. If audiologists knew that all this bill did was A) align with the FDA regulations, and B) allow licensed professionals to deliver hearing aids by mail, while C) not cutting licensed audiologists out of the process, then I think most would be in support. We need to get past the hyperbole and think about how our profession can adapt to changes in technology that could allow us to reach so many more people in need.
Q: One could argue that HIA has taken a bit of a middling position – opposing the current legislation but waiting for the OTC regulations from the FDA to be codified before supporting similar direct-to-consumer measures. Is it a mistake to prudently wait for the FDA on this? If so, why not wait and support this at the state level?
A: There are two ways to look at this. One is, the rules in Florida have not been changed in 25 years so why not wait a few more until the FDA’s OTC rulemaking. The other is, the rules in Florida have not been changed in 25 years, and it is harmful to wait even one more day to expand access to high-quality care by licensed professionals simply by explicitly recognizing the federal regulations that already apply. Especially in a time where we are telling people to minimize exposure it seems unreasonable to say that someone with treatable hearing loss must have an in-person visit, when we know that many people cannot do so and clinically do not need to.
Q: Here is some telling data from the Consumer Technology Association. According to a recent article in Forbes, “the earbud market is estimated $80 billion by 2025. Hearing aid average selling prices are higher than earbuds, but as earbud manufacturers add even more features (like customizable amplification), they will grow their ASP as they compete for share dollars.” It looks like consumer electronic companies are poised to grow their business in the hearing care space. How do hearing care professionals fit into this picture? Should they ignore the entry of consumer electronics into the space or do offer something new and different from a consumer electronics company to attract segments of this potential market?
A: This is a great question and further demonstrates why our community should support this legislation. The simple answer to your question about how hearing care professionals fit into the earbud market is that they are not included and will be cut out. This is bad for our profession, bad for patients and a central reason to support this legislation. We believe that licensed professionals can greatly help improve outcomes, whether in-person or remote. These new rules will allow for greater access to hearing aids but still have the patient overseen by a licensed hearing care professional.
Q: Any other words of wisdom, based on your 40 years of experience, that you can share with our readers on this pertinent topic?
A: In my experience with “change management”, those doing the change are convinced it is the right thing to do and the right time to do it, those that are asked to accept change are fearful of the unknown. This is why clarity on the legislative initiative is really important. This was my experience when asked as Sr. Vice President of Amplifon’s Sonus brand to rebrand it to the Elite Hearing Network. No one thought it would survive, but it did. It flourished when the value proposition was clearly defined.
I find the initial reaction to this legislative change to be predictable, based on the misinformation spreading the fear that the HCP & Audiologist would be cut out of the care of the patient. As I’ve stated, I’m proud of my profession and the countless people we help on a daily basis. I’ve also realized the only major thing that hasn’t changed is the delivery system. I’m 68 years old, and I’ve been “connected” to a computer, tablet, & smart phone for over 20 years. I’ve gravitated, even more rapidly in the past year, to online services, including healthcare, banking, grocery shopping, and all forms of daily communication, in the face of social distancing, due to Covid-19. Frankly, many of the connected Seniors prefer this method of care, as evidenced by NPS (customer satisfaction metrics) scores that are on par with Telsa, Netflix, Peloton, and Apple. They deserve the right to choose an alternative delivery system, which also allows high-quality professional intervention. The one key learning I’ve taken away over the years is “People drive change”.
Paul Martin is the founder of Blue Ocean Advisors. LLC. He can be contacted at firstname.lastname@example.org