Oh, The Places We Will Go – Harbinger of Deregulation?

In this week’s post, Angela Loavenbruck continues with her look at the “Audiology Elephant” of the PCAST recommendations.  

by Angela Loavenbruck

In my last two columns, I examined the imaginary elephants that PCAST participants and audiologists have created.  I was pretty crabby in both of those discussions.   I hoped to make some positive suggestions about how audiologists should respond to the challenges of the disruptive forces now in play.  I’m sorry to report that I’m just going to continue to be crabby.  As Lucy van Pelt says in one of my favorite cartoons, it’s rainy, it’s cold, it’s windy – it’s a good day to be crabby.

In doing some web searching about disruptive innovation, I happened upon the website of an online hearing aid company.  Within seconds after I clicked onto the website, a chat window opened and the following exchange occurred with “Robert”, whose photo had the words “hearing aid expert” beneath it.

“Expert”:  Welcome to ____!  Let us know if you would like our audiologist to review your hearing test results or if you have any questions about our hearing aids.  Our experts are here to help out!

Visitor (that’s me):  Who is your audiologist?

“Expert”: Sure, we have a licensed audiologist on staff that programs all hearing aids.  Once you purchased, you will receive the information that insurance requires.  Specifically, the audiologist license number, tax ID, and proof of purchase.

        Visitor:  How is the audiologist able to test to be sure that the hearing aids are working as they should for me?

“Expert”:  Well, we ask that you send a recent copy of your hearing test to program the hearing aids specific to your level of hearing loss.  This allows us to get the hearing aid programmed specific to your needs from the get go.  Only about 10% of customers need any adjustments in the first 1-2 years.  It shouldn’t be expected that you need adjustments if you send a recent test.

        Visitor:  Yes, but after you program the hearing aids, how do you test to make sure that the aids are working for me on my ears.

“Expert”:  They will come working exactly based on your hearing test results.  Since we ask for a recent copy, the programming will be accurate to your current level of hearing loss.

Visitor:  I have worn hearing aids for many years – the audiologist always tested after fitting to be sure that the program was actually doing what it was supposed to on my ears.  Your aids are less expensive, but it doesn’t sound like there is any service.

 “Expert”:  Well, if it is not working, you send it back to us and we repair it.  We have pretty quick turn around.

         Visitor:  I don’t mean if it breaks, I mean the professional services to be sure that it is providing benefit.

“Expert”: Yep and for that you can send the hearing aids back to us for the reprogramming.  We have a survey that we have crafted after working with thousands of customers over the years.  We ask the right questions to be able to program the hearing aid to your needs.

         Visitor:  Without doing any testing on my ears?  This doesn’t sound right to me.  Do you have research results that I could read?

“Expert”:  We don’t have any specific results that are public, but this is what our audiologist has told us based on working with our customers.  The local audiologist is simply accounting for the need to do adjustments, as they know they can see you over and over again.  It’s part of their process.  We do offer a 45-day trial period that is 100% risk-free, and we do that because we know that you will likely be satisfied and keep the hearing aids.

         Visitor:  Can a local audiologist program them?

 “Expert”:  Well, they need the right software, so for that you would send it back to us and we can reprogram the hearing aid.  But again, most people do not require that in the first 1-2 years.  It’s offered locally as part of the reason they can mark up the price, but generally, they do not need to do that.

Visitor:  As I said, I have worn hearing aids for many years – the new aids always have to be adjusted during the trial period so they sound best to me.

“Expert”: I think that’s where we would disagree.  Now for some people, they do require adjustments in the beginning, but we have had enough customers over the past 4 years (thousands) that we feel confidant that the majority of people do not require this.  But I understand the concern.

         Visitor:  Thank you.  I will have to think about this.

“Hearing Aid Expert”:  Of course.  We will get back to you in a few days.  We always suggest that you think about it before you decide to move ahead.

I was only mildly crabby before this interchange with the Hearing Aid Expert, but afterwards, I knew the crabbiness was going to last for days. What if I was a first time hearing aid user and had no idea what questions to ask?  What about the deliberately misleading statements about the reason for follow-up visits when hearing aids are obtained from a local audiologist?  What happens when “cutting out the middleman” means removing virtually all of the services of the audiologist?

The website showed photos of four models of hearing aids – a stock canal type aid and three tube fit BTE’s with different size open tips.  The descriptions of the aids indicated that two models were for mild to moderate hearing loss and two would fit mild to severe hearing loss, presumably with one of the open fit tips.

This called to mind the 42-year-old man who came to my office with a severe, precipitously sloping hearing loss wearing a large BTE tube fit aid and an open tip.  The tube was far too long for his ear and therefore the tube and the tip were barely in his canal.  He had purchased it in Walmart and had not had his hearing tested in years.  They provided virtually no useable gain.  There have been several discussions on a number of audiology discussion sites about patients coming in with online purchases that are totally inappropriate and have locked proprietary software.

Do you think the PCAST folks had any awareness of this kind of consumer experience?  In the wild west of deregulation that their recommendations would create, how many patients (or customers!) would have successful experiences with self-diagnosed hearing loss, and self fit amplification.  How would we know?

I’ll have to wait a bit to regain my ability to make positive suggestions about what audiologists need to do in the current “disruptive” environment.

Angela Loavenbruck, aka The Crabby Audiologist, has been in private practice since 1975. She has served as president of both the New York State Speech & Hearing Association and the American Academy of Audiology.  She was awarded the Joel Wernicke Award by the Academy of Dispensing Audiology for her work on behalf of the AuD.  Angela has been Associate Professor at Teachers College, Columbia University and has spoken widely about ethics, private practice and accreditation standards. She and her husband recently celebrated their 50th wedding anniversary and have three children and three wonderful grandchildren.  Angela is also renowned for her Italian cooking and award-winning blueberry pie.