In my last entry, I examined the mythical elephant PCAST created in its examination of the hearing healthcare system. The creature seemed to be purely product – no professional services needed – and closely resembled the vision of the Consumer Electronics Association and PSAP manufacturers.
In many ways, the PCAST report is the epitome of the commoditization of hearing healthcare.
The word audiologist was barely used in the report while the more generic “dispenser” and “hearing health care provider” were used more often. Without any evidence whatsoever, the PCAST vision delegated those with mild to moderate hearing loss – the largest category of hearing impaired individuals – into a category where self-diagnosis, self-fitting and self-adjusting are all that is needed.
The Audiology Component
Has the audiology profession contributed to this notion of hearing healthcare? As a primary stakeholder, what kind of a mythical elephant have we created? If our advertisements are any indication, it seems clear that, as a profession, we have bought into the notion that product forward marketing is the way to reach the public.
A History Lesson
Audiologists are late entries into product dispensing. Prior to the mid and late 70’s when pioneer private practitioners began including hearing aid dispensing in their practices, audiologists had a symbiotic relationship with manufacturers. We were practicing in community clinics or hospital settings, evaluating children and adults, doing hearing aid evaluations (using the Carhart method!), making specific brand name recommendations and referring the patient to a retail hearing aid store for fitting.
Manufacturers provided the clinic with aids and supplies. Local hearing aid dispensers provided service and consultation on products.
The hearing aids purchased for children were frequently delivered directly to the clinic and were fitted and adjusted by the audiologist. Adults were referred to dispensers and typically never returned to the audiologist for follow-up services. They became the clients of the dispensers and audiologists seldom monitored the results of these patients. The vast majority of adults purchasing hearing aids at that time never saw an audiologist.
As audiologists began to enter into private practice beginning in the late 70’s and throughout the 80’s, the need to obtain the skills and knowledge necessary to run a business became evident. University programs certainly were not providing this information. ADA and then AAA quickly responded to this need, but manufacturers also began providing tools for private practices, including marketing ideas and strategies.
Advertising: What is the Message Consumers Get?
The notion that hearing aids were just one part of a more comprehensive rehabilitation plan became lost in the product based advertising campaigns suggested by manufacturers. Many audiologists mimicked the advertising style of dispensers.
Fast forward thirty years and the vast majority of advertising done by audiologists is still product/promotion based, stressing price, free services, specials, sales, friends and family discounts and other gimmicks that clearly portray hearing aids as commodities.
The concept of hiding hearing loss is also prominent in many of the ads. One of the most misleading is currently running in my local papers. A full-page ad declaring that the manufacturer is looking for 35 people to participate in a research study that does not exist.
While some manufacturers and practice management groups suggest more professional/service based advertising and overall marketing campaigns, manufacturers simultaneously support large budget, direct to consumer, product forward advertising. Any service-based advertising done by individual audiologists, or even practice management groups, is easily drowned out.
A Rose by Any Other Name Is Obscure
One of my pet peeves is the very successful effort by manufacturers to eliminate the word “audiologist”. In the corporate hearing aid world, we are “hearing care professionals” – a term designed to obliterate the clear differences in education, training and expertise between dispensers and audiologists.
How would consumers know the difference between the FREE test given by a dispenser and the testing provided by an audiologist. Especially when audiologists often provide free “screenings” which are actually not screenings.
Manufacturers also own their own retail operations and have marketing budgets that far exceed the budgets of most private practitioners. These entities use product-forward brand advertising, along with sometimes exaggerated claims for hearing aid performance.
These types of ad campaigns only add to misinformation and unrealistic expectations for benefit.
Bundles or Not
In the first year of my practice (1975), we had an unbundled fee schedule. We charged the patient a fee for the hearing aid, and a separate fee for the services. Remember that we were fitting analog hearing aids at that time, so hearing aid adjustments were extremely limited. There was a 30 day trial requirement. Post fitting verification was limited to sound field testing and therefore extended follow up visits were not scheduled.
As hearing aids became more complex, we began bundling our fees. Custom hearing aids became available; trial period requirements were extended to 45 days, extended warranties were available and multiple level digital hearing aids began arriving.
The bundled fee package was expanded to include multiple follow up visits, more verification and validation testing and regularly scheduled maintenance and programming visits.
It seems intuitive that bundling fees obscures the critical service part of the fitting process. On the other hand, unbundling may suggest that a patient can purchase a product and forego the service part of the package. It may also make patients hesitant to return for the follow up visits they actually need, in order to avoid the expense. In our bundled pricing, we try to make clear that both service and products are included, and that the services are essential to make the products work effectively for individual patients.
The PCAST committee cited data that indicates that 25% of patients do not return for follow up visits for which they have paid. Trying to solve the problem by creating a category of product with no services is a drastic oversimplification of the issue.
Another Misshapen Elephant
That’s what audiologists have created. We continue to leave critical business/marketing training out of our AuD programs. We embrace product forward advertising programs, rather than develop innovative marketing tools that stress our services. We allow manufacturers to obscure the differences in training, education and skill between audiologists and dispensers.
We continue to spend millions of dollars on certificates which do not insure that practitioners are using evidence based practice or appropriate validation methods. By misdirecting this money, we under-fund ACAE’s accreditation process and political activism committees that would promote the diagnostic and rehabilitative service component of hearing healthcare.
What should we do? Positive suggestions next time…