by Mike Metz
A short time ago, I wrote a post regarding lack of access to the software of some hearing aids. My comments arose from conversations with other dispensing audiologists. They saw patients that were having problems with hearing aids purchased from large distributors — Big Box stores primarily.
Evidently, patients believed that they were not getting sufficient benefits from their hearing aids and, after returning several times to the place of purchase, sought clinical help.
Locked Hearing Aid Software: The Problem
It seems that the locked software problem is similar to denying a second medical opinion. It becomes more relevant when the seller of the device(s) makes very few measures of potential and ability, degree of problem, or outcome performance.
In perhaps harsher words, when sufficient investigative information is not acquired, a retail purchase should not prevent the patient from seeking and receiving clinical care for a hearing loss from any source. This issue is made more questionable when most retailers selling these devices foster this confusion.
There are several contributors to the present situation. I would place the majority of blame on audiologists who have become sellers of devices in lieu of providing investigative and rehabilitative care to hearing impaired patients. Their decision to function in this manner evolved slowly from audiology’s past.
For example, new procedures involving new and expensive equipment may have prevented new audiologists from providing broad hearing care. It costs a lot less to outfit a dispensing office than a hearing and balance clinic, to say nothing of the added expertise.
It was a lot of work and effort in the early years of stand-alone audiology offices to sort through and succeed in third party reimbursement at rates that would support an office. The easier path was to ignore these difficult methods and sorry payment rates in favor of a “cash” business. Many physicians from “plastic” residencies appreciate this (cosmetic) aspect of their practice.
How Did We Get Here?
Speaking of ENT physicians, some will also bear a portion of responsibility. An audiologist in a medical office is much more profitable selling devices than in performing hearing tests that make little difference in the medical care of hearing impaired patients as well as the finances of the office. (Prepare for a coming post on this topic.)
Some of the fault for public confusion belongs to hearing aid sellers who are not licensed clinicians. From what is easily and broadly observable, many present themselves in advertising, manner, and procedure as if they were something beyond what their license allows.
To think that many of the hearing impaired public can easily determine the differences in all who dispense hearing aids is naïve.
Public opinion of our entire industry has now spread broadly—to the government in particular. No argument by any member of the above groups will result in moving the government committees to a position other than one supporting a public position. Impeded access to fitting parameters certainly does little to dispel this view.
Is This Truly a HIPAA Issue?
As one responder to the prior posting noted, the manufacturers hold some of the blame. Perhaps more than just a little. If some manufacturers of regulated devices allow access to their device parameters to anyone with the appropriate software programs and others do not allow this access, how does this difference support either side of the HIPAA issue?
If it’s called a hearing aid, it falls under the HIPAA regulations.. Its parameters ought to be visible and manageable by any hearing health clinician. Every hearing aid manufacturer has a responsibility to adhere to these health-related regulations. To lock out those who would help manage the hearing loss is likely a violation.
As an aside, it would be interesting to investigate the failure rate of those large distributors/sellers and to make some estimates of any increased success rate following some real clinical intervention.
This would also support the arguments of hearing rehabilitation. In the absence of data supporting a high success rate, we can reasonably assume that there are some patients who fail with amplification due to misfits, maladjustments, or just inadequate care. At least in part due to outdated sales methods and public confusion.
Following the past posting, one manufacturer responded with a comment that their hearing aids sold through Costco do have accessible programs if a clinician has that brand’s software. So, good clinical management would involve advising a Costco customer to purchase instruments that are accessible outside of Costco for purposes of rehabilitation, adjustment, etc.
I’m glad this issue provoked some comments from readers. For the sake of patients involved, I hope that some of you will also make comments to the manufacturers where the easiest solution to this issue lies.
Mike Metz, PhD, has been a practicing audiologist for over 45 years, having taught in several university settings and, in partnership with Bob Sandlin, providing continuing education for audiology and dispensing in California for over 3 decades. Mike owned and operated a private practice in Southern California for over 30 years. He has been professionally active in such areas as electric response testing, hearing conservation, hearing aid dispensing, and legal/ethical issues. He continues to practice in a limited manner in Irvine, California.