Editor’s Note: Today’s post is brought to us by Virginia Ramachandran, AuD, PhD, and Brad Stach, PhD, offering their view of how the recommendations of the PCAST report could actually harm, rather than help, hearing impaired patients.
When we think of hearing aid care, we think of our patients–the vast majority of whom are over 70 years of age. Most noticed a little bit of hearing loss years before and didn’t pursue hearing aids because they felt they didn’t need them or didn’t feel their problem was “bad enough” to commit the financial and other resources necessary to be successful hearing aid users. Then they reached a certain tipping point in life, and they sought us out as healthcare providers to diagnose, treat, and monitor their chronic communication disorder.
We also know that there are many other patients out there who have hearing loss but simply do not want hearing aids at the present time.
When we think of the cost of hearing aid care, we think of the cost of the device, the cost of our time, our staff’s time, and all of the resources that our institution commits to ensuring safety, quality, and privacy for our patients.
When we think of the hearing aid industry, we think of companies that are driving technological advances at a rapid pace, especially for such a small market. It seems that every season we are learning new and exciting ways to help our patients. We also think of the educators we know from the companies who are working hard to keep us updated on how we can best adapt their technology to our patient’s needs.
Consumer Electronics Perspective
Imagine for a moment that we are not us, that instead we are members of the consumer electronics industry. We see hearing aids as electronic devices, not as a part of a process of care for a chronic healthcare condition. We don’t see on a daily basis the otologic disease and other health conditions that impact successful care of our patients.
What we see is a massive economic opportunity. We see an untapped market. We see millions of potential customers who are not buying electronic devices to help their hearing. And why are they not buying these devices?
Well, they tell their doctors and their spouses that hearing aids are too expensive, so it must be the cost.
And it might also be that they are regulated to protect the health and safety of the customers, so it must be the government regulation.
Or perhaps that regulation conspires to keep competition out of the market. Surely customers would buy these devices for their hearing if only we could de-regulate.
The PSAP Clamor
Back to being audiologists, we have seen for years the presence of, but lack of traction for, what are now called PSAPs. That doesn’t surprise us. We know our patients don’t really want hearing aids until they need them.
Still, the PSAP clamor is growing, as is the call for more over-the-counter (OTC) hearing technology solutions. From our patient-centered care perspective, this is at least mildly unsettling. Stated nicely,
“Empirical research on the economic value of patient-centeredness and the importance of trust in the patient-physician relationship shows that a patient’s sense of feeling known, cared for, and understood can directly promote emotional well-being linked to better care, and respect and trust in the patient-physician relationship can improve health through better continuity of care, patient satisfaction, and commitment to treatment plans.” (Berenson and Cassel, 2009)
We certainly know this to be true of the patient-audiologist relationship as well.
PSAPs have been available over-the counter for years and haven’t had much of an impact, so what has changed?
The PCAST Perspective
Recently, the President’s Council of Advisors on Science and Technology (PCAST) released a report to the President of the United States on recommendations that it claims will increase access to hearing care for Americans. Although the focus on hearing loss and care for our aging population is laudable, the report is based on faulty assumptions and a limited evidence base.
In our opinion, the report’s recommendations are dangerous and will not result in greater benefit to our patients. Given that the council purports to support scientific recommendations, it is stunning how much the actual data are ignored in favor of what appears to be a bias toward the consumer electronics industry.
We’ll explain and support those opinions in next week’s post.
Berenson, A., and Cassel, C. K. (2009). Consumer-driven health care may not be what patients need – caveat emptor. JAMA, 301(3), 321-323.
Virginia Ramachandran, Au.D., Ph.D., is a senior staff audiologist and research coordinator in the Division of Audiology, Department of Otolaryngology – Head and Neck Surgery of the Henry Ford Health System in Detroit, Michigan. Dr. Ramachandran also coordinates the clinical education experiences of the audiology students at Wayne State University where she is an adjunct assistant professor. She serves as a member of the American Academy of Audiology’s Board of Directors. She is an associate consulting editor for Plural Publishing Inc. and has co-authored and edited several textbooks geared toward audiology students. “The opinions and assertions presented are the private views of the author and are not to be construed as official or as necessarily reflecting the views of the American Academy of Audiology.”
Brad A. Stach, Ph.D. is Director of the Division of Audiology, Department of Otolaryngology-Head and Neck Surgery, of the Henry Ford Hospital in Detroit, Michigan. He also serves as a consultant for Audiology Clinical Education at Wayne State University Department of Communication Sciences and Disorders. Dr. Stach has served in audiology leadership and clinical positions at The Methodist Hospital of Houston, Georgetown University Medical Center, the California Ear Institute at Stanford University, the Nova Scotia Hearing and Speech Clinic, and the Central Institute for the Deaf. He is a founding board member of the American Academy of Audiology and has served as its President and the Chair of its Foundation’s Board of Trustees. Dr. Stach is the author of a number of scientific articles, books, and book chapters and is the Audiology Editor-in-Chief for Plural Publishing.