Hearing Healthcare 2020 is a column where we explore the forces behind the changing landscape and disruptions impacting the hearing healthcare industry.
This week, HHTM is exploring the impact COVID-19 may have on the hearing healthcare consumer and what sort of trends might we expect to see over the coming months and years.
To get a broader view of how the hearing healthcare consumer may ultimately evolve as a result of the COVID-19 pandemic, HHTM sought out commentary from the industry, from hearing professionals and, importantly, from consumers with hearing loss:
Hearing Professional Viewpoint
A View from Private Practice
How we are moving forward and the projection of what we will be doing differently for the short and long term is ever-evolving in private practice.
How We are Adapting for the Next 3-6 Months
A major change we have made is trying to control patient flow within our building. We have a standalone office which has one door for in/out for public traffic. Our business has always fallen under essential in our state, but in early March 2020 there was little guidance and we locked the front door, moving to curbside emergency and in-house only for dome removals.
We continued to have a soft closure for 5 to 6 weeks. During that time, we studied CDC, OSHA and State guidelines to figure out what PPE we would need and for what situation. I was on the Entheos Audiology Cooperative Task force for Infection Control and with the help of Dr AU Bankaitis we updated the manual to include a COVID section. We feel we will be using PPE such as masks, shields, and gloves for the foreseeable future. The PPE and enhanced sanitation, changing chairs to be of a material which would be easier to clean, spacing seating in our lobby, increased spacing in between patients will be protocol moving forward as we see spikes in viral infections in the future.
Installing a drop box and pick up locker system has been working well for the office with a low touch policy. At one point we had 150 people on our waiting list to get back into the office as we were booked 4-5 weeks out before the pandemic hit. We have hired another audiologist who will start next month to help us catch up. We took the time to develop better protocols for Aural Rehabilitation classes, Tinnitus Therapy, Central Auditory Disorder marketing, Cognivue screening for cognitive health, production of videos for education and database clean up. We are now introducing services on-line, thru telehealth, Social Media and Zoom classes.
Long Term Changes Next 2-3 Years; Different Scenarios
I see consumer behavior polarizing even more extremely than we thought in the past. There will be those who see Audiology as product driven and buy devices online with little or no service added value. On the other hand there will be those who see us as Service driven and appreciate our expertise in tinnitus, dizziness, aural rehabilitation and CI mapping abilities.
There is space for both, but the only way for private sectors to survive is to find areas they excel at in service–quit worrying about your competition and make yourself better! We will need to clean and service all types of devices and charge for our expertise. The pandemic has taken away our fear of telehealth and there is absolutely a place for this in the future, but to never underestimate the power of how we can help in person.
Being flexible and figuring quickly what 2 or 3 options to offer to our patients is important, not to overwhelm them but being specific to their needs at the same time. It is a balancing act that we must be very nimble with. Those who want to stay with “how they have always done things” will find it very frustrating to move into the future.
Judy Huch, AuD is a private practice owner in Tucson, AZ since 1998. She is a presenter and has been published in trade journals, OpEds, and numerous online outlets with her focus on Audiology Healthcare and Services, Private Practice, Tinnitus Counseling, and Giving back to the Community she lives in. She has 2 sons, a Marine and a senior in high school and a very patient husband.
A Changed Business
Many of us have by now accepted that our business will change dramatically during the pandemic. However, I think most of us have focused on the simple mechanics of continuing to see patients, rather than the impact of the epidemic on business levels. I understand that, but I think we need to look at the broader context of the effects of this event on the people we serve and our businesses.
I believe that this pandemic will dramatically change our business levels and therefore may lead to a very different delivery model. I think there are several reasons for this, and I have coined the phrase motivation/fear ratio for want of a better term.
The driver of the motivation to begin the journey to better hearing is most often the ability to hear in social situations. People feel left out of the conversation. Eventually, the motivation to do something builds and they, or their loved ones, make an appointment to see us.
What Social Events?
Social events, typical of our cultures, are on hold for some time. Social distancing, the act of keeping as far away from someone else as possible will continue for quite a while. Even if respective governments order the use of masks, they will continue to use social distancing as a requirement. What then will be the motivation to get hearing aids? Even if social events begin anew before the end of this crisis, how many will attend?
Afraid To Socialise?
The longer this goes on, the more ingrained the habit becomes. I think the restrictions that we live under and the underlying fear of this virus will change the outlook of many people. This crisis is having a direct psychological effect on all of us. It may be the case that people will begin to fear crowded spaces and continue to do so until there is a cure or a vaccine.
This pandemic could have a dramatic effect on social interaction and outlook moving forward and for years. It could certainly have that effect on older people who know they are at heightened mortality risk. The underlying fear, whether conscious or not, will further work to keep the motivation low. If there isn’t a massive problem with your hearing, why risk another trip out?
I have brought this up elsewhere, and a lady rightly pointed out that Americans were a resilient bunch, citing the after effects, or lack of them really after seminal events in our history. Singular societal events such as 9/11 or the assassination of Kennedy have an impact on societal psychology, but those effects tend to fade over a short period.
In general, those events are distant to broader society, and while there is an emotional effect, there is little or no intimate experience.
To a certain extent, that is why we see reopen protests across some areas of America. The people involved understand what is going on, but have no intimate experience with the issue. The disease event has not affected them so far, the economic impact has.
A Very Different Prospect
This event is very different from seminal events that have gone before. Neither time nor initial impact constrains this event. It is not a single seminal event over one day; it will go on for a long time. As this disease continues to affect us in several waves, more and more people will have an intimate experience with it. The death toll will continue to increase and areas, where there has been little impact, will begin to see that change.
Consider the emotional impact to a community of the release of restrictions—the death of several members of that community and the re-introduction of restrictive measures. Consider the emotional and societal impact of repeated cycles over an eighteen to twenty-four month period? Unfortunately, there is little study evidence available to understand how pandemics have affected societal norms historically. The one article I could find was not hugely encouraging.1
That Motivation/Fear Ratio
I feel that many of the people with mild to moderate hearing problems which have been responsible for incremental increases in the sales of hearing aids will no longer be motivated or may well fear to attend our clinics. We could see a return to the historical precedent of people with moderate to severe hearing loss being the only ones who search out our services mainly because the motivation/fear ratio is different in that demographic. Even then, fear may spur them to search out solutions that don’t involve face to face appointments or unnecessary trips out.
An Unpalatable Choice
Let us begin to assess the use of the remote provision of hearing solutions. While many within the profession, myself included, are aghast at the trade-offs inherent in such a provision model, we need to be cognisant of the consumer, their specific wants and needs. It may be the case that many consumers want remote provision. It may well be the case that remote provision could change the motivation fear ratio for many people, including the mild to moderate cases I mentioned earlier.
While ensuring consumers understand the active measures we are undertaking in our clinics to ensure that they are safe will help, I am not sure if that will be enough for any but the most urgent or exceptional cases. For the rest, we will have to look at strategies that make it easier for them to access hearing care from home.
For some of us, that may be unpalatable, and I know it goes against the grain for many of us. However, we have to be realistic; we have to ask the question, do we accept that we need to look at non-traditional methods to survive, or would we be happier going out of business? I honestly think the choice maybe that stark for many going forward.
- Vox, CEPR Policy Portal, Pandemics and social capital: From the Spanish flu of 1918-19 to COVID-19: https://voxeu.org/article/
Growth in Alternative Care Models
Here in Australia, Covid-19 has seen clinic visits drop right across healthcare as more and more people seek out and become aware of telehealth alternatives.
In the years I’ve delivered teleaudiology servic
As people start to explore their hearing care options and learn about online services like teleaudiology care, the challenge is discerning what is being offered, especially whether they will receive fully vetted and qualified care remotely. It’s up to audiology providers to clearly outline and develop a support service that works for their practice and revolves around consumer needs.
So in the short term I predict a positive trend in awareness and inquiry for consumers and clinics into how teleaudiology can work for them.
Possible Long Term Changes in Consumer Behavior
I predict that one of the lasting impacts of Covid-19, for hearing care professionals, will be that telehealth is an expectation. The new normal.
When using teleaudiology, the hearing care professional is essentially invited into the environments that people want help with most. Both the responsibilitie
I believe that teleaudiology is a vital tool for hearing care, not a threat, and I’m excited that the conversation is now getting much bigger and more inclusive.
Sophie Brice is a Digital Health Lead at Swinburne University of Technology, alongside developing and delivering Teleaudiology services at Blamey Saunders hears. Curriculum development, educator, researcher and author in Teleaudiology and related practices for hearing and health care professionals.
A View from the Hearing Industry
The COVID-19 pandemic has reminded us that hearing is critical for clear communication. For 53 years, this has been Starkey’s sole focus. During these challenging times, many people are realizing that they are struggling to hear everything during this 24/7 news cycle.
While it may take some time for our industry to settle in to a “new normal”, we expect that demand for hearing health products and service will increase. As long as patients feel that practitioners are following CDC guidelines for care, they will return to hospitals, clinics, and retail shops. The role of the professional is essential to optimal outcomes, and we’re working with our partners to ensure that they have access to PPE and the latest information.
What long-term change in consumer behavior might be seen over the next 2-3 years?
If there is a “silver lining” to these very unfortunate times, perhaps it is that the role of the professional has taken on increased significance.
We foresee increased use of telehealth in the long term, not as a substitute for face-to-face care, but to augment that important patient-provider relationship for minor adjustments that do not require an in-person visit. We are optimistic that emerging generations will not be as stigmatized by hearing loss and hearing aids, and instead seek products that provide outstanding hearing benefits and a gateway to health and wellness. We’re optimistic for the future, while acknowledging that this will not be business as usual.
Brandon Sawalich is the President of Starkey Hearing Technologies, leading a global team of more than 6,000 employees, with 26+ facilities worldwide. He also currently serves as the Chairman of the Hearing Industries Association (HIA).
Covid-19 and the Electronic Mediation of Speech
How does the Covid-19 pandemic impact the consumer-patient experience with hearing loss? A crucial change is that social distancing results in a significantly greater proportion of speech being mediated by electronic devices. This new element in the consumer-patient’s experience suggests important opportunities for hearing care professionals (HCPs) to update their service model and for hearing aid companies to consider new feature-functionality.
When people observe social distancing, phone calls, video calls and videoconferencing become the predominant medium for spoken human communication. Speech mediated by electronic devices replaces much of in-person interactions. People hold work meetings, “quarantinis,” even memorial services over video.
Yet people with hearing loss often struggle over video. Poor internet connections cause the speaker’s voice and lips to become unsynched. Speakers turn away from the camera mid-sentence or their lips slip below the camera line. As a result, speech degradation caused by electronic mediation, as opposed to speech-in-noise, takes center stage as the primary hearing challenge.
In the near term, HCPs can remain relevant by providing services to help patients succeed with video calls. HCPs may recommend videoconferencing resources, such as this excellent knowledge base. Of particular help would be to show patients how to activate captioning features on the videoconferencing platform of their choice.
Public health experts predict that we are in for “at least another 18-24 months of significant Covid-19 activity, with hot spots popping up periodically in diverse geographic areas.” In other words, expect intermittent social distancing for the next two to three years while the country builds up immunity. The exceptions of essential workers—about 28% of men and 33% of women—combined with people who chose to flout social distancing requirements will not be significant enough to eliminate the impact on society. In fact, in states with relaxed requirements, some people will continue to take precautions by maintaining social distancing. A prime example will be the hearing industry’s core customer, people aged 60 and older, given their higher risk of mortality.
In a world of periodic social distancing, consumer-patients will have even a tighter relationship with their smartphones and personal computers. Apps which provide customized amplification by frequency range may become more appealing for people with hearing loss. Contributing to apps’ appeal will be their convenience and also affordability in what could be an extended period of economic downturn.
The pandemic may also drive increased penetration and use of earbuds. In the home, earbuds enable multiple members of the household to conduct video calls at the same time; at work, earbuds will most likely become more socially acceptable for minimizing noisy distractions. As in the case of apps, consumers may find an all-in-one solution, an earbud which also provides hearing personalization, to be more convenient than a hearing aid. This is particularly true of those with mild hearing loss. To remain competitive, hearing aids will need to keep pace with earbud feature-functionality.
With the prospect of ongoing and periodic social distancing, the shift of a significant portion of in-person communications to phone and video calls will be a multi-year phenomenon. Both HCPs and hearing aid companies will need to adapt to a consumer-patient experience which is moderated more than ever by smart phones and PCs. The industry’s recent innovations in online hearing tests, direct ordering, and remote fittings demonstrate the kind of flexibility needed to succeed in this new world wrought by Covid-19.
Nancy M. Williams is President of Auditory Insight, the strategy and marketing consultancy for the hearing healthcare industry. She advises leaders of pharma and device companies how to transform hearing healthcare with effective engagement strategies and innovative models of care. Adept at breaking through conventional molds to create value, she has generated over $120M in new revenue in public and privately-held companies. Prior to founding Auditory Insight, she created and ran the patient engagement business for HPOne, working with Medicare Advantage payers to close care gaps through patient outreach. Nancy holds an MBA from Harvard Business School and a BA from Stanford University in Quantitative Economics, both with distinction.
Change is a Certainty
One certainty provided by the Covid-19 virus is change. The pandemic has brought forward a number of issues that we must address for the consumers of our products and services. One looming question is, “how will consumer behavior change?”
As we re-open our practices what can we expect in the near future, three to six months, as well as on the horizon, two to three years from now?
Near Future (3-6 months)
The number one issue consumers should expect from their professional in the near future will be safety. Given the population we serve, older adults with sensorineural hearing loss, we are interfacing with patients that are “high risk” for serious health consequences including mortality if the virus is contracted. The new normal will require continuous monitoring of employee health and a strong infectious disease protocol that says to the patient “you are safe here”. This messaging starts with the clinic website and pre-appointment communication. It continues upon arrival to the clinic, throughout the service protocols, and finally, it must become part of the treatment plan… “here is how we treat you to limit exposure to the virus”. Safety will be priority one.
One of the safest ways to treat our patients will be through remote care. Tele-medicine and tele-audiology will become a significant part of how we treat consumers. The adoption rate for remote programming of hearing aids, pre-pandemic, was below 10% according to several manufacturer sources. This number will increase significantly as follow-up visits and adjustments for hearing aids can be accomplished without a face to face encounter. In the banking industry, mobile deposits were growing a rate of less than 5% annually pre-Covid. That number jumped to 55% in one month as consumers adapted to electronic deposit — people do adapt. In our profession, in the near term, there will be a learning curve for professionals and for our consumers. Some patients may be unable to easily navigate the technology hurdles for this type of interaction. This will mean longer training times in the short term or the need to interact with the patient’s care givers to allow this appointment type to take place.
The near-term consumer will, most often, also be cautious. They are faced with two issues. The virus and what it’s economic fallout will mean to them financially. The good news is the majority of our patients are retired and have predictable income streams; they haven’t lost a job. That being said, they will be cautious about large expenditures until they understand the full impact of the economic downturn. To address that issue, we believe consumers will be interested in subscription and/or finance programs with monthly payments they know will fit their budget. It will allow them to get into new products without a significant hit to their cash position. Additionally, service plans and extended product warranties could be very attractive as the cautious consumer tries to extend the life of their current devices.
Given the home quarantine consumers have faced all across the nation, we need to anticipate a high number of consumers (or their care givers) have been surfing the internet. The near-term consumer will have many questions about internet offers for product. Professionals need to anticipate these questions, be familiar with internet product offerings, and most crucial, be able to discuss the value of getting services through a local medical professional.
Don’t ignore the consumers who will want to use their insurance benefit. The market, on a more likely than not basis, will not bounce back right away and professionals need to look at how they fill their schedules. Discussions with two of the third-party hearing aid benefit provider companies indicate that while their referral numbers are down, they are not seeing the same level of decrease experienced with private pay patients. The insurance-invested group of consumers have already purchased a benefit and will want to utilize it to save cash. The third-party benefit providers, meanwhile, need locations to send patients because many offices have been closed during the crisis. Now is the time to evaluate these programs and determine which are a good fit for your clinic.
On the Horizon (2-3 years)
Tele-health will most likely be the biggest and perhaps the best thing to emerge from the pandemic. Consumers are experiencing the convenience of healthcare from the comfort of their homes. Providers and clinics are discovering the efficiency and effectiveness in using technology to prioritize patients and provide excellent treatment remotely. The consumers of the future will expect this kind of service to continue and it should. This could be a great windfall for the profession of audiology and the industry of hearing aids as we settle into the Covid-19 “vaccine” era. We will have the ability to interact daily with more patients in a more convenient manner. Access to care will increase with the remote care model– this is a good thing.
State and federal laws governing the utilization of tele-health will most likely be relaxed to provide better access for consumers to all medical professionals. This could impact current legislation for direct access to audiology. Additionally, state hearing aid and audiology licensing regulations will need to be changed to allow for the delivery of services across state lines. This could take place in the form of a national registry for reciprocity or low-cost registration fees by state. For the consumer this again will mean more access to care via telehealth.
Over the Counter (OTC) product definition guidelines by the FDA have taken a backseat to the virus. Those close to the issue anticipate its completion in 2021. These products will become more prevalent and will most likely be utilized by a younger age cohort. Home quarantines will have revealed a higher incidence of communication issues. This younger population will use technology to access care. This will further accentuate the need for remote care channels and the use of audiology techs to interface and cultivate future hearing aid candidates
As consumers adapt to a world of remote care, avenues for the internet sale of products will increase. To counter this, the manner in which we reach out to our patients will change. The services we provide will shift to management of a chronic disease state, sensorineural hearing loss, using technology based patient monitoring. The hearing device itself, still being a critical part of the treatment plan, will simply be a part of the management of the chronic health issue and not the single treatment modality.
Due to the government expense for the Covid Crisis and sub sequential economic downturn, legislative initiatives to include hearing aids into Medicare will most likely fail due to budget constraints. However, insurance for hearing aids through Medicare Advantage programs should continue to grow because the programs are paid via personal expenditures. The growing trend the industry experienced prior to Covid-19 should be accelerated as consumers invest in Medicare Advantage programs to ensure coverage for any health issues they will encounter in the future. Hearing aids, eyeglasses and dental services will continue to be an important value in these insurance plans.
Dan Quall, MS, CCC-A, is the Director of Strategic Initiatives for Fuel Medical Group.
A Consumer’s View
Disruption and chaos are often catalysts for change, innovation and creativity. COVID-19 is likely to be no different. The pandemic has already forced a number of changes in hearing care that are likely to remain in the short and long term. Many of these are positive steps that will provide more flexible and varied treatment options for people with hearing loss and the clinicians that care for them.
- Tele-health has arrived. Tele-health has been accelerated and is proving a viable option for hearing care when executed well. The availability of captioned video platforms and remote programming of devices support these initiatives. Tele-health will likely remain a potent option for patient care beyond the pandemic, particularly for patients with mobility issues and for those who live in remote areas.
- The use of alternative forms of hearing devices will increase. With hearing aid repair more challenging and more time consuming, patients are likely to experiment with alternative options when faced with a broken device. This will lead to a greater acceptance of over-the-counter type devices like Bose Hearphones, amplifier apps like Ear Machine and speech-to-text apps like Live Transcribe or Otter.ai. Hearing aids may become one of the tools people use to help them hear, rather than the one silver bullet that is prescribed for all situations.
- Patients will take more responsibility for their own care. Partnering in hearing health care will become more typical as audiologists rely on patients to clean and maintain their devices from a distance. This will generate confidence on both sides as patients feel more capable in managing their own care and audiologists feel more comfortable letting them do so.
- Aural rehabilitation and counseling services will gain importance. Patients will need advice and support adjusting to the new normal of post-pandemic life. Masks and physical distance rules will create new hearing challenges for many. Audiologists will become critical partners in figuring out the tricks that make communication possible for people with hearing loss in these new circumstances.
Shari Eberts is a hearing health advocate, writer, and avid Bikram yogi. She is the founder of Living With Hearing Loss, a blog and online community for people living with hearing loss and tinnitus. She also serves on the Board of Trustees of Hearing Loss Association of America. Shari has an adult-onset genetic hearing loss and hopes that by sharing her story she will help others to live more peacefully with their own hearing issues. Connect with Shari: Blog, Facebook, LinkedIn, Twitter.
Delivery of Medical Care, Including Hearing Care, Likely to be Forever Changed
It is my personal belief that the pandemic has changed forever the way medical care of all kinds is delivered by accelerating trends that were already beginning. Chief amongst them is the use of remote consultation and care delivery. We were already moving in that direction to support people for whom travel was difficult or who lived far from their providers. For example, the US Dept. of Veterans’ Affairs (VA) launched their telehealth service in 2018 and saw its use expand rapidly last year.
Closer to home, the hearing aids I purchased in late 2018 came with an app allowing remote tuning. I asked an audiologist if she thought her clients would find this useful. She responded that most of her patients were older and not comfortable with using smartphone tech. Therein lies the challenge for hearing care providers specifically.
From consumer point of view, I see adoption of remote hearing care dividing up along two lines. The first is between existing and new clients. Though it would be ideal to introduce remote care services in an office visit that is not possible today. It is possible for hearing care professionals to proactively reach out to their existing clients (or someone assisting them) to introduce remote care. There will be lower friction for clients who already have an established relationship with a provider. Therefore, remote care adoption rates will likely increase amongst existing patients.
I see a different picture for potential new clients. Because hearing health is infrequently addressed as part of routine medical exams, there is a high degree of reliance on self-awareness in seeking hearing care. In the best of times people wait years before coming to grips with their hearing loss, this contributor included. I have a difficult time envisioning potential new patients, already uncomfortable with the associations attached to hearing loss, making the leap when they must initiate the relationship on remote basis. Without having seen data, I suspect new client intake is very low today and will remain so during the pandemic.
The second dividing line is along comfort with tech and remote care in general, with the line shifting in longer term. As consumers become used to remote care in other settings, hearing care will be part of the package. At the same time more of tomorrow’s hearing aid users will have become comfortable being seen in public wearing something in their ears. Having adopted both hearable tech and smartphones, the next generation of clients will feel less stigma around hearing loss and give more weight to the convenience of remote care. While I wouldn’t hazard a guess as to the timeline, I have little doubt that remote care will one day be mainstream when in-person exams are not necessary.
Andrew Bellavia is a hearing aid user who currently works as Dir. of Market Development for Knowles Corp. in the music earphone and hearable spaces. He has written or contributed to numerous articles and podcasts on the future of voice and hearing tech. All opinions are his own.
Fewer Office Visits and Less Sales in Short Term; Telecare Expected to be Adopted and Utilized More Over Time
What Might Occur in the Next 2-3 Years?
Steve Claridge has been wearing hearing aids since he was 5 years old, when a mild hearing loss was first diagnosed – now in his 40s, that mild loss has progressed to a severe one and he relies on some pretty awesome hearing aid technology to be able to stay in the conversation. He’s passionate about helping people to understand hearing loss, hear more and communicate more easily. He has been writing about his hearing loss on Hearing Aid Know for over 14 years. Also a huge software geek, programmer and keen runner.
Consumer View: What Changes Might we Expect to See?
It’s likely that consumers will continue to use the online shopping that they have come to depend on during the isolation of this pandemic and this could extend to hearing aid supplies. I already order batteries from Amazon and from the Canadian company that handles Cochlear’s CI supplies.
As for auditory telehealth, I believe people would be open to it. For boomers and younger, though. Just as I can let the Geek Squad access my computer remotely, it makes sense that you could access my hearing aid or cochlear implant remotely.
Unfortunately, people have gained a new fear of transmittable viruses, and I think that handshaking will cease to be a common custom. Hearing clinics will have to adopt a new standard of sanitization–standards that I’m sure are being developed even as I write.
On the other hand, I fully intend to hug everyone I know, once it’s deemed permissible, because hugging had increased dramatically in recent years, even among strangers. I have hugged my audiologists! But that will change, and many people will not want to be hugged even by people they know.
Gael Hannan is a writer, speaker and advocate on hearing loss issues. In addition to her weekly blog for Hearing Health & Technology Matters, which has an international following, Gael wrote the acclaimed book “The Way I Hear It: A Life with Hearing Loss”. She is regularly invited to present her uniquely humorous and insightful work to appreciative audiences around the world. Gael has received many awards for her work, which includes advocacy for a more inclusive society for people with hearing loss.