How Do We Meet Consumers Where They Are? Interview with HIA President, Kate Carr

Amyn Amlani
Welcome to This Week in Hearing where viewers get the latest information on all things happening in the hearing care space from device technology to pharma therapeutics to practice management. My name is Amyn Amlani, and I have the privilege of serving as your moderator. Historically, the hearing aid industry has seen a modest growth in serving the needs of patients with hearing loss balance, tinnitus, and other ear related issues. And if we want to accelerate this growth in the years to come, there’s a need to meet consumers where they are to help us gain a better perspective on this topic. Please welcome Kay Carr, President of the Hearing Industries Association. So nice to have you here. Kate,

Kate Carr
thanks for inviting me to join you today. I mean, looking forward to our call.

Amyn Amlani
Absolutely. So am I and so for our viewers, can you please tell us a little bit about HIA, and then your role within the organization,

Kate Carr
HIA was founded in 1955. And in all of those years, it has served as the forum for manufacturers, suppliers, distributors, those hearing care professionals, to really keep up on what’s going on in the industry, there’s been such an evolution of hearing health during that time, as you well know, our main focus is probably two things come to mind. advocacy is very important. We’re talking with members of Congress, and their staff here in Washington, we sometimes get involved in state issues, we get involved with the regulatory agencies, because the FDA, the FTC, the FCC, are all important to us. The other aspect is our awareness, our education and awareness campaigns. And we take that very, very seriously. We want to serve as a trusted voice for consumers. When it comes to their hearing health, there are other things that we do that are associated with our with HIA. And that includes collecting data on sales, we conduct MarkeTrak, a long term na study, that will, at the end of this year be going into our 11th round. So in that we really take a deep dive into what consumers are thinking, what they’re doing, what their attitudes are about their parent care professionals. So your your viewers and listeners can look forward to a market trek study coming out sometime probably in the second quarter of next year.

Amyn Amlani
That’s exciting. It’s exciting. We’re looking forward to that. So Kate, as we’re talking about meeting the consumers where they are, let’s start off with a little bit of a negative and then we’re going to make this a very, very positive videocast here. So let’s talk about a barrier or a couple of barriers that you see that has impeded individuals from entering the market space.

Kate Carr
Great question. And I’ve thought about this. And and I have one thing, I’ve decided that one word that I’ve decided I’m not going to use, and that is the word journey, we talk about the journey towards getting a hearing aid. And I think that a lot of people their responses, that’s a journey I’m not really interested in taking until I absolutely, positively have to. And words are important. And so we need to focus on some things to put the positives out there about hearing health and the way that you can acknowledge it, you can treat it, and you can improve the quality of your life. So when I think about those barriers, you know, there there are several of them. Many people talk about I can hear well enough for I don’t want to wear something that my grandfather or grandmother wore. And they’re they’re stuck on what technology used to be like many years ago. And they’re also not acknowledging, perhaps that hearing loss, in many instances is age related. So how do we meet them where they are? How do we introduce the fabulous technology that exists today that can do so many things for you that will address your unique hearing loss? We need to make it easier for people to get to see a hearing care professional. They need to understand that there are a couple of different ways you can visit a hearing care professional from an end to an audiologist to a hearing specialists here before I started this work, I wouldn’t have had a clue about that. And I think that when I’m thinking about how I talk to people, I keep that in mind. I was not an educated person about hearing Just a few years ago, and we need to help people understand that that first step that is so important is to understand your degree of hearing loss, your unique degree of hearing loss because no two ears are the same, and no two people are going to be exactly the same when it comes to what is happening to them, then it’s once you know that what kind of device should I buy. And when we talk about BTE and ITE and RICs and In The Canal.

Is that really the way to talk to people, that’s why it’s so important to have someone who’s a hearing care professional, help you understand perhaps what you might need. And here’s the technology very quickly, people became used to wearing AirPods. I’m, I’m a user I have, I have AirPods. And I like to use them for phone calls, sometimes even conversations like this that are on video, but they don’t stay in my ears for 12, 14, 16 hours a day, nor do their batteries last that long. And the comfort level isn’t quite the same as a hearing aid. Let’s talk about that. Let’s talk about how hearing aids are now able to tell you what my Apple Watch does, you know from streaming to other other features that are incorporated in it. A lot of people when they’re when they’re saying I’m not doing it because of the cost. You know, there’s so much misinformation out there about the cost of hearing aids. And the reality is that you can find hearing aids at a variety of different styles that have different features. And that come at different price points. And instead of saying the average hearing aid costs $4,000. That’s a figure that I saw just today, let’s help people understand that you can get something that is like an entry level, to something that is a premier level. And it’s not unlike other things that you purchase in your life or other services that you get in your life. So many, many, many things. Some of the biggest concerns that I have are about the misinformation that’s out there, you know, just in the past few months 17 Attorney General’s have issued warnings to consumers in states as large as California, and many of the states that are home to persons who are likely candidates for hearing aids. And they’re warning them that there’s misinformation out there about what is a hearing aid, or some of the devices that are being marketed as a hearing aid actually hearing aid, or are they a PSAP? And what exactly is a PSAP? You know, and what’s the difference between a PSAP, you know, can I go into a pharmacy and buy a hearing aid? Well, probably not yet. What about these OTC products that the even the President of the United States has been talking about? Well, we don’t have the regulation yet. And once we have a draft regulation, it’s likely to take another at least nine months until we get to a final. So our our focus, that’s why I underscore while there are routine things that we do on advocacy or collecting data, or doing research, getting the message out there to people about the importance of a hearing care professional, the options that you have the various price points style that might work best for you. These are important things to do.

Amyn Amlani
Yeah, no, you bring up a lot of a lot of valid points. And it almost sounds like there’s a need for awareness to educate individuals. You share a little bit about that from HIA’s perspective.

Kate Carr
Certainly. A few years ago, when I first started, I started this job in 2018. And I read the NASEM report, I was doing my background, getting up to speed on the information. As I already said, I really didn’t know very much about hearing but I knew a lot about working in organizations that look at health issues for people and how to educate people on in the NASEM recommendations number 12 was really needed to create a broader education and awareness campaign. And I thought that’s something I could do. Get Started. I reached out to Barbara Kelly at the Hearing Loss Association of America and said how about if we do a little think tank and talk about this and talk about how we might be able to put together a campaign from that meeting we did come up with here will stay vital campaign that was joined not only By HLAA, but by the American Academy of Audiology, the Academy of Doctors of Audiology, the International Hearing Society, ACI, the American Cochlear Institute, the Hearing Health Foundation, we have their seven partners all together, who look at a consistent message. And we created a a social media toolkit that we’ve distributed to everybody. And we asked them to share those messages, we did a first round of psats. And those PSAs aired nationally, and had a earned media value of over $2 million dollars, came up with another round of PSAs. First one was called preserve your passion. The second one is ‘keep life going’ positive messages that bring consumers information about their hearing health, I’m very pleased to say that campaign which includes a turned down the volume spot aimed at teenagers, about protecting hearing due to the what we’re seeing is as an increase in, in younger people having hearing loss. So we we are educating at every level. And that campaign so far has an earned media value of six and a half million dollars. And that’s in one year. So we’re we’re trying to get the word out. And and it’s not that we have tremendous resources, it, we’re not buying media for that amount of money, we’re placing PSAs, and we’re united and we’re presenting a unified message. If there’s one thing that I have learned in my years of working in the nonprofit industry, is when we come together with a unified message. And we’ve repeated and repeated and repeated it, we do better at changing behavior. changing behavior is a very hard thing to do

Amyn Amlani
the the campaigns that you talk about, are they available to practitioners in any form or fashion,

Unknown Speaker
all of the ‘Hear Well, Stay Vital’ materials, from videos to social media tiles to to a social media toolkit is all online and downloadable to anyone it’s at HearWellStayVital.org. So anyone a consumer, a practitioner, anyone can download that material to help get the message out. And I encourage people to do that.

Amyn Amlani
That’s fantastic. What we’ll do Kate is we’ll put the website in the in the right video at the bottom, so that folks can have access to it. And then they can go to that site if if they’re interested in looking at those those materials. Okay. All right, let’s move on to the next piece here. So let’s turn our focus now to discussing factors that facilitate earlier adoption to hearing care. Any thoughts?

Kate Carr
Wow, yes.

And, and no surprise, we’re working on a number of that, when the US Preventive Services Task Force issued their unfortunate recommendation for persons who are 50 and older not to be hear not to be screened for hearing loss. That was a blow. That was sort of a what one might call a gut blow. Yeah, for for all of us who care about improving quality of life through addressing your hearing loss. So we, we recognize that they cited a lack of research that would demonstrate the benefits of having everyone scraped now I’m not exactly sure why they pick the age of 50, as opposed to perhaps 60, or even 65. When people enter, traditionally enter Medicare. So we know that funding for the NIH and the NIDCD comes from Congress. And so we did our work. And we were joined by all the members in, and there are 14 of them, friends of the Hearing Health Caucus, a large group, all the professional organizations, consumer organizations and industry, we all went to work together to get language inserted into the bill. It’s referred to as report language that instructs the NIH to complete the research and report back to Congress on this issue. So we’re attempting to have the NIH do the work that is required that will ultimately we hope, and we believe, demonstrate the need for universal screening. And we do screening for so many different things. And I think given what we know about hearing health and the associated co-morbidities, and we’ve talked a lot about this to members of Congress and their staff, that is an important step. And that language is in the the House bill that has passed the House, we’re now waiting for the Senate to also include it as well. And that would be a success on something that we hope, and it will take you years, it’s not an instant come around your will happen. You know, this, you’re familiar with research, we want to see that actually take effect and produce some data that will be reliable data that can be used by the Preventive Services Task Force in the future. There’s a lot that’s going on in this Congress when it comes to hearing health. Probably your listeners are familiar with the topic of Medicare expansion, the President has really embraced not only pushing the FDA to release the OTC regulation, and you gave them four months back in July. So, maybe by November, we’ll see a draft regulation. But the issue of expansion of Medicare benefits to cover dental, hearing, and vision is a hot topic. And it has been embraced by Speaker Pelosi and Majority Leader Schumer as high priorities. And we’re very much involved in those discussions. Now, when it comes to expanding benefits for Medicare. Of course, Congress is going to look at what the cost is. There was a bill that passed the house back in 2019. And it provided for hearing coverage for those with severe to profound hearing loss and it only named audiologists in that language. And it had some other aspects that we were paying attention to the classification of the device as a prosthetic device, some language around competitive bidding, we had started talking to members of Congress back in 2019, early before the bill even came out, because quite honestly, I thought at some point, we are going to see Medicare expansion. And here we are in 2021. And we are seeing bills moving through and a serious serious commitment that’s coming from both the leaders of the House and the Senate to include it in the budget reconciliation bill. Now all of this is under discussion, probably the the there are a number of things that we consider important. But in the earlier part of this conversation I talked about perhaps consumers would be confused about do I see an ENT, an audiologist, or hearing specialist and each one of them have a scope of practice that is quite defined, and they’re licensed within their state to practice, we would like to see all of the professionals who are licensed to practice be able to practice within the scope of their license and be covered by Medicare. And that’s a point of discussion is a polite way of saying whether, you know, anytime that you’re looking at expansion of benefits, you’re looking at the cost, you’re looking at the does, do all of the players in the professional field agree with one another about who should be included and what they should be included for? What’s the reimbursement rate? And how long if this passes, how long will it take to implement it because it will be a complex undertaking for the Senate, that CMS so we would count anticipate that, you know, come come you know, a few months from now we’re going to have Medicare expansion under traditional Medicare. However, Medicare Advantage plans right now 90% of them do provide some benefit for hearing, along with dental and vision. Those, those benefits vary from regional area to regional area. So I can’t say that every program will provide $500 per hearing aid or you can replace your hearing aids within X number of years. So if you live in Washington, DC, and there are benefits available, that’s where I live, then you have to look at your plan and understand what the level of benefit is. We know from MarkeTrak that people want to understand want to have some type of insurance, some type of benefit. That’s a barrier that is beginning to change it, it doesn’t exist for veterans who are in the veteran health system. It’s there’s a bit of coverage, some type of coverage under Medicare Advantage, whether we’ll see Medicare expansion, maybe we’ll know by the end of the year and then we’ll see how long it takes- that issue though of covering severe to profound as compared to mild moderate or the area we’re most concerned about moderately severe. Well, it If you’re a consumer, and you just said, I know I need something, and I’m going to go, maybe I’ll go, one OTC products are available at my local pharmacy, that may not be the right step for you. So, really, really encouraging and working hard to get people to that screening to get people into the care of a hearing care professional, is, is the key focus for us.

Amyn Amlani
Yeah, and you bring up a really good point, bringing it all the way back into the circle, is that, you know, you’ve got to get people to see their need, you got to get people to see the provider, and then you’ve got to see people who are willing to be treated in all three of those pieces have to be joined together, in order for their quality of life to be improved. It’s, it’s, it’s so important that we see it in that in that realm, we

Kate Carr
do have to see it in that realm. And you know, no matter what, just taking the step, to change your life, and to actually become a hearing aid user is an important law. And I like many people know, someone who’s in my family, who just now has said to me, You are forbidden to speak to me about my hearing, I don’t want to hear it anymore. And this is not someone where cost is a barrier. This is just someone who really doesn’t want to acknowledge their hearing loss. And it’s my brother, one of my brothers. So I get that it’s hard, I get that it’s hard. But how we make it like important to do because your health depends upon it. Given the associated co-morbidities, your work might depend upon it, your quality of life will improve your relationship with your spouse is likely to improve. There are a lot of things that that we can we can talk about. But then there’s also the dynamics, kind of what I think of as the nitty gritty, you know, the nitty gritty when, when you’re going to make an acquisition like this, that and you know, will cost you a significant amount of money with or without a benefit perhaps then, except your if you’re a veteran, or you have total insurance coverage for it. But let’s assume that, you know, you’re going to have to pay some out of pocket and what that out of pocket cost could be a struggle for many people, how do we demonstrate that become educated know what your options are? Look for financing plans that work for you, we count almost equate the cost, if you break it down and look at the cost of a hearing aid over a five year period of time, and compare that to the cost of your telephone service or your or your device before your service, you might begin to see some comparable ranges. If you look at how long will I have my iPhone, how long or my or my Samsung Galaxy or? And how long will I have my hearing aid? And how do I break it down by 60 months? So it’s it’s nitty gritty stuff. But that’s meeting the consumer where they are talking to them in real terms. This is about your budget, this is about your life and what’s going to work for you.

Amyn Amlani
Yeah, and as you’re talking about breaking it down, the thing that pops into my head is unbundling and how important that is, as well. And as you said, you know, as I’m looking at my cell phone bill, I can separate the product from the services that I’m getting. And so what are your thoughts on on bundling in our profession?

Kate Carr
No, unbundling is going to be a decision that’s made by business people within their practices. And I think the case for unbundling has been made, demonstrate, you know what the cost of the device is and what the services are. And particularly as we’re going into a period where we have OTC products, or we have other sales channels, you know, the value of being able to go and see someone face to face, as opposed to self fitting or doing something online. Each of those might work best for some people, some people will be comfortable self fitting, some people will be comfortable with online services, some of which are excellent, some of which have some room to improve. And, you know, if if I were to call it the gold standard of being able to be with a hearing care professional and to have a discussion about your needs and answer any questions that you have, some people want that they want to see someone face to face. And remarkably, the channels for being able to purchase devices have expanded even in the short time that I’ve been in this industry. So we’re looking at even a lot more competition and I’m not going to name all the names that are out there. But there are a lot of new there are a lot of new brands and a lot of new a new companies and I will say this our association is open to anyone Who is a manufacturer, supplier or distributor. So if you want to see who our members are, you can visit betterhearing.org. And if you’re interested in becoming a member, then you can, you can send me an email, and I’m happy to have a chat. But there there, you know, there’s a impression that there are only five. And there are five major hearing aid manufacturers that produce the vast majority of hearing aids sold. But times are changing. And there are new companies out there and competition is is welcomed by the members of our association, and our door is open to those who want to abide by our policies and join forces with us. At the end of the day, I think we all share the same thing, which is to help people and to help people improve their quality of life. You can help people. I worked for President Clinton way back when. And he used to say “you can do good, and you can do good in your business at the same time”. I think that’s what our our members already do.

Amyn Amlani
Absolutely. Absolutely. Well said. So, as we move on in this discussion, which has been fabulous so far, and I thank you for all that you’ve input. Let’s talk about a little bit about accessibility. And you just said something that really resonated with me, and that is that consumers are looking for different ways to be integrated into the hearing healthcare model, whether it’s self fit, whether it’s via video, whether it’s seeing the patient. So what would you tell a provider today about being dynamic, especially given the fact that we have a little bit now experience given we went through this whole COVID-period?

Kate Carr
That’s a great question. And in terms of our advice, I refer to some data that we already collected on telehealth, because given the COVID pandemic, we know that a lot of people learned to, to do video calls like this, to connect in new ways. And, and for existing hearing care professionals who were able to remotely make an adjustment to someone’s hearing aid if the software was in both the provider’s office as well as on on the cell phone of the user. And we have, we have technology that’s allowing us to do a lot of different things. And I think in the not too distant future, we’ll have the opportunity to do everything remotely. We recently convened a group of our audiologists, some of the best in the field. And we talked about telehealth, and we talked about the different models from completely seeing someone in person to a blended model to a fully remote bought model. And fully remote is going to be an option. And to some extent it already is. Because you can purchase hearing aids with the help of a hearing care professional online, as I said, it’s there. Now will everyone become an adapter? I doubt it. I think some people will want that human touch. And, and we’ll want to want to be able to to meet someone in person and establish that very important bond. But some people are going to be doing it, you know, and just wait for it to be delivered in their mailbox and have a conversation like this with someone so they they know what they can answer any question and, and fix it or maybe not even deal with a hearing care professional until they have a problem with their self fitting hearing aid. So the models I think have to have to be adaptive. They have to be adaptive to the time to our times. And you know, I think it was Charles Darwin who’s who reflected on if you don’t change, you perish. And that’s that’s to quote someone who’s I think, studies and experience really could point us in the direction of his advice is better than mine. Think about how you need to change so you can survive and thrive.

Amyn Amlani
No, absolutely. Absolutely. And as you’re talking about telehealth, there’s also some regulatory changes that are that are occurring in that realm as well. Would you care to talk about those?

Kate Carr
You know, it’s been a topic of discussion, certainly at the federal level, and there are concerns as one would expect that are any kind of, of reimbursement, members of certain members of Congress who look at the bottom line worry about fraud and misuse. And, and so there have to be the guardrails put in place, we know the services can be delivered, the reimbursement structure has to be worked out, and it has to be protected from any type of bad play. So I see it happening, I think those discussions are going to be ongoing. But in, in the world that we live in now, where we’ve all had to adapt from the youngest kids who had to be remote learning to a person who is in a remote area and doesn’t have easy access, or in COVID times to people who are in nursing homes where they have to be really super protected, we’ve got to find ways of delivering appropriate quality services. So in addition to looking at reimbursement, we’ll want to make sure that the level of service meets the standard of care or exceeds the standard of care. That’s, that’s what we’ll be watching for.

Amyn Amlani
Yeah, that’s great. And then there’s also the whole issue of crossing state lines and interstate compact and some of those things as well. We’d love to get your opinion on that.

Unknown Speaker
Well, again, you know, the interstate compact now has the required number of states that have agreed to participate. And so the process of creating the regulations and rules for that can now begin. And you know, we have when we look at it, there are some very significant states that have not signed on to the compact yet, we know that some practitioners are worried about their their business being impacted in a negative way. But we live in a very mobile world where you, you might I can just think of all the times where I’ve wanted to access a health care provider when I was someplace else, whether in the United States or somewhere else in the world, and to prohibit that, when we have the tools to deliver quality care, I think I think we really have to work on being able to ensure that a patient’s needs are met, no matter where they’re sitting. No, it’s if you have an established relationship, and and you you can appropriately deliver quality care via the technology that exists today, I think that would be a good thing. Now, I want to emphasize that that is not the position of HIA, we don’t have a formal position on that particular matter. We’ve talked to our members about the interstate compact, and we’ve briefed them on that. But we’ve not put a formal position out. So I’m speaking on my own personal behalf.

Amyn Amlani
Thank you for sharing that. I think it’s good for the viewers to at least have some insights. And I know that This Week in Hearing, we’ll have the interstate compact individuals from ASHA, I believe it is on in a couple of weeks. And it’ll be nice to get, you know, the framework and some of the developments that are going on there, available to the viewership as well. So thank you for your input. That’s been wonderful.

Kate Carr
Well, they’re they’re doing the lion’s share of work on it. And I look forward to listening in on on that particular interview.

Amyn Amlani
Yeah, Wonderful. Wonderful. So last thing before we conclude here, Kate, let’s talk about the direct to consumer segments. What about protections for for consumers? Any any thoughts on that? You know,

Kate Carr
one of my least favorite things that I do is I’ll I’ll get notices from my members on companies that have false advertising. And and if there is, I mean, it could be talking about a device and using the word registered with the FDA when it’s not 510k compliant, where it’s it hasn’t had a pre-market clearance. It could be calling it a hearing aid when it’s not it could be calling it an OTC product, when the category doesn’t exist. Just a lot of misstatements of facts, and we take them very seriously. We write to companies and we follow up and when we notify the FDA, so FDA, the compliance FDA is I can’t say that they’re going after everyone I can tell you we send them a lot of letters, and they don’t reveal what their action is after. After we send it. But we know that enough of it continues that as I mentioned before 17 attorney generals have notified consumers about it when it comes to the consumer protections that are in place. And this is an important area where we’ve done a lot of work when it comes to OTC products, because the Congress inserted language about the new regulation will pre-empt any state laws and state laws, of course, are in place about licensing the hearing care professional, and providing many important consumer benefits, whether it’s about the warranty or the return policy, or just those are probably two of the biggest ones that are out there. But when those existing state laws protect a consumer from a sale that could go wrong, think about return for credit, you know, a lot of them are 45 days to 60 days a warranty for several years, you want to make sure that we don’t lose them in any way. And that’s an issue that we’ll be paying close attention to, as it comes to the OTC regulation. When it comes to direct to consumer. I think there for consumers. If, if they are buying directly because of an ad that they see online, or on TV or in a print, then check the Better Business Bureau for the rating, do your homework, do your homework and know if there’s an FDA claim in it, you can go to the FDA website and find out if it is in fact a product that has met all of the criteria that the FDA sets for medical devices, hearing aids are medical devices and their medical devices for a reason. Because we want to make sure that they’re safe and effective for the end user, the

consumer,

Amyn Amlani
and that sage advice. I mean, at the end of the day, we’ve got to protect the end user, you know, and what you’ve provided today has really, really been I think useful not only for our viewers, I’ve learned quite a bit of out of this as well, Kate, I really appreciate your time, I’m hoping that we are able to do this again, in the future here and get your thoughts and your impressions of what’s going on and in the your abilities to share information that isn’t always available in print somewhere so that we can stay abreast of what’s happening in hearing care,

Kate Carr
I’ll happily accepted an invitation from you any day and, and happily share the information that that we are we’re gathering it, as I said, for the good of people who need our help. And that’s what motivates me every single day. So thanks for this opportunity. I’ve really enjoyed our conversation, and I look forward to joining you again.

Amyn Amlani
Well, thank you, Kate. And again, we’re fortunate to have you and we’ll be in touch soon and we’ll end it here.

Transcribed by Otter ai