The Round Table: Exploring Key Insights on the Changing Hearing Health Landscape

Dave Kemp 0:11
All right, and welcome to another episode of this Week in Hearing, we have a little bit of a different episode this week we’re going to be recapping some of the major takeaways across the first 30 episodes of the show, I wanted to first shout out Audeara for supplying these headphones to each of us. Amyn, I know yours are currently charging. But these are great headphones that allow you to tailor the sound to your hearing profile, so that if you have a bit of a hearing loss, the digital sound that comes through your computer, your TV, whichever device it’s logged into, it will match up to your hearing profile. So thanks, Audeara. Okay, to get started here, I thought that maybe we go back to the start. I was kind of categorizing some of the different episodes that we’ve done and bucketing them into like, similar episodes. And so one of the first ones that we did Amyn, you had a conversation with Alicia Spoor. And I guess we’ll call this the the bucket of legislative changes and updates that are happening within the space. So kick us off with the conversation you have with Alicia some of the big takeaways about this MAASA Act and what hearing professionals should know about it?

Amyn Amlani 1:23
Yeah, Dave thanks for putting this together. And I think this is really going to be exciting for for our viewers. So the conversation that I had with Alicia Spoor about the Medicare Audiologist Access and Services Act had to initially do with the bill that had been proposed on Capitol Hill. And this particular bill was there to amend the Social Security Act in allowing audiologists to reclassify themselves as practitioners, allowing them to furnish audiology services within their scope of practice, and then allowing them to also provide services to those under the Medicare program. And it was going to do this under three different pillars here. The first is to allow the audiologist to practice this to allow the provider to have practitioner status under under Medicare. The other one was to have Medicare direct access. So that would eliminate the need for physician order. And then the third one would be to allow for Medicare coverage of medical necessity. And so we went through and had a conversation about these different tenants of this bill. And Alicia was kind enough to also share with us that we had some sponsorship that was bipartisan. This is a bill that was also supported by all three professional organizations, and that we were just waiting work to see where this thing would go. And so it’s an exciting time for audiologists, because it’s going to allow them to see patients on a more frequent basis without the unnecessary referrals that sometimes takes place. And then also allow them to try to practice within their scope, you know, in provide treatment, and then also, for the first time be able to bill for services that we haven’t for example audiological rehabilitation.

Dave Kemp 3:21
That’s really exciting. I mean, this is one of those things that I think is at the top of the, you know, top of mind for a lot of people within this industry. I know at ADA, there was the whole – MAASA was very front and center within the whole thing. How does that compare? How does it coincide with what’s going on with the audiology and speech language pathology interstate compact? I know you had that conversation that was I think your second episode with Susan Adams and Tracy Ambrose. So can you speak to that? How do these two things coincide? Just what should we know about this? Yeah, so

Amyn Amlani 3:57
the Interstate Compact is not necessarily only Medicare appropriate, what it’s going to do is it’s going to allow you to have one license to practice in different states. So the best example that the presenters gave was your driver’s license is an interstate compact. So I’m in the state of Texas, and when I drive into Oklahoma, my Texas license allows me to do that. But then what happens is, is as soon as I cross the border, I no longer follow Texas statutes, I now follow Oklahoma statutes. And the same thing will happen eventually, because it’s still a work in progress. We’re not quite there yet. There’s only 15, I believe, at this point states that have ratified the interstate compact, and there’s several others that are having conversations. But what it will allow you to do is if I have a license and audiology license in Texas, and I wanted to treat someone in Oklahoma, I could do it under my Texas license, but under the framework of what’s going on in Oklahoma, so if Oklahoma doesn’t allow for example, otoscopy I wouldn’t be able to perform it there. And I couldn’t Texas because Texas allows it. So I’m not saying that’s what’s happening. But that’s an example.

Dave Kemp 5:09
You remember how many? Because when I listened back to that, I couldn’t remember how many it was, but it was like 15 states they’ve got on board. And at what point does that become something where it goes federal? I mean, is it does it have to get to all 50 states? Or is it a certain amount? Basically pushes it into that direction? Where it’s like a license?

Amyn Amlani 5:30
Yeah, good question. And I wasn’t clear. So yeah, 10 states ratifies the the compact, which then allows for a group of individuals to get together. And I believe that’s going to happen from the conversation that we had sometime in the late spring, early summer of 2022 where they will sit down, and they will come up with a framework for how these cross state, you know, these interstate licenses will come together. But it takes 10 states in order for that act to happen.

Dave Kemp 6:04
Okay, so changing gears a little bit. Bob, I know that you had two conversations with Starkey CEO, Brandon Sawalich. Around it was sort of right, as I think the first one was right before the news came out about potential Medicare expansion into hearing services. And then you had one shortly thereafter. So what’s top of mind for you? And what are some of the things we should know about? Brandon’s position that, you know, kind of a hearing aid manufacturers position, and then this whole idea of Medicare expanding to include hearing services?

Bob Traynor 6:41
But I hope well, Brian will chime in a little bit as well, with this coming from another manufacturer also. Yep. First, I thought it was very nice to have Brandon to come to come once and then a week later come back again. And then in the middle of the second one, some guy comes into my my area here to, to blow out my sprinkler system. So we had to make a big modification. But other than that, I was amazed by the by the by the number of individuals that were all involved in this whole OTC thing. The first time I heard about it was from an old friend Tom Tedeschi, who, who did some work for us as well in the last few few weeks. But Tom sent me some of these proposed regulations two, three years ago, and I looked through them, and they, they seemed semi-reasonable, but knowing that there would be a lot more discussion, I was also impressed with how involved HIA was in the whole process, how, how they had interacted with all three of the associations to find out where they were in those areas. So now, and the other thing that I thought was, was interesting about the the discussion with, with Brandon, was the idea that manufacturers are interested in what it’s going to do for their for patients, and for the people that work with their products that allow their products to be beneficial to the group. And we also talked about the fact that there’s a lot of players that are entering into the OTC market, and all the new players are out there. But I think I remember saying, well, most of the manufacturers would have to be asleep at the switch, got to have something ready to go. And my impression was that things were pretty much ready to go whenever the, whenever the comment period is over. And and we begin to start working with the OTC products. On the Medicare side, nobody seemed to really know what was going on with that. It looks to me like it’s so early in the process that, number one, it may or may not make it. Number two, if it does make it, then there’s got to be a whole bunch of regulations that have to go through it. So it’s going to be a while before it will actually become something that we’re doing in the clinic. I think probably the thing that’s the the premier thing for Audiology is what what Amyn was talking about a moment ago with the MAASA act, that will just change the whole concept of how we practice. I mean I remember trying to figure out how he’s going to get paid for Cerumen management, right. And if that’s part of my scope, that’s gonna be fabulous. So honestly, there’s a nobody really has an idea what’s happening with the Medicare act yet. So anyway, well, we’ll see what happens with that as as time goes on.

Dave Kemp 9:58
Brian, do you want to jump in with that? The thoughts comments about any of this, whether it’s the OTC side of things, the potential Medicare expansion, as Bob mentioned, you know, from where your vantage is is both an audiologist and somebody that works within WS Audiology, I’d be curious to kind of get your thoughts on the way in which this side of the industry is shaping?

Brian Taylor 10:18
Well, I think

it doesn’t take a lot of, it doesn’t take a lot of time to realize that all the manufacturers are moving in the direction of at least self-fitting hearing aids and you see how apps work, the ability for the person to fine tune self adjustability to use machine learning to fine tune the hearing aid, it’s pretty clear that everybody’s kind of moving in the direction of at least self fitting, which I think is important to distinguish between self fitting and OTC those are kind of two different things. Not all OTC devices are going to be self fitting, and not all self fitting hearing aids necessarily would be sold over the counter. So I think that’s an important thing that we have to kind of wrap our heads around. What I think there’s a lot of, to Bob’s point, there’s a lot of things we don’t know about the Medicare Act. But it seems like we’re moving into a world where mild hearing loss would be OTC like devices, and more severe, moderate severe losses are prescriptive devices. It’s kind of this dual world between those two, that has to be pretty carefully defined. You don’t want to have a big doughnut hole in the middle where people aren’t able to get both. The other thing I’d like to just kind of chime in about is the regulations around OTC and they haven’t been finalized yet. And I’ll just give you my opinion about it. I think that consensus statement from a few years ago, all the groups got together and said, output has to be 110 dB. And there’s a few other things in there too. I think there’s some pretty significant flaws in that document. I’m not convinced that 110 dB is the best place to be. I don’t, you know, I think we have to follow the science when it comes to what the maximum output requirement is going to be. And I think we have to be careful that we keep the best interests of consumers at mine in mind, when we shape those documents, not the best interests of you know, device manufacturers.

Bob Traynor 12:24
You know, you mentioned the self fitting products. This isn’t something that just happened yesterday or this year or last year, I remember sitting in a discussion in Denmark in about 1997. And at Eriksholm, they were already working on self fitting products. And I began thinking boy, that’s that’s a pretty interesting, interesting situation. And so this is something that has been developing for an extremely long period of time. And now it’s beginning to move into fruition.

Dave Kemp 13:02
I thought that the you know, the first place my mind goes when we talk about the self fitting side of things, you know, in regards to these episodes that we’ve done, my mind goes to the convesration, the two part conversation, you had Amyn, with Steve Claridge and Geoff Cooling, sort of around this theme of the changing consumer expectations. And again, you know, when you’re thinking about self fitting and to Brian’s point, you know, I do, the biggest point of contention I’ve heard around the proposed OTC legislation seems to be the decibel threshold. And so if that’s the thing that really gets challenged the most, and that comes down, you’re likely going to be looking at a scenario where you will have the, the OTC self fitcategory will very much be tailored to the mild to moderate losses. And then, you know, up above into the more severe levels of hearing loss will be the professional prescription hearing aids. And so I thought that when you you know, the thing that’s really exciting in my mind about this whole expansion into the consumer side of the market, whether it’s through products that don’t even look like hearing aids, or it’s basically removing a lot of the barriers around the accessibility. So the self fitting, my mind goes to that conversation, Amyn, that you had with those two. And so can you share maybe your thoughts around that it was about a 60 minute conversation in whole. And I just thought that those two provided such an interesting perspective of you know, Steve, as somebody that’s a lifelong hearing aid wearer, who has been blogging in this industry for like 20 years, he’s as well informed as any about the changing environment of the technology. It’s not like he’s some naive consumer. So he has a foot in both worlds. And I thought that he provided this really, really interesting perspective that was complemented by the always hilarious Geoff cooling, who’s sort of been advocating for a lot of the same things. That Steve was saying,

Amyn Amlani 15:00
yeah, yeah, it. That was a that was probably one of the more not only entertaining, but one of the more informative conversation, not that the other ones weren’t. But this was a different perspective. So before I start, I think, you know, we need to bear in mind that the largest group that is not being served are the folks with mild hearing loss, because this is the group that doesn’t see the benefits or whatever the case may be. And that’s where the adoption is not taking place. And to that end, you know, as we had this conversation with our friends over in the UK and Ireland, the conversation started with well, is this really a medical issue? Or is this more of a consumer issue? And so we kind of had that dialogue. And for mild cases, you know, it tended to be more of a consumer issue, because they’re able to hear in certain situations, but not in others. And because of that, you know, is it like picking up a set of readers so that you can read the menu at the restaurant versus doing something else, then the conversation went into what we know how’s the technology is the technology really improved? From a traditional standpoint, and both of these gentlemen said, head over heels, the technology today is bar none better than it ever has been. And so the fact that we’ve got better technology, the fact that we now have better computers, the fact that we now have the abilities for machine learning, and all these other things, I mean, I think it’s just a perfect storm, that’s going to allow for those individuals who need to fit themselves to do so. Right. And for those individuals who need services, and we know that there’s a group of those individuals, particularly first timers, who really want that concierge kind of service, they need the extra help, they need the extra support to come in and see the audiologist. So there’s such a large and broad number of individuals, I think there’s enough business to go around for everybody. And as Brian pointed out, it’s not just about the manufacturers putting out a product, it’s about what’s in the best interest of the patient, and how they can utilize that these these devices, in order to better here.

Bob Traynor 17:02
I think another factor in this whole thing is the group of consumers that are out there in the marketplace at this time, are better educated, they know more about technology, they’ve been fiddling with smartphones, they’ve been fiddling with computers, and so on. So they so it’s a whole different ballgame now than it would have been a number of years ago with the previous generation, who really didn’t care much about that. Now, most of the time, people who have had to develop things into their, into their careers, where like a lot of us, you know, we didn’t know much about computers, we didn’t grow up with them. But we sure integrated them into our our life, our life and how we went about doing that. So I think the computer integration generation kind of is what we’re dealing with here. And if you have a milder hearing loss, and you’re young, you grew up with all those things was probably pretty much easier to work with a self fitting kind of a product than it would have been otherwise.

Brian Taylor 18:10
But now it’s gonna say I think the other exciting opportunity are so many people out there that have normal audiograms, but situational difficulties that really expands the market. You know, there’s like a couple of studies that say somewhere between 12% and 15% of the population has normal audios, but trouble communicating in challenging places. That’s a huge opportunity for everybody.

Bob Traynor 18:39
What’s another case for the idea that we need to do a speech in noise testing as part of our basic battery to facilitate some of those things?

Amyn Amlani 18:50
Well, and I’ll, I’ll just add this in real quick. Part of the conversation was generational differences. Everybody, each generation has a different use for these products. The younger generation is born to these YouTube videos and TikTok videos and all this and the older generation is more inclined to have conversations. So these products actually have to be able to service these different needs of the consumer as well.

Dave Kemp 19:15
Yeah, I think this now really ties into the conversation that I had with James Fielding and Andy Bellavia, where we were breaking down the Qualcomm 2021 State of Sound report, and I just want to rattle off a few more of these statistics because they tie in directly to what Geoff and Steve were saying, which is, you know, first of all the consumer expectations are changing. So, in this Qualcomm report, more than 60% of consumers cited hearing enhancement in sound personalization as key drivers to their next trough, TWS earbuds or headphone purchase. And then you couple that with the fact that if you look at these consumer demands year over year, they keep rising and this is I think the theme is that like it really is sort of like a rising tide that’s lifting all ships, because the expectation keeps going up and up. So now everybody wants active noise cancellation, HD audio has been another one of these premium features. And so what’s exciting is the table stakes. For a lot of these products are just becoming that, that you have to have some level of hearing augmentation baked into it. We’ve literally just saw this with the announcement of Mimi, which I know that I mean, you did a conversation with the the Chief Research Officer over there about the that that technology being baked into Skullcandy headphones. So we’re really like in this period right now what what’s exciting is that you have sub $100, headphones and earbuds that are going to have hearing augmentation baked into it. And I think that we gain when we look at this, like from the highest level up and we see these different pockets of people with hearing loss, the people in the mild or Hidden Hearing Loss end of things, what’s dramatically changing right now is that they’re now all the devices that they’re buying to stream podcasts and YouTube and Tik Tok and all these different things that they’re doing throughout their life, it’s having the secondary feature be baked in, that’s hearing augmentation. And so I think that one of the most exciting things that’s happening right now is that millions upon millions of people are going to be exposed to some level of hearing augmentation for the first time almost unknowingly, they’re going to be buying these things. And it will be a secondary feature that oh, by the way, you have this baked into it. And that starts to get people thinking a little bit about wow, I can now I can hear the fidelity in my music so much better than before. Or if it has sort of like the Nuheara ability to do both where it’s augmenting your digital sound, but then it’s also serving as that amplifier in the in the natural world to you’re hearing the birds chirp again, it’s just I think it’s getting the wheels going in people’s heads where they’re starting to realize, you know, maybe that that’s a more effective way to institute widespread change is led people to come on their own terms with this, rather than say you need to go and see an audiologist and get fit with hearing aids. I think if you can give them a taste of this early on, that’s really, really encouraging because they’re going to be the ones that ultimately have to get past the seven to 10 year gap that we hear about where they recognize “shoot, I have some sort of hearing difficulty”, but they don’t take any action. Why is that? And I feel like that’s at the root of what’s really exciting that’s happening right now. And you’re seeing it in a lot of these different conversations that are being had right now. And a lot of the market research that’s suggesting that there is an appetite that’s building here on the more consumer driven side of things.

Amyn Amlani 22:40
And to add your point real quick, Dave, it’s not just headsets, because that maybe has an SDK or an integration, that fits into your TVs and fits into all these other things. So you can optimize sound through these different environments based on your hearing preferences, whether it’s hearing loss, or whether it’s just, you want some sort of, you know, some sort of emphasis on sound. And so these consumers, as you’re pointing out, will have options in these different areas. And I know Brian’s going to talk about the audiologist role here in just a minute. But I think as audiologists, we’re gonna have to expand outside of the traditional device into some of these other areas, whatever those may be, in order to give folks a taste of what this is going to look like.

Bob Traynor 23:26
Yeah, you know, the, the the you brought up a point, Dave, about the fact that people have decided not to do anything, you know, Sarah Sydlowski had a beautiful piece, short, sweet little piece about our biggest competitor as clinicians is the the Do Nothing patient that has decided we’re gonna do nothing. And the apathy kind of well, yeah, I mean, I got a little hearing loss, but no big deal. The kinds of things you were referring to with all the additions into many of these products should reduce that do nothing group, maybe substantially.

Dave Kemp 24:08
Yeah, I totally agree. And one other thought that comes to mind here is when you were talking earlier, about, you know, what’s what’s different this time around than what we’ve seen in the past, because when I talk to professionals that have been in this space for a while, a lot of the time when there’s something that’s new and exciting. There’s a bit of a tendency, I think, to say, we’ve seen this before pattern recognition, you know, and, and so what is, I think objectively different is that the technology does keep getting better and there’s lots of advancements that are happening. And another really good example of this is the conversation I had with Giles from Chatable – Chatable AI and Andy Bellavia where you’re now seeing these chips, so the the Knowles AI Sonic chip that is basically it’s been integrated Lots of these different headsets, what’s unique about it is it has an AI engine in it that’s able to have something like Chatable AI processor live within it. Well, what does that mean in like layman terms, it means that you can have the processing capability of that of like, which we’ve never seen before. And those are the kinds of things that can solve for something as common as the speech and noise issue. So again, it goes back to this point of, well, maybe instead of giving somebody like this all day solution, what they really want are something more like cheaters, where you were on very situationally in those instances where you need that added boost. And, you know, so it’s something like, whether it’s in baked into your earbuds, or it’s like, what Tim Trine’s building with Noopl, it’s this, you know, dongle that you attach to your phone that acts as like a directional microphone on steroids. That’s there’s a lot of different examples like that, that I think, again, speak to this trend of like, we are at a point where the technology itself is getting so much more advanced in allowing for use cases that we’ve not really seen before. And it’s all sort of revolving around the thing that we all have, you know, which is our smartphone. And that’s the other game changer here is that we have a proliferation of smartphones, to where it’s ubiquitous, that everybody has this like supercomputer in your pocket that is being laden with all kinds of new additional things that you can do with it. So there are a lot of things I think that very much are different this time around that are encouraging, as I think they’re opening more and more doors for new and exciting things,

Bob Traynor 26:37
was actually circling kind of back to the beginning of where we discussed the MAASA group where we’re going to need to amplify our service levels and minimize more of the product levels. And we may have some of the capabilities to do that, based on some of the changes in the atmosphere. It’s out there in the community.

Dave Kemp 27:00
Totally agree. A few others that I thought were really interesting. You know, I think that, Brian, some of these conversations that you had, whether it’s the one that you had with Lori Zitelli I thought was fascinating. The one with Lindsay Jorgensen. George Cire, I think I’m saying his last name correctly, about the implantable hearing devices. Any and all of those what stands out in your mind from some of these different conversations?

Brian Taylor 27:25
Well, I guess my, my aim was to try to bring a fresh perspective, maybe a new perspective to clinicians out there around some of the things that have changed over the last decade or so. I guess when it came to the conversation with George, Cochlear, he had a great article in hearing review, I think earlier this summer that showed kind of who’s a candidate for implantable and we’ve been talking so far about one end of the spectrum, people that have normal hearing, and mild hearing loss. But it’s amazing to me how many people out there really struggle with your hearing aids that are in the severe profound that really would benefit from some type of an implantable solution. And what’s kind of astounding to me is how many clinicians routinely don’t screen for cochlear implant candidacy. And so that’s why I wanted that George a conversation with him to kind of raise awareness. I know Cochlear, maybe the other companies have done this as well, but they’ve kind of they’ve built an entire network around raising awareness on cochlear implants, which I think is really important. The other kind of conversation I had with Nick at Johns Hopkins, I think, yeah, that was what I well. And what I love about all the work that they’ve done there over the last decade plus is that it’s obvious to all of us that hearing loss impacts communication, well, they help us connect the dots with their research to show that it’s much more than just helping somebody communicate. I mean, that’s great that we’re able to help somebody when we fit them with hearing aids or an implant or whatever. But this connection between untreated hearing loss and depression and cognitive decline and healthcare expenditures. That’s such an important set of data. And I think, you know, we talked about Medicare, and some of this changing legislation or that I don’t think that would happen without this data that they’ve collected at Johns Hopkins and other places. Really important. So that’s, that’s mainly why I wanted Nick on the call because he’s one of the guys find all that.

Dave Kemp 29:32
Absolutely. I mean, that whole everything that’s going on with the ACHIEVE trial I feel is in. It’s sort of similar to masa where it’s just like, it can be so transformational. You know, kind of like to the industry writ large. And so I always am keen on understanding what’s going on at Johns Hopkins because they, they’re really trying to influence it at the policy level. And I think that’s really exciting is to think about this elevation of the audiologist in the healthcare ecosystem. them, you know, going all the way down to the level of like, why isn’t it that every single time you go and you see a physician, you get your hearing tested in the same fashion that you get your blood blood pressure taken. I just find that to be crazy that that’s not something that’s, that’s done, and it’s standardized. But the ACHIEVE trial is really setting out to make a case for why that should be.

Brian Taylor 30:22
Right. And then I think what Lori Zitelli and Catherine Palmer and that group have done by essentially taking that message to the streets, I mean, they’ve actually implemented and they have for a long time now, and gotten into all these other parts, other departments within their medical system, where they, you know, give away or dispense non custom amplifiers for conversations that patients have with their doctor with nurses. I think that’s I wish everybody did that I give them so much credit for is pounding the pavement and getting that putting those programs together.

Dave Kemp 30:59
Yeah, couldn’t agree more. So changing it up a bit. You know, I know that. Another theme that’s really interesting that I have been thinking about Bob is, you know, some of the, you know, we’ve talked about some of the technology innovation, but I found that conversation that you had, with Dan Quall at Fuel and Jim Kothe, who’s the head of sales for Whisper that episode around the whole changing landscape of the business model? Really, really interesting, too. So that one really dove into subscription and leasing models, but as somebody that has been a private practitioner for years, what what’s your thoughts on that as as to kind of the innovation that’s happening on the business model side of things?

Bob Traynor 31:42
I think you and I know, colleagues that found the leasing component to be essential during the COVID period, where they felt like they were really, that really assisted their practice. But, you know, the leasing thing, as, as most of us know, had, you know, was around in the 60s and first part of the 70s. And then kind of went away, and went away simply because, you know, if you release the product, it’s exactly the same as the product they had before. So but now we have and of course, also, the culture was quite different, we always, that group wanted to buy everything rather than to than not necessarily to own it, or at to actually own it, rather than not necessarily. Have it happen just on a rental basis. So the but I think the, the leasing component, this is just the beginning of that, because, and Brian may want to chime in here a little bit too. But I think the idea of manufacturers as we move away from the mild to moderate level, be having the capability for patients to lease products, and then have the new generation just upload it into their current products. That’s, that’s a, that’s a fascinating kind of an idea. And then, so I think the leasing is likely here to stay, it’s a matter of how you integrate that into your system. And while we’re talking about leasing, might as welll talk about some unbundling things, which has been around for a long time as well. But what happens when somebody purchases something from somewhere else, and all you have is a bundled pricing system, and they come into your clinic and they need to have some things done. Again, it amplifies the capability of doing some a lot of service kinds of things. And, and, and at least having maybe a bundled system as well as having an unbundled program for for for some patients and for those who purchase elsewhere. And then a leasing program for those who don’t want to take 6 grand or 10 grand or whatever it is out of their out of their savings account. And they just want to take that extra couple 100 bucks out of Social Security and put it on their on these products each month. So I think the, the bundled, unbundled and leasing all together as a, as a pricing system tends to work well, I know Amyn[s quite involved in the pricing side. And he may have some things to say about that as well.

Amyn Amlani 34:27
No, I think you’re absolutely right. I mean, you know, if you go back to this, this leasing thing where, you know, you’re upgrading on a consistent basis. I mean, think of generationally, you know, these these these younger generations, that’s what they’re used

Dave Kemp 34:39
to 100%

Amyn Amlani 34:40
you, you know, I’ve got, I’ve got a brother in law, you know, he’s on a leasing program. And as soon as the next iPhone comes up, they trade it in, they get the new one and they keep going. So I think it’s it’s the culture that we’re starting to develop through other technologies that’s going to transfer or permeate into what we’re doing here. I think it’s an exciting time for Audiology. And I think you’re absolutely right. From the standpoint that, you know, as practitioners, they’re really going to have to start thinking about evolving in expanding what it is that they’re doing, because the middle of the road of what they were doing is not going to be able to survive them in down the road. And if it does, it’s going to be a very narrow pathway for them. And so, you know, the idea of all the things that we’ve been talking about, and kind of the epicness, behind our webcast, is to help these individuals now start to look at these different iterations that are there. You know, as Brian pointed out, maybe you don’t only work with hearing aids, maybe you look at some of these other avenues, for example, cochlear implants, or Bone Anchored, or whatever the case may be. And then you also look at subscription models, because that’s what the public will, that’s what the consumers want in your various areas. So, you know, I think it’s an exciting time for audiologists, they’re going to have to be a nimble on their toes, and they’re gonna have to do some homework to figure out what works for them. But, you know, again, there’s enough business to go around for everybody. And I think, I think it’s, it’s gonna be interesting to see how it plays out

Dave Kemp 36:11
Couldn’t agree more, I’m looking forward to the next wave of episodes, because I think, just to your point there, I think something that I personally really want to tackle and dive into more, some of these, like additional services that you can lean into, and ways to really specialize as a provider, because I continue to feel like, there’s so much opportunity, you know, that that sort of falls outside of the current scope, and it’s in the scope is sort of, I think, in the midst of, of being transformed in in an exciting ways. So the the last few episodes that I wanted to talk about here that we’ve done, that I thought were really interesting, were the ones that you did mean with me, and then also with amplify. And so I think these are two, again, just totally different digital solutions, that open the door to I think, another really interesting route, which is, you know, the the expansion of the services, but also a more, I think, a more comprehensive ecosystem of health care, with the, you know, sort of your, again, your phone, or some of these digital services all being tethered together in such a way where it’s, you know, for the individual, it’s not just about hearing loss, it’s part of a broader ecosystem of things that are going on, whether it be a combination of apps that you’re using, or different forms in which you know, digital therapeutics, like what Amptify’s building toward the conversation I have with Delain Wright, definitely ties into this, too. So curious to kind of get your thoughts on some of your takeaways from that one?

Amyn Amlani 37:51
Yeah, no, absolutely. So we’ll start with Mimi, you know, Mimi again, you know, is a, they have a hearing profile that you can take, and then from that, it will optimize, if you will, right, basically spectrally enhance, whether it’s your smartphone, or whether it’s a, a device, like a TV or whatever, based on your hearing needs, or maybe even your environmental needs. And so, as you’re talking about ecosystems, you know, what a great way to enhance your abilities to hear speech, in noise in different environments, and all that. And I think the other thing about Mimi that was really, really cool is that they actually collect data to and they call it the World Hearing Index to see where sounds are louder versus softer, based on some normative reference. And, you know, if you go, for example, to Canada, which was, which was one of the more quieter places, versus if you go down to a third world country where there’s a lot more transportation and those kinds of things where it’s louder, you get a sense of where folks are having some more issues where there may be some opportunities for occupational health kinds of things, and so forth and so on. And then, you know, going over to Amptify, Amptify is basically gamified audiological rehabilitation. And Nancy Tye Murray has been around for a very, very long time kind of started this with clear, Chris Cardinal came on from the digital world, and they’ve now repositioned themselves from clEAR and to Amptify. And their whole goal is to allow practitioners to engage with, with patients to engage with providers in so that they then become the coaches for these individuals using that Noom model, where you’re consistently helping these individuals achieve goals. And I think goal-setting is one of these things that we need to talk about as well more as a community because it’s what allowed people to lose weight, quit smoking and all these other things. And I think it will allow individuals to wear their hearing aids more so that communication skills could enhance could be So again, there’s so many opportunities here, you just have to find the ones that work for you. But, you know, if I was an audiologist coming in right now, I’d be very excited, because I got all these opportunities, and I’ve just got to pick the bag that works best for, for what I’m able to do, given where my consumers are and where they need to go.

Bob Traynor 40:19
The thing that’s always been so sad about the aural rehabilitative treatment side, is that there’s never been a way for, for us to actually monetize that at all in a practice, we’ve always had to, you know, monetize it somewhere else, and then do it or whatever. Now we’re finally seeing people such as Nancy Tye Murray and Dusty Jessen and some of those that are beginning to figure out ways in which this can be monetized. So we can actually provide good rehabilitative treatment to our patients. And then if we end up with the MAASA, we could actually bill for it, as well. So there’s all kinds of things and as Amyn says, it’s a exciting time, I think, to be an audiologist, so many things that that that we have to change. But the change is also opportunity as well.

Dave Kemp 41:20
Couldn’t agree more. This has been great. I really enjoyed kind of summarizing some of the big takeaways, as we wrap here. I know for some of you this has been sort of the first foray into podcasting and doing these, what’s your experience been like? I mean, are you enjoying this is, are you finding it to be something that, you know, once you get the ball rolling a little bit, it just gets kind of like riding a bike where it gets easier over time. Just curious to hear about your experience, so far as three people that kind of in the midst of doing this for the first time.

Brian Taylor 41:52
It’s all about making it up as you go along. Yeah, you learn something new every time you do it.

Dave Kemp 41:58
So true.

Bob Traynor 42:00
I found that I did a little less stuttering over time. And, you know, before we quit, I’d like just, one of the things that just happened. And I, and I’m not really sure how they found me. But this this nano technology piece, well, it’s just a piece that came to be and, and for those of you who haven’t seen this, you’ll want to pull that one out, because this is the future of treatment for hearing and possibly tinnitus and some of these other things, because they have a way now to deliver treatments through the tympanic membrane, and even through the round window. It’s a fabulous idea. In fact, it always reminded me of Star Trek, you know, gold boldly where no man has gone before. And they really have found a place where gold man has gone before. That’s Otomagnetics. Otomagnetics. Yeah, that was the group and what I mean, that was just fascinating stuff to me that I mean, that is truly rocket science stuff, or the kinds of things that all of us have spent our careers in.

Brian Taylor 43:12
Have you interviewed them, Bob? did you interview them?

Bob Traynor 43:14
Yeah I did. And it was a, it’s a, it’s a project that came out of the University of Maryland, and had and they now have a place a research component in India, as well as they’ve just started one in Europe. And of course, they could get by with trying a few things in those places that we don’t allow them to do here. So it’ll be interesting to see how all of that suffice, all that goes over the next couple of years. So maybe do them again, and see what happens. Yeah, it’s been interesting to what I think so I was gonna say, that’s what I think is the coolest part of this whole thing is people start coming to us now. Sorry, Amyn

Amyn Amlani 43:56
I could I cut you off, though, I was just gonna, I was just gonna say, when you when you pause there, you know, for me, and I shared this with Dave, I was a little apprehensive doing this, I wasn’t quite sure where this was going to go. It’s been a lot of fun. It’s been very educational, as Brian pointed out, you know, it’s, for me, the biggest thing has been our expanded scope. So you know, I’m working on doing some things with Cognivue here in the next couple of days. And as we start to expand into that realm, and then as we talked about a little bit with the group out of Pittsburgh, you know, the whole body integrated healthcare, I think that’s where healthcare is headed. And I know the Johns Hopkins group is working a little bit in that way as well, is how could audiology play a bigger role in this whole framework? And so looking at that in coming, you know, I’ve been in this field now 25, 26, 27 years and you start to see the expansion of the of the audiologist in the healthcare system, when it’s delightful and number two, you know, it also brings up some some things that we need to consider from both an educational standpoint, from a training standpoint, and then also from a licensure and legislative standpoint as to, you know, do what do we need to expand in order to better ourselves? And I think, you know, there’s there’s lots of things to learn and is was we’re learning as we go, we’re, you know, we’re kind of building this as we fly. But it’s really, really cool. And I think our viewers will start to see some of these opportunities. And again, they have, you know, it’s wide open as to what you can do just have to find the things that work

Brian Taylor 45:31
for you. Yeah, go ahead. No, I mean, I can’t agree more with it. I mean, just said, you know, there’s things are moving very rapidly, it seems like it for the profession, which is a good thing. Yeah.

Dave Kemp 45:48
I mean, I think that, you know, whenever you go and you start a new kind of content project, one of the fears is, am I going to run out of things to talk about? And I feel like the answer is very definitively No, in this instance, there’s so much that’s happening, it keeps, it keeps happening at a faster pace, it feels like and I totally agree with you Amyn, that’s my favorite part about this is like for my own personal education, understanding what new opportunities are starting to emerge and becoming more educated about those different opportunities, and just having a finger on the pulse of like, okay, this whole we’ve now, it’s now well understood that there’s obviously some sort of link between cognitive decline and hearing loss. So what are we going to do about it? And then boom, you have a company like Cognivue, that kind of comes out of left field, and everything they’re doing is an absolutely fascinating take, that might truly help elevate the audiologist in a significant way, I have a conversation that I’m doing on my podcast here shortly with Jill Davis, who’s implemented it into our private practice, one of the most exciting parts about it, her referrals of physicians has gone through the roof. So everything is sort of correlated in that way, where it’s like, new things, new research comes about. And that’s why I think it’s so important to have, you know, these folks from Johns Hopkins or whichever university is that sort of is leading the charge with, here’s an area of opportunity, more or less, and then you see those opportunities manifest and then you start to actually see those new, you know, solutions come in widespread and that’s to me is like, you’re actually seeing this happened in real time, the evolution of this industry of this profession, and you’re kind of seeing the genesis of it to fruition. And it’s really cool to to kind of have happen unfold before your eyes like that.

Bob Traynor 47:37
Also, you know, when Jay Hall and I took a lot of heat a year or so ago, from people who, because we were advocating a modification of the basic evaluation, which is 75 years old now needs to be changed significantly. And, but But it’s all the medical necessity people who are our colleagues that are watching out for us to make sure we don’t go to jail for billing for this and that that we shouldn’t bill for. But, but I think as again, to come full circle back to where we started here. The legislative kinds of changes that are that are that are being discussed, may allow us to do the research and the development that’s necessary to change that basic evaluation into something that will be a lot more useful. And so that, again, this kind of goes along with the ideas that there’s so much change going on that it is a very interesting time, not only to be an audiologist, but to kind of sit where we’ve been sitting and listen to the people who really know about some of these issues. So, so for me, my goal in the next ones will be less stuttering, and more preparation, maybe to facilitate a little better discussion. And I think one of the other challenge, challenges is we get into these discussions and it’s hard to keep the time at a shorter time.

Brian Taylor 49:11
Yeah, that’s true.

Dave Kemp 49:12
Yeah. For sure, well, with that, with that being said, this has been awesome. Thanks, guys for jumping on recapping some of these first discussions. I know we have many more to come. So it’s, it’s exciting. What’s what we’re building here. And I would definitely say for anybody that’s listened this far. And if you’re interested in coming on, you have something to share something a story to tell whatever it might be reach out. We’re always looking for new things to discuss on this show. And we hope to continue to bring as much value as we can. So thanks, everybody, and we will talk to you next time.

Brian Taylor 49:47
Yeah, good to see you all.

Bob Traynor 49:49
See you guys.