ASHA Task Force Activity – Guidelines to Price Fixing
Following passage of Resolution 13, the ASHA Task Force prepared proposed guidelines for the sale of hearing aids by audiologists titled: “Guidelines for Audiologists and Centers Engaged in the Dispensing of Hearing Aids” (1972), and distributed it to ASHA members for review.
The Guidelines met substantial resistance among ASHA members, and, as a result, the Task Force was forced to modify the Guidelines, which was issued in April of 1973. However, included with the revised Guidelines was an additional document titled, “Guidelines for Speech and Hearing Services Based in the Relative Value Scale,” which provided a basis for the “fixing” of prices with respect to the sale of hearing aids. A more specific suggested pricing schedule, consistent with ASHA guidelines, was then distributed, essentially as a manual, on April 19, 1974 {{3}}[[3]] Letter to ASHA members from Kenneth L. Moll, Ph.D., President, April 19, 1974[[3]]. It was titled: “Conditions Under Which Audiologists May Dispense Hearing Aids.”
ASHA Defeats, Then Adopts, Principles for Dispensing Products
In 1973, the ASHA Legislative Council defeated a resolution to “…permit the commercial dispensing of hearing aids directly from ASHA-certified audiologists to those needing them.” The rejection of this resolution was based on the judgment that dispensing of hearing aids at a profit would violate the Association’s commitment to the general philosophy that public trust is the foundation and sine quo non for all service professions. A major component of public trust in service professions is the assumption that members of the professions maintain a high degree of objectivity in selecting and providing services. Maintenance of this trust requires that conditions for objectivity and integrity be apparent. Practices that compromise public trust, or present an opportunity for compromise of that trust, must be avoided in every practical way {{1}}[[1]] The Elimination of the Hearing Aid Specialist, National Hearing Aid Society, March, 1975[[1]].
ASHA believed that as procedures and practices develop and change, audiologists and speech pathologists should keep clearly in mind that their purpose is to provide needed services to the public, and the public, in turn, must be assured that these services will be provided within a consistent context of professional objectivity.
The 1973 Legislative Council then reaffirmed its endorsement of “…the concept that audiologists may dispense hearing aids under conditions which are considered ethical by the Ethical Practice Board and endorsed by the Executive Board.”
Conditions Under Which Audiologists Could Dispense Hearing Aids Without Being in Violation of the ASHA Code of Ethics
Suggested, was the following:
- The member shall not dispense products associated with his professional practice for the purpose of supplementing his income or the income of his employer. Thus, charges for services to a person shall be independent of whether or not a product is dispensed.
- The member shall not receive profits from persons served, other than payment for services rendered.
- The member shall not be employed by an employer who receives profits from persons served by that member, other than for payment for services rendered.
- The member shall not dispense products associated with his professional practice at a cost exceeding that charged by the supplier.
- The member shall not be employed by an employer who dispenses products associated with the member’s professional practice at a cost exceeding that charged by the supplier.
- The member shall provide to persons served a freedom of choice for the source of services and products.
- The member shall provide to persons served a complete schedule of fees and charges in advance of rendering services to these persons.
- The member shall present to persons served a bill which clearly differentiates between fees-for-services rendered and costs of products dispensed.
- The member shall evaluate the effectiveness of the services rendered and products dispensed.
ASHA and Hearing Aid Manufacturers
During this time, the Resolution 13 Task Force had contacted various hearing aid manufacturers and sought their assistance in implementing the proposed program. ASHA sent a letter to hearing aid manufacturers on January 26, 1972 {{2}}[[2]] American Speech and Hearing Association Letter to Hearing Aid Manufacturers, January 26, 1972[[2]] inviting them to a meeting at the ASHA headquarters. The purposes of the meeting were to:
- Provide background information concerning the present consideration of dispensing hearing aids by audiologists,
- The rationale for this development, and
- To present the current status of the Guidelines that were intended to regulate these activities should they eventually be authorized by the ASHA Legislative Council.
The letter was not signed, but held the names and positions of the ASHA President, President-Elect, Vice Presidents, and Executive Director.
From Resolution 13 to Resolution 58 – “Principles” Adopted
In October 1973, the ASHA Legislative Council passed Resolution 58 that reaffirmed its endorsement of the view that audiologists may dispense hearing aids under conditions considered ethical by the Ethical Practice Board and endorsed by the Executive Board. This essentially mimicked the points previously mentioned in today’s blog.
In making this announcement, the ASHA Executive Board stated, “While the Principles provide guidance to both audiology and speech pathology members, adoption of these Principles represents the culmination of a three year effort by the Association to develop standards of professional conduct for audiology members who elect to dispense hearing aids. In the course of the discussions preceding the Executive Board’s action, the recognition of mounting concern among Association members over the inadequacy of habilitative services being provided to some hearing-impaired persons assumed an important role” {{3}}[[3]] ASHA adopts principles for dispensing products, American Speech and Hearing Association, October 1974[[3]].
Sale by Some, With or Without ASHA Sanctions
Some members of ASHA became so enthused about the prospects associated with the selling of hearing aids, that they chose to disregard the Code of Ethics of ASHA and openly engaged in the sale of hearing aids prior to any formal adoption of an Amendment to the Code of Ethics authorizing this activity, or the adoption of new proposed Guidelines.
The hearing aid dispensing community objected to some of these activities, especially when the dispensing practice took full advantage of tax exemptions, the use of public funds, or the benefits of disparaging any competition from hearing aid specialists – all of which they believed resulted in a situation of gross unfair competition.
An example referenced was that by the Department of Audiology, Eye and Ear Hospital of Pittsburgh, a Division of Otolaryngology, School of Medicine, University of Pittsburgh, headed by Leo G. Doerfler, Ph.D.* (a staunch proponent of Resolution 13), that served notice that his department would sell hearing aids as of July, 1974 {{4}}[[4]] Letter to the President of the Pennsylvania Hearing Aid Dealers, dated March 28, 1974, signed by Lyle W. Byers[[4]]. This was in reply to a letter from the Pennsylvania Hearing Aid Dealers dated March 4, 1974 asking about the conditions under which hearing aids would be sold. The reply appeared to be written to respond to questions related to unfair practices. It mentioned that hearing aids would not be sold to the general public on a walk-in basis, but rather, would be sold only to patients who had been evaluated in their Department of Audiology after having been examined by a physician. The reply noted also that Eye and Ear was not a recipient of United Fund grants, nor did it receive tax supported subsidies for operations – that it was a voluntary, non-profit hospital receiving its funds from various third party payers based on services rendered.
* Author note: As an aside, I knew Dr. Doerfler fairly well. He did contact me, when I worked for Audiotone, a hearing aid manufacturer, and asked if I would come to Pittsburgh and help train his staff in hearing aid fitting and management. This I did, as I had done for many other persons dispensing hearing aids who asked for such assistance.
