Dear Esteemed Consumer with Hearing Loss – A Letter From an Audiologist

On November 7, 2016 U.S. Senators Elizabeth Warren (D-Mass) and Chuck Grassley (R-Iowa) introduced the Over-the-Counter Hearing Aid Act of 2016, legislation that would make certain types of hearing aids that compensate for mild to moderate hearing loss available over-the-counter (OTC) , eliminate the current requirement for medical evaluation or the need for patients to sign a waiver, and allow personal sound amplification products (PSAPs) to be sold as a treatment for hearing loss. On-going discussions have been taking place between my audiology colleagues at meetings, conferences, and numerous channels online including the American Academy of Audiology’s listserv AudiologyCommunity and Facebook groups Audiology Happy Hour and SOUNDing Board. Regardless of how you feel about the legislation, our patients’ well-being (along with the potential pool of patients we currently do not serve) is at stake. Yesterday, I came across a post on Facebook by a colleague who expressed what she would like to say to every hearing impaired consumer if she had the chance. With her permission, the following is the letter she would write to adults with hearing loss:

Dear Esteemed Consumer with Hearing Loss,

I am an audiologist and have been involved in this industry for over 25 years.  I am very supportive of your initiatives to change the hearing aid delivery model and industry.  I support the Hearing Aid Tax Credit and the Over the Counter Hearing Aid Acts.

I believe that you, the hearing aid consumer, have the following rights:

• You have the right to control your hearing healthcare and amplification journey.
• You have the right to have access to a wide range of amplification options, including over-the-counter options, provider delivered amplification, personal sound amplification products, assistive listening devices, FM systems, and implantable devices. These devices should have technologic and manufacturing specifications to reduce the risks of over-amplification, as well as ensure the quality and integrity of the product.
• There should be clear labels on all products that explain the intended use of each class of product and provide warnings of the risks of improper use.
• If you seek an evaluation from an audiologist, you should receive a copy of your diagnostic audiologic evaluation and a copy of your plan of care.
• If you purchase hearing aids from a provider, those hearing aids should not be proprietarily locked. In other words, those devices are yours and you should be able to go to any provider for those aids to be adjusted or modified.  At the very least, you should be informed that your devices are proprietarily locked prior to purchase.
• Prices should be transparent and they should reflect the costs of the device as well as the costs of the evaluation, treatment and follow-up services. Long-term service should be an optional purchase.
• You have the right to see any provider and pay for the services they have rendered, yet not purchase a product from them. You should never be pressured to purchase.
• Every patient does not require premium technology. Their communication needs may not warrant them. Providers have a responsibility to assess you and your listening and communicative situations and to find you the aid that best meets your listening needs at the most affordable price.
• Provider driven care should be readily available and accessible. Providers should offer evening and weekend hours as well as telehealth services, when possible.
• Providers should consistently provide evidence based care and treatment. You, as the consumer, have the right to demand that level of care.
• Providers should utilize all available treatment options and delivery modalities, including telecoils, assistive listening devices, FM systems, over-the-counter products, and aural rehabilitation.

I, personally, support these patient rights and will advocate with you for commonsense industry regulations that minimize risk, ensure quality and safety, and allow for increased access and affordability.

But, with rights also come responsibilities. Providers need hearing impaired consumers to acknowledge and accept their roles.  Consumer responsibilities include:

• Hearing aids, regardless of their cost, do not cure hearing loss. They maximize your communication and listening abilities. Your expectations of amplification should be realistic for the type and degree of hearing loss you exhibit. You have as much influence on the outcome and performance of amplification as does the provider and the devices themselves.
• There are significant differences in the providers in this industry. Consumers should educate themselves on the differences between hearing aid dispensers, audiologists and physicians, their different roles in the delivery process, and their different motivations.
• The evidence suggests that patients have better performance and outcomes if they receive an evidence based audiologic evaluation. In other words, you would, if possible, be best served to be evaluated by an audiologist prior to any purchase. Many payers pay for this initial evaluation or an evaluation to determine the cause of hearing loss.
• If you experience tinnitus, dizziness, drainage from your ear, earwax buildup, a sudden or rapidly changing hearing loss, a hearing loss where one ear is poorer than the other, an ear deformity, or ear pain, please seek an audiologic evaluation and medical intervention prior to any over-the-counter, mail order or internet purchase. Otherwise, you could be wasting your money or missing a treatable or serious medical condition.
• Over the counter hearing aids are NOT appropriate for every hearing loss. They are appropriate for mild hearing losses to moderate flat hearing losses.  You may experience insufficient gain/volume, difficulties in noise, and feedback if your hearing loss is more significant. This will lead to poor performance and satisfaction.  No one wants to see you waste your money on an inappropriate option.
• Over the counter hearing aids are NOT appropriate for children. Children have unique audiologic and communicative needs that require professional intervention and engagement.
• There are pros and cons of purchasing hearing aids over the counter. If you purchase hearing aids over the counter, please understand that audiologists cannot adjust or modify all of these products.  Also, it is important that you understand that providers will charge you for the care, treatment, and guidance we provide.  We cannot provide care at no charge.
• There are costs, which you will be financially responsible for, when you seek the evaluation and guidance of a provider. Many consumers currently demand free hearing tests and hearing aid evaluations and consultation. “Free” though was never really free.  This has only worked so far because of bundled pricing and provider driven care.  The patient who purchases the products pays for the evaluations of themselves and every other patient who opted to not purchase products. When hearing aids are unbundled or itemized, the patient will now need to pay for the hearing test and pay for the hearing aid evaluation/consultation, even if they opt not to proceed with a purchase. Providers cannot be expected to provide their expertise at no charge.
• The evidence also suggests that patients have better performance and outcomes when they receive evidence based care and treatment. This includes inventories, verification, speech in noise testing, and aural rehabilitation. Many providers, as a result, have a non-negotiable, no exceptions standard of care.  It is our right as providers to practice in a manner which we know benefits the patient.
• Insurance cannot and does not pay for everything and you cannot expect that it will. The allowable rates within provider contracts with the third-party payers often indicate the level of technology that we can provide and not take a loss from fitting the device.  Insurance often does not cover our costs of premium technology and many payers do not allow us to allow you to pay the difference between basic and premium technology.  Payers often do not cover long-term follow-up or service. They do not cover batteries, earmold, or wax filters. They do not typically cover rehabilitation. Remember, insurance coverage is an agreement between you and your insurer.  The provider is just executing that agreement, to the best of their ability, within the confines of their own contracts.  Sometimes, you, the patient, are just financially responsible.
• If you want to minimize your out-of-pocket provider costs, you should take on as much of the daily care of the device as is possible. You should clean your hearing aids every day.  You should keep them dry and free of hair products, perfumes, and sprays.  You should change your own batteries.  You should replace your own wax guards and clean your own earmolds.  You should follow the instructions outlined by your provider.

The purpose of this is to improve the dialogue between the audiologsts and consumers. Speaking for my audiology colleagues, we want to help each of you maximize their hearing, listening and communicative abilities.  We want to be partners in your success. We want to be available to evaluate, educate, manage and treat. But we both have to realize and appreciate our roles in this journey and be understanding and respectful of each other. I want our relationship to be a win-win for both of us. I feel as though if you are successful, I will also be successful.

Respectfully,

Kim Cavitt, AuD
Audiology Resources, Inc.
Chicago, IL

NOTE: The Federal Trade Commission (FTC) is hosting a workshop in Washington D.C. on April 17, 2017 to examine competition, innovation, and consumer protection issues raised by hearing health technology, particularly hearing aids and devices with similar functions. The FTC is inviting comments from the public (COMMENT FORM).

Dr. Cavitt is an audiologist and owner of Audiology Resources, Inc, an Audiology consulting firm that provides comprehensive operational and reimbursement consulting services to hearing healthcare providers. She served as President of the  Academy of Doctors of Audiology (ADA) in 2015, a representative to the Audiology Quality Consortium (AQC) and as a member of the State of Illinois Speech Pathology and Audiology Licensure Board. She also serves on committees through ADA and ASHA and is an Adjunct Lecturer at Northwestern University.