AU Bankaitis's Audiology Blog

OK, I’m a nerd and a geek, I’m enamored by facts and data and evidenced-based research as opposed to innuendo, conjecture and anecdote.  Not that those last 3 do not have a place in our society – primarily in social media and political ads – but I tend to abide by my Myers-Briggs® Type Indicator of ‘ENTJ’ and want to deal with things rationally and objectively. One of my favorite (non-biblical) quotes is by Mark Twain: “Get your facts first, and then you can distort them as much as you please.” And boy do folks like to distort the facts…but I digress.

Here are some facts:

• TransWorldNews (London) 10/19/2012: “The global hearing aid devices market was valued at $7.2 billion in 2011 and is forecast to grow to $11.3 billion by 2018 at a Compound Annual Growth Rate (CAGR) of 7%.” ¹
• Sixteen percent of adults (age 18 and older) self reported some degree of hearing loss on the Center for Disease Control – CDC’s:  Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2010.  The self report was defined as, “a little trouble, a lot of trouble, moderate trouble or deaf (without a hearing aid).”  Based on the U.S. Census Bureau’s estimates for 2010, the adult population (18 and older) was approximately 228 million people.  That works out to about 36 million adults with self-reported hearing loss (of some degree). ^2,3
• Senate Report 110-410, Report of the Committee on Appropriations (2009): “…recommends that the NIDCD support research to develop, improve, and lower the cost of hearing aids…” ⁴
• Healthy People 2020 (Health and Human Services):  “Increase the proportion of persons with hearing impairments who have ever used a hearing aid or assistive listening devices or who have cochlear implants.” ⁵
• NIDCD Working Group on Accessible and Affordable Hearing Health Care for Adults with Mild to Moderate Hearing Loss, 2009 (excerpt):  “The working group focus was not on identifying research needs related to the development of increasingly sophisticated or technologically complex hearing aids; nor was the focus on children or adults with severe hearing loss or complex or extensive hearing health care needs. NIDCD sought research needs that would complement and supplement, not replace current paradigms and services (my emphasis added). Ensuring quality was paramount in all considerations and deliberations. Research recommendations were designed to lead to outcomes increasing accessibility and affordability of hearing health care, ultimately leading to an increase in the number of hearing-impaired adults receiving quality hearing health care in the United States.” ⁶

There are so many more facts related to healthy hearing, hearing loss, hearing aid use, public health initiatives, incidence and prevalence figures, etc., but A.U. has limited me to a ‘single’ blog this time, so let me make my 3 points.

Point #1: The profession of audiology has a long and distinguished history of providing hearing and balance care to millions of individuals.  As professionals dedicated to the early identification and diagnosis of hearing loss and balance disorders (across all ages and demographics) and early and effective management and treatment of those individuals, we have developed a vast body of evidence that supports the importance of the ‘professional’ component in the delivery of hearing and balance healthcare.  Just one small problem:  we don’t have a comprehensive warehouse or clearinghouse of that data from which we can draw to make evidence-based claims – at least not in a universal, standardized format.  We are getting better at this now with advances in technology such as cloud-computing and the like that allows us to store and share our data, but we are far from having all the information standardized and easily attainable.  In today’s current healthcare climate of cost-cutting, cost-sharing, reduction of services, etc., audiologists have a mandate to participate in the collating of all the data we develop each and every day we see patients. Many in our field have studied this and the Health and Human Services websites are replete with these kinds of data storehouses for all manner of healthcare statistics and outcomes.  Until such time as we have an audiology-focused data clearinghouse, then, we need to focus on our own facility-specific data and find a way to cull the data to tell our story.  It is no longer feasible for us to say that we’re the best – anyone with a computer and a few minutes to set up an online website can do that – we need to ‘show’ how we are the best in terms of caring for individuals with hearing and balance issues.  And the data is there.  We are capable and cost-effective in the delivery of the care we provide.  That’s cool.

Point #2: While we develop our databases which provide the foundation for all of the decisions we make with and on behalf of our patients, we need to heed the NIDCD’s plea and the Senate Committee on Appropriations Report language for the development of complementary and supplemental services and delivery models to the current hearing health delivery options.  This is especially important in the area of hearing loss treatment where every day we see another start-up company opening up for business online with the next best device that will be the cure for all hearing losses.  The individuals who are doing this are tapping into the reports from sources like the CDC reports and TransWorldNews (above) which indicate the sheer magnitude of the potential: 36 million adults with self-reported hearing problems and billions of dollars in profits up for grabs in the hearing device market (and this is just the U.S. data – the numbers worldwide are magnitudes greater).  Audiologists are smart people and they recognize the fact that online retailers of hearing devices are blurring (quite well) the distinction between hearing aids which are regulated by the FDA and personal sound amplification devices (PSAPs) which are not (really) regulated by the FDA.  So much so that Consumer Reports in 2009 provided an account of their own ‘shoppers’ who were sent out to procure hearing aids.  The gist of their report was that individuals looking to purchase hearing aids are faced with a “fragmented and confusing marketplace”; have difficulty sorting out good hearing aid providers from those less capable and they find minimal standardization, i.e., hearing aids can be obtained from hospital-based clinic and strip-mall storefronts alike.  To be sure, the sale of hearing aids over the internet is nothing new and before the internet, there were mail-order hearing aid operations.  So we’ve had decades of this kind of marketing that did not take down the profession.  However, change is happening, access online is easier, facts are distorted and people want to make money.  All of this adds up to a mélange of everything from comprehensive, professional hearing care provision in the traditional face-to-face paradigm to snake-oil-like salespeople online hawking their goods and taking their profits.  No wonder consumers are confused.

Further, I would agree with our colleague Robert Sweetow who posted on this guest blog in December 2011 that it’s time to get back to our roots and reclaim the comprehensive treatment “concept of AR (aural rehabilitation) which incorporates education, counseling, amplification, assistive listening devices, communication strategies, group training and auditory training.”  Not every patient needs every component to the same degree but then not every cardiac patient needs open heart surgery to control cholesterol!  There are levels of treatment available across the continuum and by working with the patient face-to-face, we can determine the best most quality-focused, cost-effective course of action.  Regardless of the level of third party reimbursement, if it is in our scope of licensed practice, we should do it to extract the best possible outcome for the patient.

Robert’s blog was accurate in many areas but I respectfully disagree with his comment that, “Waiting for our well-intentioned, but often ineffective professional organizations to produce change and protection through legislation is not sufficient.” Our professional organizations, and I can speak intimately regarding the hard work and singular focus on the profession of Audiology by the American Academy of Audiology, work every day to change, update and eliminate the legacy issues we inherited, e.g., lack of direct access to audiologists by Medicare beneficiaries which we know will help to reduce the cost of hearing and balance healthcare once we obtain this; tying private certification from a membership organization to the ability to practice when licensure covers the professional and protects the consumer, limited third-party payment for our full scope of practice and much more.  “Ineffective” to describe the dedication of professional organizations to break from the past is wrong. The organizations are ‘us’….WE are the members of the profession and changing the problems of the past, which should have been handled sooner (IMHO), is not an easy task but we work from a multitude of angles to attack the out-dated and ill-advised regulatory and legislative ‘ties that bind’ our profession. But – it is a lengthy process to effect change. It’s incumbent upon all of us to partner with each other to educate and provide myriad choices of resources to enhance the delivery of comprehensive audiologic care. We all know that:  ‘If you’re not at the table, you’re on the menu’….audiology is at the table – but it takes ALL of us pulling in the right direction.

Point #3 (and I could go on…): Audiologists have to ‘kumbaya’, come together, unite and take the lead in hearing and balance healthcare as a member of the integrated health care team.  Many of us do this effectively on a local level in our facilities, but on a national and even international scale, it is our imperative to be seen as the expert who can improve on the hearing and balance health of our patients.  We do this through an integration of contemporary knowledge based on understanding our outcomes data, remaining cognizant of the basic science and clinical research that comes out in droves at meetings, conferences, AudiologyNOW!, journals, etc., staying connected to the state and national organizations who are fighting every day on our behalf and the patient’s well-being through regulatory and legislative processes, and personal participation in moving the profession’s agenda forward through participation in our advocacy efforts and philanthropy support.

The time to connect and align our efforts is now.  We are not alone in this endeavor.  Every healthcare system (private/public) and provider will have to look at service delivery more closely as healthcare reform (whatever its form) looks to cut unnecessary services, unnecessary costs, focuses more on keeping patients healthy in the first place (good idea) and focuses on outcomes as opposed to procedures performed to reimburse providers (better idea).

As practitioners who are competing with other healthcare providers for limited resources, we must make sure that we are on the inevitable winning side; that is: the healthcare consumer. Technology and access to knowledge will drive patients to our practices (as well as the internet) and people know the choices they have.  We need to know those choices and we need to accept that patients searching for hearing and balance healthcare will be looking for the best possible outcome for the lowest possible out of pocket (everyone wants this).

In closing, I was listening to JJ Ramberg, host of MSNBC’s “It’s Your Business” ⁷, recently, and she stated something plainly obvious with regard to small business owners and entrepreneurs (I’m paraphrasing): “Don’t tell people ‘what’ you do, anyone can do ‘what’ you do; rather, tell them ‘why’ you do it.”  Although she was focusing on small business owners, the lesson for audiologists and most healthcare providers is the same.  In this competitive healthcare environment, we need to be able to help our patients understand ‘why’ we do what we do and ‘how’ we can help them improve their hearing and balance health.  Everything from preventative care to treatment for hearing and balance problems is within out purview and we need to own it.  This ownership rests on our unique and fine-tuned skills, comprehensive education, licensure, contemporary knowledge of best practices and a full understanding that these factors will help us to secure the positions of autonomous provider.  There are those who would challenge our autonomy but that outdated and paternalistic thinking is a thing of the past – the ancient past – and through documented safe, cost-effective provision of care, we will illustrate our worth and value in the current and ever-changing healthcare arena.

Therese C. Walden is a Research Audiologist at the Audiology and Speech Center, Walter Reed National Military Medical Center.  She earned her BS in Communication Sciences and Disorders and her MS in Audiology from Towson State University and her Au.D. through Central Michigan University.  Her clinical/research interests are in the areas of adult and geriatric diagnostics, amplification, evidence-based practice and treatment efficacy. Professionally, Dr. Walden serves on multiple editorial boards and has been active on professional boards, committees and task forces and is currently serving as immediate Past-President of the American Academy of Audiology.

References:

1. http://www.transworldnews.com/1184502/a70079/global-hearing-aid-devices-market-to-hit-value-of-11-point-3-billion-by-2018

2. http://www.cdc.gov/nchs/data/series/sr_10/sr10_252.pdf

3. http://quickfacts.census.gov/qfd/states/00000.html

4. Senate Report 110-410, page 111, Report of the Committee on Appropriations, U.S. Senate, on S. 3230 (making appropriations to the Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriation Bill, 2009).

5. http://healthypeople.gov/2020/topicsobjectives2020/ objectiveslist.aspx?topicId=20

6. http://www.nidcd.nih.gov/funding/programs/09HHC/Pages/ summary.aspx#26

7. http://www.msnbc.msn.com/id/13832409/ns/msnbc-meet_the_faces_of_msnbc/t/jj-ramberg/