Perhaps it was the number that made AARP sit up and take notice. It was certainly large enough to command respect: six million. Six million, that is, of the organization's members who reported a hearing loss in a 2008 AARP survey.
The magnitude of the problem emerges in sharp relief when considering that less than 20 percent of those with hearing loss seek care for their condition, according to the National Institute on Deafness and Other Communication Disorders. And Medicare generally does not cover the cost of hearing aids, nor do many insurance programs, and those that do pay only a portion of the costs, making it all the more unlikely that those with hearing loss will get help. With some 46 million Americans uninsured, the need to do something had become a moral imperative.
And what organization better than AARP? The organization chose HearUSA in October 2008 to administer its AARP Hearing Care Program, expanding awareness of hearing loss to AARP's 40 million members and offering easy and affordable solutions to those in need. The program marked the first time that hearing care services were endorsed by AARP, which also lends its name to travel goods, financial plans, and insurance programs. Those services are made available by independent providers to AARP's millions of members in exchange for a royalty paid to AARP for the use of its logo.
HearUSA introduced a test program in 2009 at its more than 180 hearing care centers and in its network of affiliated hearing care providers in Florida, New Jersey, New York, Massachusetts, Ohio, Michigan, Missouri, North Carolina, and Pennsylvania. Acting on the success of the pilot, the company expanded the program to an additional 24 states, said Cindy Beyer, AuD, HearUSA's Senior Vice President for Professional Services. The program is now operating in 45 states with more than 1,000 providers. She said the company wants to double the number of providers in the next year and move into the remaining U.S. states.
David Mathis, Senior Vice President for Health Products and Services at AARP Services, Inc., said the company evaluated hearing plans from a number of organizations, and chose HearUSA for its “commitment to improving the quality and the process by which hearing care is delivered.”
Up to 14 percent of more than 36 million Americans with known hearing loss are AARP members, and AARP Services realized hearing care was “an unmet need,” not only for its members but also for the 50+ community, Mathis said.
HOW IT WORKS
AARP members are entitled under the program to receive a package of services for set fees. Patients pay $49 to the provider for a hearing assessment, plus the cost of the hearing instrument, if the evaluation warrants it. Patients purchasing a hearing aid can save approximately 20 percent on various digital hearing aids according to a five-tier system: $1,280 for the basic package and $2,600 for the top tier. Directional microphones are included when appropriate for the patient.
AARP members receive a 90-day money-back guarantee, a three-year manufacturer warranty, free hearing-aid batteries for three years, follow-up care for one year at no additional charge, an aural rehabilitation booklet or DVD, and discounts of approximately 15 percent on accessories such as batteries, assistive listening devices, hearing protection, listening systems, and telephone amplifiers.
HearUSA's Beyer said the program dispels the confusion many older Americans have about where to get care while helping them evaluate the recommended treatment and reassuring them about the high costs that often discourage many from seeking proper treatment.
“It's a program based on best practice guidelines, educational support materials, quality products at affordable prices, and good follow-up. The program reinforces AARP's influential brand, and implies a guarantee that the provider's services will uphold that reputation,” she said.
Any licensed audiologist or board-certified hearing instrument specialist can join the AARP hearing care program, though most providers are members of HearUSA's Hearing Care Network. All applicants must submit to HearUSA's credentialing process, which requires that they have no malpractice, sanctions, or licensing violations against them. They also must agree to the program's standards of care.
Citing “strict qualifying requirements,” Beyer admitted that the program had a slow start in spite of aggressive marketing to HearUSA's existing network and to the profession at large through advertising, trade shows, and telemarketing. Beyer said she was hopeful, though, that the company's plan to ramp up marketing to providers and consumers in the next few months would double the number of practitioners in the program over the coming year.
Manufacturers are also welcome to take part in the AARP-HearUSA program, although only Rexton and Hansaton Hearing Systems are currently participating The Hearing Journal contacted other manufacturers, all of which declined to discuss their reasons for not joining. Some industry experts speculated, however, that manufacturers had bristled at the program's standards for products and the limitations on what providers will pay for the instruments.
Other companies and networks started discount programs in response to AARP's, and Beyer said HearUSA continuously revised its structure to be competitively priced and rich in features and member protections. Credentialing and enrollment fees created some early resistance from providers, Beyer said, leading HearUSA to drop the $500 initial signup fee and the $100 credentialing fee that was due every three years. The company also reduced the testing and evaluation fee that AARP members pay, from $90 to $45, making the program more attractive to consumers.
HearUSA faces its own problems, however, filing for bankruptcy in May. (See sidebar.)
WHAT CONSUMERS ARE SAYING
The proof of the pudding is in the tasting, as the saying goes, and the success of the program ultimately rests with consumers. To that end, HearUSA arranged for Pro Survey Solutions of Boston to assess customer satisfaction. The survey's seven questions, rated on a 10-point scale from extremely dissatisfied (1) to extremely satisfied (10), were posed to HearUSA customers in early January 2010, and the results revealed “remarkably strong customer commitment and satisfaction levels,” according to Pro Survey.
Ninety percent or more of the respondents ranked the staff's willingness to help, caring attitude, and overall service very highly — with 9s and 10s — and no single person rated the staff lower than a 5.
Customers said they wanted greater variety among the products and prices offered, but these conditions did not affect the overall positive experience. Ninety-one percent of respondents said they would likely recommend the program to friends or colleagues.
Those participating in the survey were also asked how the hearing care experience could be improved, and 61 percent said they were “completely happy” with their provider. Twenty-three percent said they would have liked hearing care at a lower cost, and a small percentage each said they wanted more products to choose from, home visits, payments by installment plan, and more convenient appointment times.
According to the survey firm, the AARP Hearing Care Program's providers achieved a score of 87.2 percent, which the firm said was “an extremely high score [that] highlights customer satisfaction with the program.”
WHAT PROVIDERS ARE SAYING
Consumers generally gave the AARP Hearing Care Program high marks, but does it produce worthwhile results for those who provide the care?
HJ spoke to a number of providers, all supportive of the program for altruistic reasons — to help those in need. The providers agreed that the program produced an influx of new patients to their practices and spread the gospel of hearing help to a wider audience, an enormous plus for industry growth.
Dina Rodriguez, a board-certified hearing instrument specialist and an audioprosthologist at Clear Solutions Hearing Center in Orange City, FL, said a great many AARP members who called the program's 800-number have been referred to her office. Even non-members who heard about the program came to her office asking if they qualified for discounts. These walk-ins often have no insurance, Rodriguez said, or the cost of hearing aids is beyond their means. She guides those prospects to become members of AARP, helping them fill out the paperwork for membership so they can take advantage of the program. “I promote the program because I believe in it,” she said.
Another benefit of the program, Rodriguez said, is that the discounts and other treatment benefits prompt people to address their hearing loss and its ill effects sooner.
Still, a hearing care office is a for-profit business, and it takes the same amount of time to fit a $1,280 hearing aid as one costing $2,600. But Rodriguez said her practice has benefitted, even if a patient can only afford the lowest tier hearing aid. “If it helps them, I'm happy,” she said.
The program's 800-number has referred quite a few people to her practice as well, said Marlene Forzano of the HEARx office in Riverhead, NY. Like Rodriguez, Forzano said most of the referrals don't have insurance or their insurance programs pay only a small amount for hearing care. “This program helps them get what they need,” she said. “It's good for them and good for the practice.”
Audiologist Nan Targovnik of the HEARx office in Edison, NJ, described the consumer response to the program as “sporadic,” with a big push early on and a slower stream as the months passed. She said the program is beneficial to patients and providers, but she said she sees more widespread exposure to hearing health care as the greatest benefit. “This program makes people more aware of hearing help as well as hearing health,” she said.
Edward Dobbins, AuD, owns Dobbins Hearing Service in Glendale, AZ, and has been a member of the program for about a year. He receives three or four member referrals each month, and he likes several of the program features, such as the price range of the hearing instruments. That means patients only pay for the technology they need and the built-in features, which are more generous than his practice typically offers and represent an excellent value for the money, he said. Unlike most providers who stick with manufacturers within the program, Dobbins has fitted patients with devices from Rexton, Resound, Hansaton, Bernafon, and Siemens, which gives him latitude with individual patients. “Patients like these features, and that's good for my practice,” Dobbins said.
More patients in their practices is a clear boon for providers, and Dobbins said new AARP patients join his practice without any marketing costs to him. He estimated that it can cost up to $200 to bring each new patient into the practice, but instead he reaps the benefit of HearUSA's marketing. “As I see it, each referral represents someone who likely wouldn't have known about my practice,” he said. “And let's face it, obviously I have some gaps in my daily schedule, and these new patients each month fill in those gaps.”
Not every provider has had such a positive experience, however. Judith A. Curtin, AuD, the owner of ABC Hearing Net in West Chester, PA, wanted to become an AARP provider, but a series of misunderstandings between her and various hearing care programs administered by HearUSA resulted in her enrollment in a lesser program with lower rates. Once she factored in test and discussion time, fitting procedures, and post-fitting counseling, Curtin said she was losing money on every low-end sale.
Curtin said she continued with the less inclusive program to establish her eligibility for the AARP program, which says Beyer of HearUSA said was not necessary for participation. Curtin admitted that she received many referrals that filled out her daily schedule, but that she was conflicted recommending a higher tiered hearing instrument based on profit rather than the patient's need. Ultimately, she said she opted out of all the HearUSA programs even though she had paid the program's $500 upfront fee.
Curtin said an ideal program would require the patient to pay for the hearing instrument and a flat fee for care. That, she said, would be fair to all concerned: patients would get the fittings they need, and providers would be compensated for their time and talent and be able to pay hearing instrument manufacturers a fair price for their products.
“I still give discounts to AARP members,” she said. “I just don't have access to AARP's mailing list” of members in her area interested in hearing help.
WHAT THE ASSOCIATIONS ARE (NOT) SAYING
With many consumers and providers on board, the missing piece is how the industry's professional associations have received the program. Although it is currently operating in 45 states involving at least 1,000 practitioners, has fielded 60,000 calls from AARP members, and has dispensed 12,000 hearing aids, the leadership of the American Academy of Audiology, the Academy of Doctors of Audiology, the American Speech-Language-Hearing Association, and the International Hearing Society all declined to comment, most noting that they do not have enough information about the program to take a position on its impact so far.
Brenda Battat, Executive Director of the Hearing Loss Association of America, said the organization supported the program early on because of its consumer protections. “The overall philosophy seems to position hearing aids as part of a program, not simply devices in the ear. The costs are close to retail, but the extras in the program make it favorable for consumers. Currently, though, I've heard nothing about it, and I don't know any consumers who have participated in it.”
This ambitious venture has the potential to bring hearing help to millions of people who, for one reason or another — cost, confusion, unwillingness to admit hearing loss — have denied themselves the means to enjoy their lives more fully through better hearing.
Whether providers will fully embrace the program remains to be seen. Certainly, they want to augment their practices by broadening their market reach and spur the growth of the hearing profession by means of a membership of 40 million people, six million of whom said hearing care is an important health issue to them.
The pending sale of HearUSA adds more unanswered questions to the mix, as more issues arise as a new owner takes over the company.
CALIFORNIA REJECTS AARP PROGRAM ON LEGAL GROUNDS
California may turn out to be the lone holdout in implementing the AARP Hearing Care Program, a decision that has made it unavailable to AARP members who live in the Golden State. California officials rejected the initiative as a pay-to-play program because of the upfront fee those participating in the discount program must pay.
Troy Cascia, AuD, the president of the California Academy of Audiology in 2008 when the program was just getting started, asked the Speech-Language Pathology and Audiology Board, the state's licensing body, about the legality of the AARP Hearing Care Program. The licensing board elevated the issue to its legal team, and Michael R. Santiago, staff counsel for the Legal Affairs Division of the California Department of Consumer Affairs, ruled in January 2009 that requiring hearing care providers to pay a fee to be included on the referral list was an inducement “by considerations other than the best interests of the patients,” a violation of Section 650 of California's Business and Professions Code.
The directory of providers “is essentially purchased by AARP members [by virtue of them paying yearly dues to AARP],” the decision said, and the program could be “a marketing tool for AARP to solicit prospective members with the promise of discounted hearing aid services and products.” HearUSA could then “solicit its own Hearing Care Network to AARP members.”
Annemarie Del Mugnaio, Executive Officer of the licensing board, said her department investigates individual practitioners for wrongdoing only in response to consumer complaints, insurance company inquiries, or other practitioner whistleblowers. Unless investigated, she said, a provider could operate outside the law with no ill effect, but if an investigation proved intent, the provider would likely lose his license to practice. The law protects consumers “by placing their individual health needs above the financial incentive of the provider,” Del Mugnaio said.
June McCullough, PhD, the current president of the California Academy of Audiology, said in an email message that it is “short-sighted” to recommend what is prohibited by state regulations just because an audiologist is unlikely to be reported to the state regulatory board.
Mark Sumner, also an attorney for the Legal Affairs Division, said a regulation to exempt discount health plans from Section 650 had been proposed but was ultimately rejected by the state's Office of Administrative Law. Still, Sumner said precedent exists for discount health plans to apply for a license to operate in California. HearUSA has not decided if it will file for one, or push for California to reconsider now that the revised AARP Hearing Care Program does not require that upfront fee from providers.
HearUSA AGREES TO COURT-SUPERVISED SALE
Company conducts business as usual
The future of the AARP Hearing Care Program may depend on which company takes ownership of HearUSA, which filed for bankruptcy reorganization on May 16. An affiliate of William Demant Holding A/S, the Danish hearing aid maker, emerged as the stalking horse bidder for the Florida-based company, meaning it was chosen by HearUSA to make the first bid for its assets.
The agreement contemplates a purchase price of $80 million, although other bids will be entertained. The final sale will be facilitated with court assistance under Chapter 11 of the U.S. Bankruptcy Code, and is expected to be complete within eight to 12 weeks of the May filing. Meanwhile, HearUSA's interim CEO, Gino Chouinard, said the company would continue to conduct business as usual.
Cindy Beyer, AuD, Senior Vice President of Professional Services for HearUSA, said once the sale is final and the new owner is in place, changes to the AARP program could take effect. Until that time, AARP members can continue to claim the benefits promised by the AARP program provided by HearUSA. Meanwhile, AARP Services, Inc., which oversees AARP-branded products and services, has insisted that AARP members who participate in the AARP Hearing Care Program be kept up to date on HearUSA's proposed sale, says David Mathis, a Senior Vice President there. “We will have more information for AARP members once the court has ruled,” he said.
HearUSA's legal problems surfaced earlier this year when Siemens Hearing Instruments threatened to take over the company after a dispute over the terms of a loan payment. In response, HearUSA filed a suit in New York Supreme Court seeking a declaratory judgment to prevent Siemens from making good on its threat.
The AARP contract with HearUSA appeared at first to be a financial boost to HearUSA's expansion plans, and good news for Siemens, a major investor in HearUSA and supplier of most of the hearing aid products sold by the company. In a Jan. 18, 2011, filing with the U.S. Securities and Exchange Commission, Siemens indicated its interest in exercising an option to buy out HearUSA which Siemens said had failed to make a timely debt payment. Disagreements between the two companies resulted in HearUSA's bankruptcy filing.