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Editorial: Have Bargains Replaced Best Practices?

Brady, Granville Y. Jr., AuD

doi: 10.1097/01.HJ.0000421134.90967.18

Dr. Brady has owned a private audiology practice for 28 years in East Brunswick and Clifton, NJ, and is a licensed audiologist, speech pathologist, and hearing aid specialist.



Article after article in our professional literature extolls best practice models with verification, proper fitting, and other aspects that are part of a client-centered approach to amplification. Now we read that MarkeTrak discovered what some of us have known for years — a hearing aid is little more than a consumer product to be purchased at the lowest possible price. The not-so-sudden explosion of mail order hearing aids on the Internet has confirmed that consumers (they can hardly be called patients) will do anything to save a buck. Where have best practice procedures gone?

Sadly, it looks like healthcare will go the way of the British model with a two-tier system. Hearing healthcare has pioneered this effort with insurance companies selling hearing aids. No doubt other goods and services will follow. Americans will get what they want — cheap goods and services.

We do not want socialized medicine like in other countries, of course, so America will adopt the model where private companies using government subsidies will sell us low-cost and low-quality hearing aids at a premium. Yes, Americans loathe socialization, but they love free enterprise and a profit-motivated market that insurance companies have adopted to keep us well. We will sell our souls to have our insurance companies provide for our every need, as long as the government is not taking care of us. Just ask a hearing-impaired person who thinks that a $500 hearing aid sold by his insurance company is a bargain.

Some of the blame rests with professionals who have long advocated free hearing tests and other free services. Insurance companies have followed our lead and reimburse little or nothing for professional services, cheapening what we do. Some audiologists favor unbundling, but the vast majority of hearing aids are not fitted à la carte. Whether this policy helps us or hurts us is a moot point. No doubt consumers, patients, and insurers would forgo paying for any services beyond the initial fitting if the industry decided en masse to unbundle. And no doubt plenty of competitors would provide free aftercare services in the hope that future aids would be purchased at their establishment.

We stopped being professionals when insurers labeled us providers, as one physician lamented to me. Medical care (and the ones who dispense it) is often seen as an unnecessary middleman. Are the days gone when doctors were considered respected members of the community? I hope not, but as we progress down the slippery slope to what President Eisenhower referred to as the military-industrial complex and more private practices are gobbled up by large corporations, you can bet that audiology services will become less valuable to consumers who used to be called patients.

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The August cover story, “Setting the Record Straight: Choosing the Right EHR System for Your Practice,” incorrectly stated the number of clinics using's practice management system as 2,000 to 3,000. There are currently more than 5,800 practices using The Hearing Journal apologizes for the error.

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