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Cover Story

Patient Satisfaction Crucial in Shrinking Hearing Aid Returns

FitzGerald, Susan

doi: 10.1097/01.HJ.0000425765.03767.c8
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Figure: Tuschman

The odds of a patient returning a hearing aid might be determined well before the provider makes the sale. Patients are less likely to be dissatisfied with a hearing aid purchase when an audiologist or other hearing healthcare provider takes the time to understand the patients' motivation for buying a hearing aid, what their needs and expectations are, and even how their significant others feel about the decision.

Judith Feigin

Discerning a patient's motivations and needs may be especially critical when a provider is dealing with a first-time user who may have ignored hearing loss for years or rationalizes why a hearing aid would not help. “The provider has to acknowledge that the patient gets to set the agenda,” said Judith Feigin, a clinical audiologist and the coordinator for the Hearing Technology Center at Boys Town National Research Hospital in Omaha. “If your patient says, ‘I want to be able to hear in church, I want to hear what my wife is saying, and I want to be able to listen to the football game,' and then you fail to meet those requirements, you jeopardize your chance to make that client a successful user.”


Hearing aid returns can be a delicate topic for manufacturers and providers to discuss, in part because the words “return” and “refund” suggest a shortcoming in providing a product or service. Data collected by the Hearing Industries Association from 17 to 18 hearing aid manufacturers indicated a “return for credit” rate of about 19 to 21 percent for the first three quarters of 2012. But those numbers can be difficult to interpret. (HIA Statistical Reporting Program. Third Quarter 2012.)

Dennis A. Colucci

“No one really knows what the real return rate is except individual providers because there are so many possibilities why a hearing aid is returned,” said Dennis A. Colucci, AuD, who has a private practice in Laguna Hills, CA. “The 20 percent return rate reported by the manufacturers consists of color changes, processor changes, style changes, workmanship errors, comparing or switching companies, the patient was ill or died, the patient had buyer's remorse or financial problems, the provider conflicted with the patient, or the patient changed his mind, and so on.”

Dr. Colucci, who has been in private practice for 36 years, said return rates can vary dramatically from provider to provider. He characterizes “returns” as cases in which a patient returns a hearing aid after an adequate trial period because of poor fit or physical discomfort, speech clarity, or sound discomfort or noise issues, and who does not get refitted by the same provider. “Some providers have 50 percent returns and others almost none.

“A hearing aid that sits in a dresser drawer still represents a failed encounter and that can cost the patient a downturn in quality of life and advances in auditory processing issues over time, including memory loss,” Dr. Colucci said. “Audiologists need to take a close look at what they are doing scientifically and clinically and how this relates to the outcome for the patient and how close to being functionally normal the patients can become.”

Dr. Colucci said his practice has almost no returns and good patient usage as determined by annual recall examinations. “In view of the quality of modern hearing aid technology, every patient has a chance to hear exceptionally well and improve their quality of life noticeably. This requires that all hearing instruments be fitted properly so hearing is maximized, not just amplified by tweaking the computer or presetting on audiogram data,” he said.

A true return rate higher than a few percentage points is worrisome, according to Dr. Colucci. It is not simply a monetary issue or business hassle when a patient returns a hearing aid, though the provider loses a sale and spends time to process a refund and ship the device back to the manufacturer at a cost. A high return rate can reflect a breakdown in the patient-provider relationship and quality of care, which begins when a patient first comes in the door and continues with a follow-up well after being fitted.


Laurel A. Christensen

Laurel A. Christensen, PhD, the chief audiology officer for hearing aid manufacturer GN Resound, said it is difficult to put precise numbers on each of the reasons hearing aids are returned. But she estimated that many returns involve people who go on to successfully use a hearing aid, often by changing to another model or brand of instrument. “I believe that if you're properly fitted with the right hearing aid, the technology is so good today that it can solve the vast majority of problems,” said Dr. Christensen, who also teaches a course on hearing aids at Rush University in Chicago.

About 25 million Americans with hearing loss do not own or use a hearing aid, according to the American Speech-Language-Hearing Association (ASHA). (See FastLinks.) About half of adults 50 and older reported untreated hearing issues, and about one-third of those said their hearing did not need to be treated though it was less than optimal, according to a 2011 survey by AARP and ASHA. (See FastLinks.) Certain patients may have worked through emotional issues that kept them from trying a hearing aid sooner, including the perceived stigma associated with wearing a hearing aid and perhaps conflicted feelings of getting old, but many others still need counseling, Ms. Feigin said. Even when patients have reached the conclusion that it is time to get a hearing aid, they need to become engaged in the process and educated on what that entails, she said.

Ms. Feigin said she encourages patients to bring a significant other to appointments so the family member also becomes invested. She recently dealt with a return in which the woman's spouse did not come to the fitting appointment but later encouraged her to return the hearing aid because “the battery life should be better than it was.” The patient came back a few months later with her husband and bought a hearing aid that she ended up keeping. Ms. Feigin said her program is designed to spend time with clients at the fitting, where she ensures that instruments are customized for each user, and extensively during the trial period to be sure those needs are met.

“We try to explain that digital hearing aids are computers, and there are different qualities and features in computers,” Ms. Feigin said. Just as no single computer is best for everyone, the same is true of hearing aids. She said trial periods are the norm, and are typically covered by state statute. Her office has a 30-day return policy that includes a $250 nonrefundable hearing aid assessment, which helps cover the time involved. “We never want someone to be unhappy. For us, the majority of our business is word of mouth so we don't want patients to be dissatisfied,” said Ms. Feigin, who estimates her return rate at less than five percent.


Douglas L. Beck, AuD, the director of professional relations for Oticon, Inc., found that providers must have set protocols to increase the likelihood of a successful patient experience. (Audiology Practices 2012;4[1]:22.) He referenced research that found “a lack of real-ear verification and validation measures increased the number of office visits, all of which increases rejection, returns and frustration.”

“One-on-one professional and strategic counseling is of enormous importance in establishing trust and establishing a professional and mutually beneficial relationship,” he wrote.

Surveys show that providers have room to improve. Sergei Kochkin, PhD, the former executive director of the Better Hearing Institute, found that customer satisfaction increased from 73.1 percent in 2004 to 78.6 percent in 2008 for hearing aids four years old or less. (HJ 2010;63[1]:19; see FastLinks.) “Hearing aids in the drawer” decreased from 10 percent to 7.5 percent during the same period. Dr. Kochkin noted that the percentage of “satisfied” or “very satisfied” customers did not improve when patient satisfaction was measured in degree of satisfaction, according to the article.

Dr. Colucci said he tries to approach every case with a fresh eye, and he talks to the patient at length not just about hearing needs but how the patient feels about getting and wearing a hearing instrument regularly. He said it is not easy to select and fit a hearing aid properly, though he said some providers seem to suggest quite the opposite in their advertisements.

“Readiness is an important aspect of patient success. Some patients have a lot of anxiety that says, ‘I really don't want to get a hearing aid,'” Dr. Colucci said. “I just can't come in and say, ‘Now I'm going to fit you for a hearing aid.' The patient has to understand how the hearing aid is going to help and why it will improve quality of life.”

Some prospective patients come in armed with information gleaned from the Internet or advertisements, and that is not necessarily a bad thing, experts said. Some patients also say they are shopping around. Dr. Colucci said he suspects that some providers set themselves up for a return by selling devices with all the bells and whistles without the justification for price or need. “Certainly a mild, high-frequency, open-mold fitting does not need a top-of-the-line device with Bluetooth and connectivity device, just a top-of-the-line fitting,” he said. He also said most of his sales are in the mid-price range, and he never sells add-ons unless the patient first adapts to the new amplification and the needs assessment suggests that amplification alone does not meet his needs.

Dr. Colucci said he stresses to his patients that a hearing aid is not just something that turns up the sound, but rather an instrument that will maintain a rich sound environment full of experiences that support brain health and auditory processing now and in the future. “Patients want to be educated on the process they are going through and what the hallmarks of a good outcome should be,” he said.

Dr. Christensen, who will be leading a panel on best practices in hearing aid fitting at the American Academy of Audiology meeting in April, said she teaches her audiology students that a satisfied patient is all about “choosing the right hearing aid for the patient and fitting this aid appropriately. It all comes down to identifying the problem the patient is trying to solve and then identifying the right hearing aid system to solve the problem,” she said.


© 2013 Lippincott Williams & Wilkins, Inc.