The FDA rocked the hearing health world on Dec. 7, 2016, by announcing its intent to consider a class of over-the-counter (OTC) hearing aids. Industry insiders buzzed that independent audiologists would suffer from falling hearing aid prices. Yet, as a patient, hearing health advocate, and an expert in patient engagement, I champion a more nuanced viewpoint: While audiologists will need to cope with falling prices, they will have the opportunity to build a new business model based on outstanding patient access, coaching, and care.
Consider the following example. Late one evening, when I removed my behind-the-ear aid from my left ear, the wire came out hatless. The dome was lodged inside my canal and was impervious to my husband's gentle tug with tweezers. Neither my ENT nor audiologist were available after hours.
Even though I have worn hearing aids for 40 years, I panicked. I ended up in the emergency room, where a doctor used a suction device that roared loudly in my ear to remove the dome.
Over the next six months, the dome got stuck in my ear twice more. I informed my audiologist each time. Yet it wasn't until the third occasion, when I pointedly told her that she needed to solve the problem, that she suggested ordering a custom ear mold.
Many of the audiologists who have treated me over the years have been knowledgeable and committed. So why did this example—highlighting limited access and disinterest in post-purchase care—happen? The answer lies in the design of the current system, with its hallmark of extraordinarily high prices for hearing aids.
A 2014 survey pegged the average price of one hearing aid at $2,400, while components that make up a hearing aid cost less than $100 (PCAST, 2015 http://bit.ly/2jWuBjL). For the limited number of customers in the market who pays these prices—perhaps as little as 14 percent of the people who would benefit from hearing aids—little tolerance exists to pay more for coaching and care (Blazer. National Academies Press, 2016 http://bit.ly/2hzcQmr). While hearing aid prices often include follow-up services, many audiologists bemoan that they lack the time to provide comprehensive care.
The FDA's announcement will have the effect of fundamentally restructuring this system. For air conduction hearing aids, the agency will no longer enforce the requirement that individuals 18 or older need to receive a hearing test or sign a waiver. The FDA will also consider a category of OTC hearing aids. As a prelude to the FDA announcement, Sens. Elizabeth Warren and Chuck Grassley made clear their intention to introduce an OTC hearing aid bill in 2017.
Although this deregulation will take time to play out, the net effect will be falling prices for hearing aids. The current prices for hearing aids online provide a directional feel for how low prices might go. Once prices fall, especially if they fall steeply, one likely scenario is that the industry will decouple the prices of hearing aids from care. “To give consumers access to the entire spectrum of hearing assistive devices, we hope to see audiologists turn to transparent pricing that unbundles the cost of the hearing aid from the cost of services,” urges the Hearing Loss Association of America (HLAA, 2016 http://bit.ly/2i2WohC).
Falling prices most likely will create an appetite in some patients to pay for additional care and coaching. This new industry paradigm could be good news for independent audiologists. For the portion of the market that values coaching and care, audiologists will be able to provide, for a reasonable fee, care on a more consistent and comprehensive basis. This opportunity exists across the patient's lifecycle for wearing hearing aids. Here are some examples in two opportunity areas.
1. Provide notable care after hearing aid purchase.
In 2010, I upgraded to a new pair of hearing aids. For the first week, I could barely stand the loud sounds thundering in my head. At one point, I heard what sounded like dinner plates clattering. When I looked down, I discovered my coat's belt buckle pinging against my briefcase.
As a veteran hearing aid user, I knew that my brain was struggling to adjust to this new level of sound, and, in fact, my audiologist had warned me this might happen. Nonetheless, I called her for a quick morale boost. I only wanted to speak with her for a few minutes. Instead, the appointment desk insisted on scheduling an office visit. I declined, and my audiologist missed an important opportunity to deepen our patient-provider relationship.
Audiologists have a real opportunity to improve post-purchase, follow-up care. Ideally, patients with new hearing aids would receive a call from a care coordinator within 24 hours of leaving the office, then another call five days, two weeks, and one month after purchase. Patients wishing to speak with the audiologist could schedule a follow-up call or visit.
This level of care would differentiate independent audiologists from online retailers such as Amazon. To create post-purchase service, audiologists will need to reconfigure their practices. Tracking multiple calls for each patient will require process definition and the appropriate calendaring software. In addition, practices will need to identify the best resource to serve as care coordinators like audiology student interns.
Another option is retired people who would do the outreach from home, particularly to patients who are over 65 years old. Other health care sectors, such as pharmaceutical companies encouraging medication adherence, have found that seniors performing peer-to-peer calls are highly effective at providing support and coordinating follow up.
2. Offer patient-centered, ongoing support.
For years, I was afraid to change my hearing aids wax guards because that tiny white cup intimidated me. When I confessed my fear to my hearing health advocate friends, I was shocked to learn a few of them felt the same way.
In this case, independent audiologists have another opportunity, to help patients with basic care and maintenance of their hearing aids. Patients need help not only with my nemesis, the wax guard, but also with changing batteries, cleaning the aid, and keeping it dry—in other words, all the questions and issues that surface from wearing a hearing aid. And patients want to receive that coaching in a timely and convenient manner.
The quick demonstrations audiologists give in the office are necessary but not sufficient. Some patients are trying to cope with the feel of the device or the new level of sound. Many patients need to hear instructions at least twice.
Audiologists could experiment with a medium that many health insurers offer today—clinical videos through telehealth. Telehealth could help audiologists demonstrate elements of care when patients have questions, and provide patients with the convenience of interacting with their audiologists from home.
The proposed OTC hearing aids present a threat to audiologists, yet also offer an enticing opportunity. Hearing aid wearers need care and coaching resources that are accessible, affordable, and knowledgeable. Audiologists who embrace change will meet those needs.