While the Over-the-Counter (OTC) Hearing Aid Act of 2017 may put hearing aids in the hands of those who need them, a recent study found that it misses the other crucial piece of the optimal hearing outcome puzzle—better hearing care services, especially for the elderly.
Researchers from the Johns Hopkins Bloomberg School of Public Health and the Johns Hopkins University School of Medicine analyzed data from the 2013 Medicare Current Beneficiary Survey to find out how well hearing aid users aged 65 and above access hearing care services for device fittings and maintenance. Their findings showed that income determined whether a patient sought and received hearing care service: Those dually eligible for Medicaid had 41 percent lower odds of using hearing care services, with 71 percent of hearing aid users in the lowest income category reporting not receiving hearing care services in the prior year. This translated into poor hearing outcomes: 27 percent of low-income Medicare beneficiaries reported having a lot of trouble hearing with their aids compared with 11 percent of those with a high income.
The high number of older adults with hearing loss highlights how important it is for this population to benefit from the proper use of hearing technology: Two-thirds of adults over 70 years old have clinically meaningful hearing loss, and the overall prevalence of hearing loss increases with age. Yet, the hearing devices and the audiology services needed to fit them are specifically excluded from Medicare coverage. Medicaid does provide some coverage for lower-income elderly people with hearing loss, but that coverage is far from comprehensive even in the 28 states that have it.
The impending OTC Hearing Aid Act adds another layer of urgency, said Amber Willink, one of the study authors. “As hearing care services become further separated from the sale of hearing devices, it is possible that fewer individuals will access these services to the possible detriment of their hearing and health,” she said.
Willink and her study co-author, Nicholas Reed, AuD, talked about the significance of this study and how audiologists can be a part of the change needed to improve hearing outcomes for elderly patients.
WHAT'S THE MOST SURPRISING FINDING OF THIS STUDY?
Amber Willink (AW): This study highlighted the low access to hearing care services among those with hearing aids, particularly among low-income beneficiaries. Given the often-bundled nature of hearing aids with services, it's assumed that those with hearing aids use these services as well, although this does not seem to be the case. This study also shows that the lower rates of accessing hearing care services among low-income Medicare beneficiaries corresponds with higher levels of continued hearing trouble. Hearing care services that support use of the hearing aid, as well as provide communication techniques and counseling for the individual, help optimize the hearing outcomes. Treatment for hearing loss is not just about accessing the hearing aid but also the services that go along with it.
WHAT'S THE SIGNIFICANCE OF THE STUDY RESULTS IN LIGHT OF THE OTC HEARING AID ACT?
Nicholas Reed (NR): Hearing care is a comprehensive process that involves crucial support services offered by audiologists. The OTC Hearing Aid Act of 2017 will improve access to devices and may spur technologic innovations that allow for improved self-fitting. It is important to acknowledge that improvements in self-fitting technology will allow some adults to achieve optimal care outcomes without an audiologist; however, many, many adults will still require support services to achieve the best outcomes. Our findings suggest that just owning a hearing aid alone does not guarantee improved hearing outcomes and access to services to maximize benefit are limited by financial barriers. In the context of pending OTC hearing aids, these results lend support for initiatives to improve access to services.
HOW CAN THESE FINDINGS BE USED TO ESTABLISH GREATER ACCESS TO HEARING CARE SERVICES FOR OLDER ADULTS?
AW: Recognizing that there is an issue with the current standard of practice is a crucial first step. Access to hearing care services is low across Medicare beneficiaries with hearing aids, and particularly among those with low incomes, highlighting that there exists a cost barrier to accessing services. Medicaid coverage of hearing care services and devices varies greatly by state both in availability and generosity. There is value to the Medicare program in covering these services for their beneficiaries. These findings identify an existing issue for Medicare beneficiaries with hearing aids, and raise concerns for the future of hearing care services under a new OTC model if it is not addressed.
WHAT IS THE ROLE OF AUDIOLOGISTS IN HELPING OLDER ADULTS ACCESS HEARING CARE SERVICES?
NR: As a field, we need to lead concentrated efforts for national policy initiatives to cover and/or reimburse audiology services. Moreover, audiology needs to look at how we can adapt our service delivery models to meet people where they are. Community-based and teleaudiology models of service delivery may make significant inroads into ensuring optimal hearing care.
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