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The Power of Partnerships

Audiologist-Physician Collaboration Improves Patient Care

Wolfgang, Kelly

doi: 10.1097/01.HJ.0000558440.98914.b5
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When considering the best options for patient care, facilitating a relationship with physicians may not be the traditional go-to strategy for many hearing health care providers. But a symbiotic relationship with physicians can improve overall patient health, facilitate referrals, and offer new opportunities for growing a successful audiology practice. By harnessing a collaborative approach, audiologists can fine-tune marketing and reporting techniques and improve communication, gain a larger patient network, and share expertise for improved whole-patient care.

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STRATEGIES FOR NETWORK BUILDING

Communication is key in building relationships with referring physicians, said Ismaly Lorenzo, AuD. “It's critical for an audiologist to perform reliable tests and deliver accurate results for the referring physician,” she noted. “If they trust you, the referrals will just keep coming.”

From a physician's perspective, that sense of trust is vital. “The physician-audiologist relationship is centered on mutual benefit and symbiotic patient care,” said Ariel Grobman, MD. “The outdated traditional model was one with the physician in the office, the audiologist in the sound booth, and the patient going back and forth with just a report on his or her inner ear function,” he explained. “The modern model is one based on discussions describing the nuanced findings and coming up with a shared care plan. Developing this relationship through open communication, frequent patient conferencing, and openness to suggestions is key to building this trust.”

When building your referral base, it's important to cultivate a positive relationship with the physician as well as other members of the practice or office staff who may send patients in need to your practice. “I try to introduce myself to as many physicians and their staff as I can,” shared Leigh Hogan, AuD, CCC-A. “It's always important to build a relationship not only with the doctor, physician assistant, or nurse practitioner but also with others in the group. Nine times out of 10, the nurses are the ones giving out your business cards, so it's important to educate everyone in the office about what you offer,” she said. Additionally, audiologists should reach out to a variety of potential referral sources such as endocrinologists and oncologists, not just the typical physician office, said Eryn Staats, AuD. “Nursing homes, assistive living facilities, and senior centers are great places to visit,” Hogan added.

Lorenzo recommends getting creative with outreach. “Lunch and learns are a great way to get to know physicians,” she said. “This allows time for an open conversation about how we can contribute better to patient care.” Hogan said she offers events such as a free hearing screening in physicians’ offices as a way to build relationships. “It's a way to capture those patients who may not be ready to make an appointment with an audiologist yet,” she said. “Try to think outside the box and create new ways to set yourself apart,” Staats said. “Open houses and demo days are all great ways to bring in patients and medical professionals.” Hogan added, “Setting up a morning to check hearing aids or an in-service to educate the staff on how to change batteries has been a game-changer.”

“To maintain good physician-audiologist relationships, you must respect boundaries and have open communication,” stressed Lorenzo. “Each one of us has expertise, and we must work together toward the greater good–the patient.”

When first meeting to share that expertise, Grobman recommended sharing as much about yourself as you can. “When I meet an audiologist for the first time, it's important for me to understand their level of training, specialization, experience, and any areas they are passionate about,” he said. “Sharing ideas and areas of interest is key to developing a referral pipeline that is fruitful for both sides.”

But finding time to visit clinicians’ offices can be difficult. To ensure the relationship continues despite busy schedules, Staats recommended a fair bit of organization. “Mark your calendar so you don't lose track of the last time you reached out,” she said, adding that sending thank you cards, information about new hires, and technology updates is a great way to continue communication with physicians. If you find that you are unable to keep up with communication and referrals, Lorenzo recommends hiring a practice manager. “If you have someone in the office who could do office visits and talk to other physicians or their practice managers about the services your practice offers, that helps you focus on patient care,” she said.

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EDUCATING PHYSICIANS ON OTC HEARING AIDS

When working with physicians and other referring clinicians, it's important to ensure that whether you're selling your services or products, your focus is on the patient, said Ken Smith, PhD. “Somehow in our profession, we have mixed our diagnostic skills with the notion that selling is bad,” he said. “But in order to put a patient's rehabilitation process in place, we end up selling a product–it's the audiology services that go along with it that are critical.”

One area in which the audiologist's expertise is most needed is over-the-counter (OTC) hearing aids. Smith noted that physicians may advise patients to get services as inexpensively as they can, such as with OTC hearing aids, but a cheap product often results in poor patient experience. “People who get amplification devices often wait years before getting their hearing checked again, which results in auditory deprecation,” he noted. “However, a good relationship between an audiologist and a physician will directly benefit the patient as we can recommend the proper device not based on price alone… We can provide a solid course of action that's well thought out and researched, which will lead to an improvement in overall health care and hearing health care specifically,” he added.

Hogan found that physicians often have questions regarding OTC hearing aids and that taking time to educate them on the limitations of these devices has been beneficial. “With proper literature and education, physicians understand that not everyone is going to fit into the population of OTC hearing aids,” she said. “I understand that cost is a big factor for a large population of patients, which is why OTC hearing aids are more appealing. But it's important to make sure patients are properly tested to verify that they are the appropriate candidates for such hearing aids before they are improperly fit,” she said. “With OTC hearing aids, more patients will have access to amplification, but who will be counseling about proper use?” Lorenzo asked. “By educating physicians about pitfalls, we can encourage them to refer patients for counseling on the proper use of OTC hearing aids as well as on the transition to more sophisticated technology when the time is right.”

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VALUE OF TIMELY REPORTING

Whether you are marketing your services or simply a product, reporting back to referring physicians about the resulting appointment with the patient will generate the best patient care and the possibility of continued referrals. “I make it a point to ask doctors what they would like to see in the reports, whether it be a full audiological report or a brief synopsis of what I've found,” Hogan said. “I'm fully aware that time is precious, so I want the report to include exactly what the physician wants to see,” she said. Though preference will vary from physician to physician, Grobman said that for his medical practice, an audiologist's expertise is invaluable. “I focus heavily on ensuring the reliability of testing,” he said. “It is incredibly helpful when audiologists share concerns that the balance or hearing tests may be inaccurate due to poor patient understanding or inability to follow prompts. Audiologists’ professional opinion and impression of the testing are almost as important as the objective data itself.”

Taking individual preferences into account, Smith said an important factor for all reports is timeliness. “It's very important that reports are generated on the same day,” Smith said. “My reports are brief, to the point, and clear in recommendations and conclusions. Most reports are placed in physicians’ charts to be reviewed at the end of the day when they are tired and ready to go home, so they need something with impact,” he said. Lorenzo agreed, noting that in her audiology practice, reports are generated using a template so they can be understood by new clinicians on both sides. “Our reports tend to be very specific, and the summary of findings points out what was normal and abnormal and what these mean,” she said.

Staats noted that sending a full report with the audiogram will help the physician “be a part of the patient's hearing health care and serve as a continued reminder to refer patients for decreased hearing, tinnitus, dizziness, or other problems.”

“Things have changed medically. Doctors don't have a lot of time with patients, so it's beneficial for the audiologist to offer services that are time- and cost-efficient to the physician,” Smith said. “When providing a referral, physicians want their patients to be seen as quickly as possible with clear and accurate results. Above all, they want the patient to have a good experience,” he added. Ultimately, Smith said that a patient referral and resulting report will be successful if the audiologist provides quality services and practical information that the physician can later use in a follow-up appointment.

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WORKING AS A TEAM

Strong relationships between audiologists and physicians often lead to further opportunities for collaboration. “Audiologists working in a bubble cannot be sure of the physician's concerns,” Grobman said. “With better collaboration, [audiologists] can tailor their testing in a more efficient, time-saving, and cost-effective manner. This collaborative emphasis builds trust, improves patient outcomes, and can generate revenue.”

Physicians also benefit from a collaborative relationship. “Patients can be seen in a more timely fashion, more urgent referrals can be prioritized, nuances of the audiometric examinations can be interpreted, and testing can be added or removed as needed when the audiologist knows the physician's concerns,” Grobman said.

Lorenzo found collaborative success in the practice of office sharing, which helps address a patient's concerns in one appointment versus sending the patient out for testing and and asking him or her to return for the results. “For example, a patient goes to the physician with complaints of hearing loss and tinnitus. If we weren't sharing an office, a patient would have had to schedule a separate appointment with an audiologist and another appointment with the physician to discuss the test results and further recommendations,” she said. “This shared practice means the patient does not have to take multiple days off from work, and this makes the patients very happy,” she noted. “Working as a team reduces the need for multiple office visits and in return, we are more productive and cost-effective.”

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IT'S ALL ABOUT THE PATIENT

Ultimately, the greatest benefit of a successful audiologist-physician relationship is providing better patient care. “Audiologists have tried to get physicians to do initial hearing screenings for years, but we haven't convinced the whole medical community that hearing loss is a serious, life-affecting situation that needs to be identified,” Smith said. “Nobody likes dealing with the fact that they have hearing loss, and physicians don't need one more negative thing in the office,” he said. However, early identification of hearing loss and referral to an audiologist will improve patients’ health and reduce the threat of further comorbidity. “Time needs to be spent educating other health care professionals about how our services would benefit their patients,” Lorenzo said. “Hearing loss and other health conditions often co-exist in patients, [such as] visual impairment, cognitive impairment, psychosocial health problems, diabetes, cardiovascular diseases, and cancer. Depending on the severity of the co-existing disease, the treatment of the hearing loss often plays a secondary role in patient care,” she said. “However, the process of rehabilitation should ideally take all comorbidities into account.”

A symbiotic audiologist-physician relationship ensures not only that physicians have a trusted source for hearing health care but also that audiologists have the same if any medical issues arise during treatment, Hogan said. “If physicians have a patient with a hearing problem, I want to be the person they trust to send that patient to. I want to be the person that they would trust sending their patients and family members.” That trust allows audiologists to build a good network, Hogan added. “By aiding each other, we ensure that the patient has the best possible comprehensive care.”

Groman agreed, noting that the collaborative approach allows for the greatest opportunity to provide exemplary care. “We work together, drawing on our arduous training and using available technology, to shed light on the inner workings of one of the most complex sensory-neurological systems in the human body,” he said. “There's no question: It's a win-win.”

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