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Private Practice Reboot: 2020 and Beyond

Smith, Kenneth E. PhD

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doi: 10.1097/01.HJ.0000719776.83043.7a
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The recent pandemic has had a profound effect on how audiologists can undertake private practice. Not only are their primary profit centers (hearing aid sales) reduced, but manufacturer support and financing flexibility may have also been reduced or eliminated. To make businesses even more challenging, we are now dealing with at-risk patients who are reluctant to be seen in office for face-to-face services. As of this writing, depending on who one believes and the science one follows, returning to relative “normal” may take several years. Audiologists must be creative in establishing novel approaches to the business of patient care and marketplace survival. Consider these suggestions:

  1. Expand and develop your virtual office call capabilities. Videoconferencing programs are widely used and being improved, but you need to select a format that is comfortable for you and teachable to patients. Remember that many older patients find it difficult to use new technology (webcams, enhanced speakers, etc.), so any virtual visit process must include a tutorial. This probably means a redesign of your website and patient education literature. With all the problems many of us have experienced with training patients to use their hearing aids with smartphones, it's essential to develop an educational program that will facilitate this process.
  2. Rethink profit centers in your practice and anticipate a decrease in income from instrument sales. Counseling should be considered a new profit center and you should be paid for your expertise (like physicians). Insurance may or may not cover this service, and charges should be structured based on the cost of an hour of your time. It's no longer a matter of using charges based on a guilt reaction to the cost of hearing aids (where batteries, ALDs, etc., are bundled into the delivery price to enhance sales). It's a matter of survival. Certainly, counseling needs to be a new primary profit center and delivered as a part of the patient care process.
  3. Support manufacturers who can provide you with the best teleaudiology capabilities, including in situ testing. Become totally comfortable with the technology, making certain that your office staff is thoroughly trained. Give extensive thought to tutorials you will use with patients. The quality of these tutorials will drive the success of this new way of providing effective and efficient patient care. On a related issue, push your instrument vendor for technology that will allow remote inspection of ear canal conditions and reflective characteristics of the tympanic membrane. To me, this is a critical element of teleaudiology that needs development.
  4. Highlight your commitment to ensuring a safe office environment. Preset appointments, temperature checks, and the required use of masks need to be advertised as you follow the science related to the pandemic. While this sounds obvious, paying constant attention to safety for the foreseeable future cannot be overstated as we all plan for a worst-case scenario.
  5. Consider the use of OTC technology in your practice. This class of products should be considered and promoted with the realization that there will be a growing number of patients who will demand a minimal-contact hearing solution. Developing a virtual process for delivery, troubleshooting, and servicing will be critical to the success of this type of patient care. Note that the primary driver for selecting this type of technology is not exclusive to price.
  6. Give new attention to creating packages for the evaluation and management of tinnitus disorders. Once the diagnostic process is completed and depending on the treatment strategy selected, tinnitus management is well-suited to a virtual counseling format. This applies whether or not the patient's tinnitus can be mitigated using amplification.

It's a new world requiring a new way of being in private practice and a new way of doing business that will foster survival and growth.

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