Final Word | July 2016 Hearing Review

Affordable hearing care?According to a January 2016 report in Forbes Online, 63% of Americans do not have enough savings to cover an unexpected $500 emergency expense. This statistic highlights the fact that many Americans may not have the funds to cover out-of-pocket health expenses.

As providers of hearing care, we place a great deal of importance on hearing, but must recognize that many of our potential patients have other priorities to consider when facing the cost of services and products needed for better hearing. The data we have from past MarkeTrak surveys, including the most recent MT9 survey, suggest that at least 70% of those who report having trouble hearing have not acquired hearing aids. The similarity in these statistics is thought provoking. Of course, it’s not all about money. The factors influencing the decision to seek hearing care are myriad and complex. As providers, we price hearing aids based on our acquisition cost, and the labor and overhead required to select, fit, and help the patient maintain an improved state of hearing. As long as we are respectful of the market and the people we serve, this approach to pricing is fair. If our patients have the resources, and the need, we are here to help them.

But what about those who do not have the resources, or sufficient need to acquire hearing aids, yet still need hearing care services? What is our responsibility? To a large extent, it depends upon the mission of our practice. If we work within a nonprofit organization that has outside support for unreimbursed services, there should be some level of service we can provide for all patients seeking help. If we are part of a sales organization whose mission does not include service for patients who lack resources, the right thing to do would be to provide these patients with information about where they can receive help. Private practitioners have the freedom to decide how they can best serve the needs of these patients and also maintain the viability of their practice.

In any practice setting, one responsibility we have is to listen to the needs of patients and provide guidance for them to make informed decisions. I think recent discussions over Personal Sound Amplification Products (PSAPs) and the President’s Council of Advisors on Science and Technology (PCAST) report have created changes in perception among the public and policy makers about hearing aids, and not necessarily for the better—the complexities of individual needs are not being fully considered.

The PCAST argues that hearing aids cost too much, putting them out of reach for many consumers, and that other technology in the marketplace can help make hearing assistance affordable. For patients who have limited financial resources, the PCAST proposal holds some truth. For the sake of argument, let’s ignore the current FDA definition of PSAPs, which asserts that this technology isn’t for people with hearing loss, and imagine we recommend high-quality PSAP devices as a lower-cost option at $600 to $700 a pair. According to the Forbes article, many still would not have the resources to buy them. If they do have the financial resources to pay for something basic, and the capacity to maintain the device, I support this option as a reasonable approach. However, we know from clinical experience that many people have difficulty maintaining the devices that we fit. They often need one-on-one training to get started with effective use, and periodic support to maintain serviceability. That involves professional time, adding labor costs to the packaged product and services.

Advances in technology might eventually offer us devices that self-fit with a simple app on a phone or tablet, have transducers that never clog, and batteries that last all day and can be charged in a case overnight. Even when such devices become available, the cost will still be prohibitive for some people, unless there is a major change in healthcare coverage whereby hearing aids and devices are at least partially covered by health insurance.

According to a 2014 report of fees commissioned by AllAboutVision.com, the cost of cataract surgery averages about $3,432. Cataracts create annoying light glare sensitivity, reduce color perception, and impair vision. As with hearing loss, the risk of cataracts increases with age, and they are associated with cognitive impairment and increased risk of falls. Like hearing aid treatment, the cost for cataract treatment is relatively high. Why is there no outcry over the “excessive” cost of this treatment? Because cataract surgery is covered by Medicare and many private insurances.

The Final Word? Although the services and products that together comprise “hearing aids” are complex, they are a health necessity for many people, yet often are not covered by insurance. Hearing care treatment services are excluded from Medicare for audiologists, yet speech-language pathologists can bill Medicare for communication therapy (92507). Providing affordable, accessible hearing care is complicated, and technology alone won’t solve the problem, but improvements in the process will help. As the recommendations of the National Academies of Sciences released in June 2016 are considered (see more about the Special Report here and on p 8 of the July 2016 edition of Hearing Review), it is important that the critical processes beyond technology are included and supported.

Dennis Van Vliet, AuD

Dennis Van Vliet, AuD

Dennis Van Vliet, AuD, has been a prominent clinician, columnist, educator, and leader in the hearing healthcare field for nearly 40 years, and his professional experience includes working as an educational audiologist, a private-practice owner, and VP of audiology for a large dispensing network. He currently serves as the senior director of professional relations for Starkey Hearing Technologies, Eden Prairie, Minn.

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Original citation for this article: Van Vliet D. The Final Word: Reality Check on Providing Affordable Hearing Care. Hearing Review. 2016;23(7):50.?