STAFF STANDPOINT | January 2014 Hearing Review

Best Practices Trump Direct Mail

By Karl Strom, Editor-in-Chief HR Karl

The consumer survey on direct-mail hearing aids by Sergei Kochkin, PhD, in this edition of The Hearing Review raises several important issues. It will also probably raise some hackles. Essentially, it suggests that some consumers are willing to make trade-offs on hearing aid benefit in return for steep reductions in price. In many ways, the study forms a logical extension to five MarkeTrak studies dating back to February 2003, which also address the issue of value. I usually think of these articles as:

1) On the Issue of Value (February 2003 Hearing Review): MarkeTrak shows that price is not related to satisfaction and benefit. The critical consumer issue is value, which is what the patient pays for each percentage-point reduction in hearing handicap.

2) Impact of the Hearing Care Professional on Successful Hearing Aid Use (April 2010 Hearing Review): Some of the industry’s brightest minds show that best practices and comprehensive fitting protocols are the key determinates in real-world hearing aid user success.

3) Quality of Life MarkeTrak (June 2011 Hearing Journal): Best practices are shown to be related to hearing handicap reduction and consumer perceptions of quality-of-life improvements due to amplification.

4) Tinnitus and Hearing Aids (November 2011 Hearing Review): There is an enhanced chance of tinnitus mitigation with hearing aids if the hearing care professional employs best practices in fitting the hearing aids.

5) The V & V Study (June 2011 Hearing Review): The use of verification and validation significantly reduces patient visits.

In all of these discussions, we should remember what the first of these “value studies” found: The critical consumer issue is value, which is what people pay for each percentage-point reduction in their hearing handicap.

There are also three key issues that I think should be kept in mind when reading the study:

1) We’re probably viewing the “upper deciles” of direct-mail products and a quasi-telepractice approach. One fair critique of the survey might be that we are observing results from what amounts to the “uppermost deciles” of direct mail firms; in other words, if you were to establish best-practice criteria for direct-mail hearing aids, then Hearing Help Express (one of the oldest, largest, and most successful in the United States) probably would be included as a top performer. After all, I doubt they would have encouraged an independent survey of their customer base if they had not been confident about its results. I have been told the company employs more than a dozen trained and experienced professionals who assist their customers via phone, and these professionals also do limited programming of the analog programmable devices. So, in some ways, one could argue they’re offering basic products and services that might be comparable to a dispenser of the 1990s. Also, due to their interaction with their customers and reprogramming of the devices, this article might be as much an endorsement for receiving benefits from a quasi-telepractice approach as it is for direct-mail hearing aids.

2) Binaural hearing aids and value ratings. I think it is also fair to take some issue with value comparisons of traditional versus direct-mail fittings in light of binaural hearing aid usage. In the most recent (2008) MarkeTrak survey, over three-quarters (78%) of hearing aid fittings in the traditional market were binaural compared to just over half (55%) in the direct-mail survey presented here. Although there are mountains of evidence concerning the benefits of binaural hearing aid fittings, there is no question that they essentially double the cost of a “hearing aid purchase” for the traditional consumer. Few professionals or researchers would argue against the overall benefits of binaural hearing aid use; in some ways, best practices dictate that you recommend binaural. But this report may generate some useful discussion concerning the value (in stark economic terms rather than in clinical terms) of binaural fittings for all first-time patients with binaural loss all the time.

 3) This is a hearing aid! One last very important distinction: Hearing Help Express sells direct-mail hearing aids; they do not sell personal sound amplification products (PSAPs). Their products are FDA-approved Class I devices—mostly analog programmable aids—that comply with FDA Federal regulations and are provided only to those consumers who sign physician waiver forms and receive all the applicable information/warnings as required by the FDA. I think this is a crucial distinction. We’re not talking about PSAPs in this study where you could literally take the device out of a gumball machine and stick it in your ear. As I stated in last month’s editorial, if their devices are designed for people with hearing impairment, then (under current FDA rules) those manufacturers of PSAPs should come clean and adhere to the same regulations as other products designed for people with hearing loss. Stop cutting corners and doing the PSAP dance! (See David Kirkwood’s article on p 10 for more information.)

Previous studies have suggested that about 57% of the benefit from a hearing aid fitting comes from the hearing care professional, while 43% comes from the device itself. Dr Kochkin’s data seem to validate these studies. It also means that audibility matters. Many of us might not like the idea of direct-mail hearing aids or even telepractice, but it shouldn’t be a shock that offering safe, basic, inexpensive audibility to hearing-impaired consumers in the form of a hearing aid has value.

The bottom line is that, in today’s market, there is an increasingly wide range of hearing aids —again, defined as devices designed for people with hearing loss and that adhere to FDA regulations—from which the consumer can choose. Most direct-mail hearing aids will enhance audition and therefore help consumers to a limited extent, and some direct-mail hearing aids (as shown in this study) have the capability of offering a relatively high value proposition due to their low price and telepractice components. But this study also shows that, if you’re a consumer who is serious about getting the most hearing benefit—or maximizing the hearing you have left—then your best bet is to find a hearing care professional who adheres to a testing and fitting protocol defined by best practices. And, in large measure, this is what MarkeTrak data relating to value have been telling us all along.

Original citation for this article: Strom K. Staff Standpoint: Best practices trump direct mail. Hearing Review. 2014;21(1):6.