It’s been awhile. I’m sorry (again). I’m learning a lot in my PhD program (and loving every minute of it!) but I’m also busier than I’ve ever been and I keep putting this blog aside. But, busy is good. Our research group has been up to some neat and important projects that I’ll be blogging about in this space (hopefully soon!).
Recently, I joined the Joy Cardin show on Wisconsin Public Radio (check out the interview here). During the show there was a comment/question that inspired me to return to the blog.
Two callers mentioned having surgery to “correct” their hearing loss, which is possible with certain types of hearing loss but also very rare. Both times I felt compelled to underline the rarity of their situations. But it begs the question – if a designation of over-the-counter hearing aids emerge and more people manage their own hearing loss, are we going to miss these “correctable” hearing losses?
Let’s break it down.
First, we need a brief anatomy lesson and understanding of the multiple types of hearing loss. The auditory system is pretty complex. Sound enters our ear canal, hits our eardrum, moves across the tiniest bones in our body (the ossicles), and then hits our inner ear where it is encoded and sent to the brain. This entire system must run smoothly for hearing to function at a normal level. Dysfunction or blockage at any level of the system can cause hearing loss.
There are two main types of hearing loss. Sensorineural hearing loss refers to a loss caused by the actual sensory system (e.g. cells in the inner ear), while conductive hearing loss refers to a loss caused by an inability to get sound to the inner ear (e.g. a plug of wax in your ear canal, fluid in your ear, bone overgrowth, etc.). Sensorineural hearing loss is permanent, but conductive is not always permanent and can often be repaired or may subside on its own. For example, fluid in the ear may subside once a cold subsides or surgeons (Otolaryngologists or ENTs) can repair some of the structural issues that would prevent sound from getting to the inner ear.
Whew. That was a lot of learning. Now that that’s out of the way, back to my original question. If hearing aids become available over-the-counter, will more people manage their own hearing loss, resulting in the “medically correctable” losses going undetected? This certainly seems like it could be a possible outcome.
However, I think the answer is no. In fact, I believe we’ll catch more of these “medically correctable” hearing losses because more people than ever will have their hearing tested.
Right now, we know that most people wait around 8 years from noticing their hearing loss before they do anything about it. Moreover, we know that a very small percentage of those with hearing loss actually have hearing aids. There are many reasons people ignore hearing loss, including cost, access, and general public health awareness. I believe the over-the-counter hearing aid model will actually improve all of these areas. By changing the way hearing aids are distributed, cost will be reduced (larger market, less middle men, and more competition), and more people will have access to them. As more people have access to them and see them in stores and online, the public awareness of hearing loss will increase.
As more people become aware of hearing loss, more people will pursue hearing testing. With increased hearing aids sales, audiologists and hearing aid dispensers will actually see more people. This is because more people than ever will be using hearing aids, which will require care and maintenance visits for counseling, fitting, adjusting, and instructions on their new hearing aids. In addition, with the increased access to hearing aids, adults will likely pursue hearing help earlier than ever, leading to many seeing audiologists down the road. While some savvy users will purchase over-the-counter hearing aids and never see an audiologist or hearing aid dispenser, I think many of them will eventually see an audiologist and give us the opportunity to identify those rare “medically correctable” cases.
In all, over-the-counter devices won’t just provide more people with devices, they may act as a catalyst to bring hearing loss into the public’s conscious and help get more people into the door of an audiologist clinic to have their hearing tested.
Have a great day!
So first off, let me apologize for not posting recently. I officially started my PhD program at Johns Hopkins School of Public Health. I couldn’t be happier or more excited but I also couldn’t be busier. Let’s agree – I’ll try not to fail you in the future and continue to post regularly; you promise to keep reading! I also want to make a note about a programming change here at the blog. I’m going to have some colleagues start posting on this blog with their thoughts, ideas, studies, commentary, and vision for audiology in general. It’ll be interesting get some new perspectives and learn about new research in the field. On that note, let’s move on to today’s post.
Unbundling. I hear this word all the time in policy literature surrounding audiology. I even use this word often myself. But what do people really mean when they use it in relation to audiology? I suppose to understand this we have to first define what bundling means and, to a lesser extent, why it exists.
In audiology, bundling is the practice of combining the cost of the device (i.e. a hearing aid) and the cost of services surrounding the device. This service package can be large – including, but not limited to, evaluating patients’ needs, making educated recommendations, programming/fine tuning devices, educating patients to use the device properly, and counseling for expectations and use. Moreover, it usually includes anywhere from several years to a lifetime of follow-up appointments which can consist of reprogramming, troubleshooting, and care/maintenance visits. These services can add up to a big time investment. So naturally, unbundling would be the opposite. It is the practice of separating out the cost of the device from the services surrounding it.
At this point, you may be wondering why I’m clarifying this or writing about it at all. I’m sure you’re thinking, “Yes Nick, I understand what bundled pricing is. My cable company has been doing it since the 1990’s.” I get it, it’s a simple concept, but I believe there are several misconceptions about unbundling and, in my opinion, we need to further refine what we truly mean when we use the term. So let’s clarify.
As noted above, we have two models, bundled and unbundled. However, in actuality, there are three models being presented and practiced in the real world. These three models are:
I was at a conference recently and learned, to my surprise, that some equate unbundling to the process of deregulating hearing aids. This is a misinformed interpretation. Unbundling would not do anything of the sort. While unbundling may lead to more direct-to-consumer device purchases before being programmed/managed by audiologists, it would in no way affect the official regulation of devices at the moment.
Naturally, one must ask themselves at this point: is unbundling a good thing? Well, I think so and, moreover, I think there is room for both the true unbundled and quasi-bundled models in the clinic. Let’s explore.
For patients, I believe many will appreciate the transparency of these two models. Some will desire and require more in-depth audiologic services and will likely pursue the quasi-bundled model. However, other patients will simply want some basic counseling and programming and will never return. The true unbundled model would benefit those who don’t need as much support. It would also be idea individuals who are transient or have multiple homes since the bundled model can limit who can service their hearing aids/devices.
For audiologists, I can think of nothing better than unbundling. By removing their services from the cost of the device (and thereby separating their worth from simply the sale of a device), audiologists can charge their true self-worth for the numerous tasks they perform for (essentially) free in the current bundled model. In the bundled model, audiologists are essentially gambling that a given patient will not take up more time than was charged in the service portion of the bundle. However, as many know, this does not always work out. Moreover, I believe the unbundled model would increase the patient-base of audiologists. In the bundled model, the patient either purchases a device or not. But, in the true unbundled model, the audiologist doesn’t care about selling a device as they can provide other services regarding direct-to-consumer devices such as counseling, programming, and more. This would likely result in many visits from patients who would never pursue hearing aids but would buy and try a direct-to-consumer device. It can also help audiologists expand their client base by enabling them to offer consultations and evaluations as standalone service offerings – helping them bring in new patients who may later purchase hearing aids or require additional services in the future.
There is also a multi-level benefit for the field of audiology as a whole. By providing services to this group of people, audiologists could significantly impact the public perception of hearing loss and educate the public regarding their role in hearing healthcare. Moreover, it would have a positive impact on the public’s perception of the field of audiology if we could remove ourselves from the sale of devices as much as possible.
So to sum it up, unbundling truly should refer to the practice of removing the device from the purchase of audiologic services and separating these services into a la carte rates – not deregulation. Secondly, unbundling could benefit the patient, the audiologist, and the field of audiology. Thirdly, I think I learned I could write a second blog post simply on the benefits of unbundling!
Have a great day!
I get a lot of calls and emails with inquiries about hearing loss, hearing aids, etc (better than solicitors calling about insurance, am I right?). One of many questions I hear (hear, get it?), is "what’s a PSAP and why is it so cheap? and how can it help me?" Let’s try to tackle those questions in a few paragraphs or less. Let’s just call this an introduction though because fully discussing this area will take many MANY blog entries.
Personal Sound Amplification Devices or PSAPs are essentially any device that amplifies sound that has not gone through the Food and Drug Administration regulation process to be called a hearing aid. Because these devices are not hearing aids, they cannot be marketed to help with hearing loss; however, they can be marketed to help in a specific situation, like hunting or business meetings. They’re available direct to consumers via online sales and, sometimes, in stores (this is pretty rare though). As to why they’re so cheap? I’m not involved in the production of any of these products so I can’t answer that directly. But, indirectly, I think it’s because these small companies have cut out many of the middle men and their products are not as sophisticated as a top of the line hearing aid.
Uh oh, it’s not as good as a top of the line hearing aid, does that mean it bad? Well, no. This area is extremely difficult to navigate for patients with hearing loss. Let’s keep this simple and do this in bullet point form:
Well, I ended up going over a “few” paragraphs, but it’s a lot to cover. Many people reading this will still have questions so I’ll say now, here are some future blog ideas I had from writing this entry: device specific reviews, the role of the audiologist in fitting a PSAP, programming PSAPs for patients, and addressing the “stigma” of hearing aids/PSAPs. Well, at least I’ll be supplied with material for the foreseeable future. Hopefully, one of those will answer your questions.
Have a great day!!
Why on earth do we need more hearing blogs? A quick check seems to show hundreds (maybe thousands?) splattered across the web, many espousing different opinions and championing different hearing products. If you’re asking that question, you’re not alone. I’m asking it too. Why would I want to do this? There’s so much out there, won’t my thoughts and opinions get lost in the mix? Also, it’s more work to tack onto my already full plate. And of course, who wants to read my thoughts anyway? However, my opinion changed drastically over the last month.
I was recently interviewed for a piece by Paula Span of the New York Times (you can read about it here). The response has overwhelmed me – calls and emails from folks all over the country telling me their stories and struggles with hearing loss and the current hearing healthcare market. I’m not telling you this to make you think I’m important (hint: I’m not important). Rather, I’m saying this because I’m moved by this outreach and heartbroken at how many people who could benefit from hearing healthcare are disenfranchised with the current system. They lack access, awareness, knowledge, and, sometimes, the wherewithal.
I can’t take on all these folks as patients due to my restricted schedule and I certainly can’t keep personally calling them back. So, I’m going to get with the social media revolution and start a blog. In this space, I will explore current research (particularly that of the Frank Lin research group), new devices, novel concepts, and my own ideas and research related to hearing healthcare to help the public digest all this information. And, of course, my own life experiences (so we can get to know each other). I hope you enjoy reading it as much as I will enjoy writing it.
- Nick Reed
Nicholas S. Reed