Let me first put out a few “truths” for this blog post.
#1: I support audiology. I support it daily with time and treasure. I believe we provide, when we consistently practice to the research evidence, the “gold standard” in hearing and balance care.
#2: I support self-assessment of hearing loss and the self-fitting of over the counter/direct to consumer hearing solutions, be that personal sound amplification devices, assistive listening devices, or hearing aids.
#3: I do not think #1 and #2 are mutually exclusive.
I became an audiologist to help people hear more and fall less. THAT has always been my goal and I have also learned that accomplishing this and making a living are also not mutually exclusive.
Our current hearing care delivery model is leaving 70-80% of hard of hearing consumers on the sidelines for various reasons, including but not limited to awareness, stigma, affordability, accessibility, and value. They have been demanding change for over a decade, with little response from providers or our industry partners. As a result, they went “above our head” to employers, insurers, researchers, regulators and legislators to demand new products and a new delivery pathway and model. Our lack of response to their needs is driving much needed change.
Now, this does not mean audiology does not matter. It does. It just means though that the risks of non-treatment are now greater than the risks of inconsistently applied or received “gold standard” evaluation and care. This is especially true given that most providers do not consistently practice to the “gold standard”.
Some hearing aid dispensing practices will not survive these changes. It is inevitable. Those who will not survive are those who continue to do the following:
- Fail to practice to the top of their state license and scope.
- Fail to consistently provide evidence based care, including but not limited to communication and functional needs assessments, speech in noise testing, electroacoustic analysis, real-ear measurements, assistive technologies, and auditory rehabilitation.
- They have a "first fit forever" mentality.
- Fail to provide or refer their patients to colleagues who are experts in tinnitus, auditory processing, or vestibular evaluation and management and/or auditory osseointegrated device candidacy evaluations when warranted.
- Fail to offer telehealth.
- Fail to offer accessible, affordable amplification solutions.
- Bill questionability to insurance.
- Have questionable financial relationships with manufacturers.
- Fail to show their value, through quality metrics and data, to the healthcare system.
We have to STOP doing things the way we have been doing them since the 1970s. We must become the best of ALL things that can NEVER be completed over the counter or direct to consumer, that are unique to audiology, and which offer benefit and value to the patient and their quality of life. We must give consumers and patients a reason to engage with us. We cannot just SAY we matter; we must SHOW we matter.
To that end, we need to think and practice differently. For me, this starts with the Communication and Functional Needs Assessment. The process, coined and outlined by Drs. Robert Sweetow and Cynthia Compton-Conley in the 1990s, is, essentially, the “evaluation and management service” of hearing healthcare. It is NOT a hearing aid evaluation or assessment for hearing aid. It is so much more. This visit will include limited, if any, discussion of hearing aid channels or features because the visit is NOT about the product. It is about patient NEEDS and DESIRES. It is a DIAGNOSTIC visit where an individual’s hearing, communication and functional abilities are surveyed, screened, documented and discussed. The RESULT of this visit is an Audiologic and Vestibular Care Plan.
This visit can include, but is not limited to (when medically necessary):
- Comprehensive case history and communication needs interview and analysis.
- Standardized hearing handicap and/or hearing aid inventories.
- Speech in noise testing.
- Cognitive screening.
If you want to learn more about implementing cognition into your practice, please consider the Cognihear training program.
- Auditory processing screening.
- Dexterity screening.
- Falls risk assessment.
- Audiologic and vestibular care plan.
- Medical, psychiatric, or audiologic referral, medication management referral, hearing protection, auditory rehabilitation, amplification, and assistive technologies can be part of this plan.
This visit will ALWAYS carry a fee, even if there is not a specific CPT or HCPCS code, even if it is not covered by insurance and, most importantly, even if they do not proceed with amplification in your office. THIS is the cost of evidence based evaluation of hearing loss, balance difficulties and communication challenges. In THIS we become the doctors we say we are and we begin to unravel our identities from solely being tied to the sale of a product. THIS is part of a patient centered path forward.
Many colleagues have already successfully made this leap (you can learn more at Audiology Online). So, are you going to continue to complain about a world who is moving past your 1970s ways of practicing audiology or do something different to reach consumers where THEY are and want to be? The choice is up to you! Do you want to practice audiology or not?