As we learned from the PCAST and NASEM reports, accessibility is a key factor in hearing care and hearing aid adoption (or the lack thereof). Increasing patient access to audiologic and vestibular care, on the patient’s terms, is an opportunity the readily exists in audiology. This “low hanging fruit” could help differentiate your practice from the competition and help you better serve your patients and community.
Let’s first talk about some facts related to healthcare delivery. The growth of urgent and immediate care facilities and telehealth options have certainly increased access to medical care (https://www.businessinsider.com/urgent-care-industry-trends) as entrepreneurs and healthcare systems continue to respond to the demands of today’s medical consumers. Individuals want care that is convenient, timely, and affordable (as emergency room visits are ten times more expensive than urgent care visits to come to the same diagnosis). Most urgent care facilities are open seven days a week, between 7AM and 9PM and most telehealth is accessible 24 hours a day in medicine.
These two delivery models, in both the healthcare and retail spaces, were created due to consumer demand and needs. These models also reflect consumer’s expectations on how they want and intend to receive care and purchase goods.
Now, let’s consider a typical audiology and hearing care delivery model. The vast majority of care is available Monday through Friday, 8AM to 5PM. Many audiology practices do no offer evening or weekend hours or telehealth options. Most do not offer access to emergency care. Most do not make supplies and accessories available through an e-commerce site. We are asking individuals to come in for a 30 minute comprehensive hearing test and, if they require amplification as a treatment option, an at least one hour communication and functional needs assessment or hearing aid consultation. If they obtain a hearing aid, we typically require a one hour fitting and orientation and at least two, thirty minute follow-up visits in the first 30 to 60 days of ownership. This amounts to three and a half hours of time in face to face care.
Now, most individuals do not live next door to their audiologist. So, this is going to mean transportation time and costs on both ends of these visits. Let’s be conservative and estimate that the patient will need to leave their home or work thirty minutes before each visit and that it will take an additional thirty minutes to arrive back at their home or office. This would add another four hours of time committed to the procurement of amplification. Now the total time spent is 7.5 hours and that is if YOUR clinic is running 100% on time.
Now, imagine that you are an hourly employee, do not have separate sick time for appointments like these but must use paid time off (which cuts into vacation), you work in a profession where taking time off is difficult (i.e. childcare, home health, education) or where you have responsibilities that require that you hire someone to take over those responsibilities so you can attend these audiology visits (i.e. child or elder care). So, you are missing an entire workday and/or possibly bearing personal costs outside of the device purchase to obtain amplification in the current delivery model.
Now, here is where other things like cost, stigma, value, perception and acceptance come into the equation. Why would an individual, who may not think they have a hearing loss, who does not want hearing aids, who may not think they can afford hearing aids, or who does not hear good things about hearing aids or audiologists take on this journey and time commitment? Would their perception and value assumption change if they could screen their own or assess their own hearing status? If providers would come to their home or office? If they could purchase their amplification device, supplies and accessories via an e-commerce or retail site? If they could have access to counseling or troubleshooting via telehealth? If they had access to evening or weekend hours? Can we, as audiologists, adapt and evolve OUR care and delivery models to better meet the needs of today’s consumers? We, through our actions, may hold the key to expanding adoption and that is through changing accessibility.
Let’s try to reimagine the typical audiology practice. Let me provide two examples. The first is a true concierge practice with no brick and mortar location. Every visit is scheduled. They go to the patient’s home or office for evaluation, fitting and follow-up care. In this model, the audiologist uses portable assessment technologies and telehealth to serve their patients and their needs. They have e-commerce sites to provide access to supplies and accessories. Their practice functions out of their home and vehicle. In this model, the audiologist controls their availability, their schedule, and where and how they service their patients. .
The second example is a brick and mortar audiology practice with flexible hours and delivery. They might have a schedule where Monday and Wednesday they see patients from 7AM to 4PM, Tuesday and Thursday they see patients from noon to 9PM, Fridays they see patients from 8AM to 2PM and one Saturday or Sunday a month they see patients from 8AM to noon. These visits can occur in the office, in the patient’s home or office, or via telehealth. This delivery model allows the audiologist flexibility in their own life and in that of their patients.
We have to explore adapting to the changing expectations surrounding access. My fear is that if audiologists refuse to adapt someone else will step into this void and niche. OTC/DTC delivery is a direct response to our unwillingness to become more accessible. Concierge and accessible care are exciting paths for audiologists to explore. My hope is that this is one opportunity we will not squander by hanging onto the status quo.
