Better Hearing Devices and Many Forms of Delivery

Transcription

1 Better Hearing Devices and Many Forms of Delivery Earl Johnson, AuD PhD Employment: Advanced Practice Audiologist, Audiology and Research Service, US Department of Veterans Affairs, Mountain Home, Tennessee Associate Professor, East Tennessee State University

2 The quality of the manufactured product is not all that the wearer should receive.

3 The primary purpose of providing better hearing is to improve quality of life, but its provision is encased in a multitude of forms.

4 Better Hearing In Its Many Forms FORM 1 For any person but intended for non-hearing impaired consumers Personal Sound Amplification Products (PSAPs) Remaining Forms To include a case history, hearing evaluation, and medical waiver or clearance FORM 2 For a person with hearing loss Self-fitting or software first-fit hearing aids (HAs) delivered over-the-counter or by the mail with minimal to no service

5 Better Hearing In Its Many Forms FORM 3 For a person of a given hearing loss Face-to-face delivery of HAs at a verified prescription with personal adjustment counseling and subsequent follow-up and fine tuning services FORM 4 For an individual person no matter the measured hearing loss Face-to-face service provision with HAs aimed at treating the whole person This includes, but is not limited to, Form 3 plus thoroughly addressing patient-specified listening goals and personal communication needs, immersive participation in a rehabilitation program.

6 Better Hearing In Its Many Forms Forms 2, 3, and 4 are operating in the free market with equivalency in some perceptions and practices. But, there should be a consideration of whether all these forms are indeed equal both in terms of: 1. the level of care that providers are capable of delivering 2. and realized outcomes of persons with hearing loss.

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8 The Use of Hearing Amplification in Society

9 A Failure to Uptake A story of Edith Fore, the actress who played Mrs. Fletcher demonstrated the utility of a device I ve fallen and I can t get up! for Life Call beginning in As an over-the counter product and with special case reimbursement, only about 5-10% of the 7 million or so older adults in the USA who could benefit have one. By comparison then, HAs with the current 25-30% adoption rate in the USA have been a real success.

10 Gerontechnology Advances since Edith Fore s day include: Smart pillboxes that remind people to take their medicine. A whole array of wearable technology like heart rate monitors, sleep monitors, pedometers, as well as hearables/psaps. A strange incongruity persists though between what science makes available and what society makes use of Let s call it the Edith Paradox or Ed Paradox.

11 Younger Ed versus Older Ed I do not have any health concerns. Hearing loss is far away and near the last thing on my mind. Why is there not coverage for hearing aids like there are for my medicines or eyeglasses? I have several competing health concerns. I need someone I can trust who understands.

12 Rather Than Just a Technology Solution Consider that Best estimates are 35 million of 308 million people in the USA have enough functional hearing loss to need help. With an average of 5 years before replacing HAs and a 25-30% adoption rate, only 2 million people seek new HAs each year. 2 million people is not typical consumer electronic device volume nor are the demographics of the people comparable. Real growth in adoption depends on the patient-provider relationship. 1. To lessen the emotional and social barriers 2. To provide a standardized protocol of care

13 Rather Than Just a Technology Solution Consider that The marketplace for HAs is inelastic (i.e., lower prices will not increase demand) (Amlani, 2005; 2007; 2013). In countries, like Japan, with hearing aid deregulation and low cost products, adoption rates are as low as 10-15%. A large evidence base already supports quality service delivery to encourage hearing aid uptake and good outcomes.

14 When formulating an effective, safe, and sustainable solution consider the following Usually Form follows Function

15 What function is trying to be accomplished? Function 1 - Putting a product in the ears of every person wanting to hear better or Function 2 - Ensuring the successful uptake and positive outcomes of persons with hearing loss

16 FORM 3 Better Hearing In Its Many Forms For a person of a given audiometric hearing loss Face-to-face delivery of HAs at a verified prescription with personal adjustment counseling and subsequent follow-up and fine tuning FORM 4 For the individual person no matter the measured hearing loss Face-to-face service provision with HAs aimed at treating not just the hearing loss but the whole person This includes, but is not limited to, Form 3 plus thoroughly addressing patient-specified listening goals and personal communication needs, immersive participation in a rehabilitation program.

17 Possible Form 4 Form 3 Form 1 Form 2

18 CEN 380/NS-EN European Standard for Services Offered by Hearing Aid Professionals standard-for-services-offered-by-hearing

19 Better Forms of Delivery are Already Affordable Using a quality-adjusted life-year (QALY), which is a measure of quality and the quantity of life lived A cost-utility analysis revealed Total cost for better forms of delivery = $1,119 per person. HAs treatment cost $60.00 per QALY gained. HAs + aural rehabilitation cost $31.91 per QALY (Abrams, Chisolm, and McArdle, 2002).

20 Better Forms of Delivery are Already Affordable As a comparison, Evans et al (1995) calculated a cost per QALY of $15,590 for the cochlear implant $11,940 for coronary angioplasty $29,220 for an implantable defibrillator $49,700 for a knee replacement (Abrams and Chisolm, 2007).

21 If Necessary, Contemplate The Cost To Subsidize Better Forms Current national demand in the USA is 3.3 million hearing aid units per year. This national demand is 4 times US Department of Veterans Affairs (VA) dispensing volume of 825,000 units. Total national cost then for better forms would approximate $2.2 billion (4 X $550 million). Without present coverage of HAs, the current national Medicare budget is ~$600 billion. A hearing aid and service delivery extension then to beneficiaries would represent a 0.33% increase to expenditures.

22 If Necessary, Contemplate The Cost To Subsidize Better Forms If adoption rates did increase to 40% nationwide, such as in the United Kingdom and Denmark, the annual demand would rise to 5.4 million units from 3.3 million Then, total cost would approximate $3.5 billion (still <1% of current Medicare spending).

23 In the presence of demand for access to better hearing and possible allowance for many forms, value must continue to be placed on Forms 3 and 4.

24 STANDARD DISCLAIMER The opinions expressed are those of the presenter and do not necessarily represent the official position of the U.S. Department of Veterans Affairs or the United States government. The presenter has a private Audiology and Speech Language Pathology practice, Johnson Hearing Technology and Communication, PLLC.

25 References Abrams H., Chisolm T.H., McArdle, R. (2002). A cost-utility analysis of adult group audiologic rehabilitation: Are benefits worth the cost. Journal of Rehabilitation Research and Development, 29: Amlani A.M. & Taylor B. (2012). Three known factors that impede hearing aid adoption rates. Hearing Review, 19: Amlani A.M. (2013, March). Influence of perceived value on hearing aid adoption and re-adoption intent. Hearing Review Products: Amlani, A.M. & De Silva, D.G. (2005). Effects of business cycles and FDA intervention on the hearing aid industry. American Journal of Audiology, 14: Amlani, A.M. (2007). Impact of elasticity of demand on price in the hearing aid market. AudiologyOnline. Bouton, K. (2013). Shouting won t help: Why I and 50 million other Americans can t hear you. New York, NY: FSG Books.

26 Chisolm, T.H. & Abrams, H. (2007). Measuring the effects of audiology treatment on health-related quality of life. In Perspectives on Aural Rehabilitation and its Instrumentation, ASHA Special Interest Division 7, 14(1): 2-6. Evans, A.R., Seeger, T., & Lehnhardt, M. (1995). Cost-utility analysis of cochlear implants. Annals of Otology, Rhinology, & Laryngology Supplement, 166: Humes LE. (2007) The contributions of audibility and cognitive factors to the benefit provided by amplified speech to older adults. Journal of the American Academy of Audiology 18(7): Humes L. E., Kidd G. R., Lentz J. J. (2013). Auditory and cognitive factors underlying individual differences in aided speech-understanding among older adults. Front. Syst. Neurosci. 7: /fnsys Johnson, E.E. (2013). Modern prescription theory and application: realistic expectations for speech recognition with hearing aids. Trends in Amplification. 17(3): doi: / Laplante-Levesque A., Hickson L. & Worrall L What makes adults with hearing impairment take up hearing aids or communication programs and achieve successful outcomes? Ear and Hearing, 33: Mulrow, C. D., Aguilar, C., Endicott, J. E., Tuley, M. R., Velez, R., Charlip, W. S., Rhodes, M. C., et al. (1990). Quality-of-life changes and hearing impairment: a randomized trial. Annals of Internal Medicine, 113(3),

27 Kochkin, S. (2014). A comparison of consumer satisfaction, subjective benefit, and quality of life changes associated with traditional and direct-mail hearing aid use. Hearing Review, 21: Northern, J. (2013). Beyond the Audiology Clinic: Innovations and Possibilities of Connected Health, NCRAR, Portland, OR Plomp, R. (1978). Auditory handicap of hearing impairment and the limited benefit of hearing aids. Journal of the Acoustical Society of America, 63: Tinetti, M. E., Fried, T. R., & Boyd, C. M. (2012). Designing health care for the most common chronic condition multimorbidity. Journal of the American Medical Association, 307(23), doi: /jama Taylor, B (2014). The five key drivers to customer intimacy in hearing care. AudiologyOnline. Taylor B, Tysoe B. Interventional Audiology: Partnering with physicians to deliver integrative and preventive hearing care. Hearing Review. 2013;20(12):16-22 citing John Bakke, MD, of Zolo Healthcare Solutions, refers to acquired hearing loss of adult onset as a triple threat to patients [personal communication, July 27, 2013] Zapala, D.A., Stamper, G.C., Shelfer, J.S., Walker, D.A., Karatayli-Ozgursoy, S., Ozgursoy, O.B., Hawkins, D.B. (2010) Safety of audiology direct access for Medicare patients complaining of impaired hearing. Journal of the American Academy of Audiology 21: