7 Questions ENT Physicians Should Ask Themselves

7 Questions ENT Physicians Should Ask Themselves About Hearing Aids and Their Audiology Department and Hearing Center A white paper for physicians seeking to increase revenue

Executive Summary ENT practices face internal and external challenges that can limit their ability to capture a greater share of the dispensing channel of hearing aids. There are opportunities, however, to improve performance in one or more primary areas of development. Investigating these primary areas of development will lead to improved performance for ENT practices that dispense hearing aids and will enable them to treat more patients suffering from hearing loss. The result will be an increase in practice revenue from hearing aid sales. Utilizing a qualified resource to perform a practice evaluation and identify opportunities for improvement will enable physicians to see results through the use of a Medical Model dispensing approach. This white paper focuses on 7 basic questions that highlight some of the opportunities available for improvement. Considering these questions is a solid first step for your practice as you focus on the growth of the audiology and hearing aid departments.

What percentage of hearing aids sold in the U.S. are dispensed by ENT practices? Over the last generation, the hearing loss population grew at the rate of 160% of U.S. population growth primarily due to the aging of America (Kochkin, 2009). The prevalence of hearing loss in the United States is on the rise (Kochkin, 2009) and ENT physicians are well positioned to capitalize on the opportunities to dispense hearing aids to patients in need of amplification. Approximately 48.1 million people in the U.S. report some degree of hearing loss (Lin, Niparko, & Ferrucci, 2011). Of those, 1 in 6 baby boomers (currently aged 50 68) have a hearing problem and 1 in 14 Generation Xers (currently aged 33 48) already have hearing loss (Sikka Software Corporation, 2014). Only 1 out of 5 people that could benefit from a hearing aid actually wears one (Sikka Software Corporation, 2014). Private sector hearing aid sales in 2013 increased by 4.2% over the previous year (Strom, 2014). As the prevalence of hearing loss is predicted to increase, the need for qualified providers to deliver hearing services and hearing aids will also increase. When evaluating all segments of hearing aid purchasers, less than 10% of consumers reported purchasing their hearing aids from an ear doctor (Kochkin, 2009). By comparison, 31.2% purchase direct from audiologists and 27.5% purchase from hearing aid specialists (Kochkin, 2009). It can, therefore, be determined there is opportunity for ENT practices to gain a greater share of the hearing aid dispensing market.

What percentage of your total practice revenue is derived from your audiology department and hearing center? The Devil is in the details and so are the profits! Keith Greene, President, Audiology Management Group. Inc. Answering this question can be difficult depending on the tracking and reporting methods that your practice uses, and on the data being readily available to the physician owners. Managing and tracking the performance of these departments as if they were a separate business provides you the framework to evaluate targets specific to the retail circumstances associated with the sale of hearing aids. Establish measures to track your patient segments and manage the hearing loss patient to hearing aid consumer channel. Know how your hearing center is performing compared to the rest of your practice. This is a good indicator of when efforts should be made to increase investment to capitalize on growth opportunities or utilize training resources to increase practice performance. Develop a highly effective hearing center utilizing Key Performance Indicators (KPIs) that should be tracked not just annually or quarterly, but weekly or even daily. These data points are best tracked independently of your other practice components. These include items such Sales, Returns, ASP, COGs, number of follow up visits, call to appointment rates, marketing results, etc. It is much easier to monitor your performance against benchmarks such as the National Trends Hearing Care KPI Ticker (Sikka Software Corporation, 2014), if you have this data easily available. Ensuring that you can track and manage the performance of your hearing center independently provides advantages and can enable you to increase the quality of care you provide hearing aid users that come to your practice for hearing services.

Is it clear to patients in your waiting room that your practice dispenses hearing aids? Many a small thing has been made large by the right kind of advertising. Mark Twain This question is just the first of many when it comes to addressing the complex arena of informing your current and potential patients about the hearing services you provide. For many practices, the fact that they sell hearing aids is a little known secret that is not made obvious to the general practice patient volume (Austin, 2006). Make it obvious to patients that walk through your door that your practice dispenses and services hearing aids. If you don t, you are missing out on a great opportunity to educate your patients about the services you provide and what makes your practice special. You have a captive audience available to be educated about the consequences associated with untreated hearing loss and the benefits from accepting amplification. An educated patient is better able to follow your and your dispensing staff s recommendations for treatment options. How you inform your patients about the hearing services you provide is crucial. Keep in mind the hearing loss segments you treat, as well as your customer channel. Establishing a solid understanding of these two critical components of marketing to patients is key to generating results. While dispensing in a medical model, it is important to focus on having materials available that will demonstrate to your patients that your practice is a high quality resource for hearing care as well as a convenient resource for the ongoing support hearing aid patients need. With multiple delivery channels available to the consumer retail, direct to consumer, online (with a service contract), and medical using the right message that fits within the medical model and fits your mission aligns you for better success (Taylor, 2013).

How many hearing tests are performed in your practice daily? Weekly? Monthly? Understand the details that generate your performance results. The number of hearing tests performed is a critical KPI to monitor so that you have a solid understanding of how many potential hearing aid patients you have tested in your practice. This measurement will help you to identify the true potential for increasing opportunities. Use a proven patient flow process to get hearing aid candidates into the hearing consultation with your hearing aid dispensing provider. This process is a critical component to capitalize on your opportunities to treat more patients with hearing loss. One of the most important components of the AMG Medical Model that has helped build our hearing center to the level where it now generates 30% of our total practice revenue has been the use of the AMG Patient Flow Process. (Herb Silverstein, MD, FACS) Use a medical model approach when dispensing hearing aids in your office. This provides a structure that will help increase your ability to identify and educate more patients that are candidates for hearing loss treatment. Identifying the number of hearing tests you perform, and identifying the number of candidates for hearing loss treatment, is necessary to evaluate the effectiveness of your office.

How is your dispensing team compensated? Determining the optimal incentive plan design will not only help improve performance, it will promote ethical behavior that is in the best interest of the company. Lisa Quast, Creating Incentive Plans That Actually Incent Employees Taking the time to evaluate the compensation structure for the audiologists and or hearing instrument specialists at your practice is a valuable effort. A detailed exploration will help you determine how your practice competes in the market. This process will also maximize your competitive advantage. A fall 2012 ASHA Audiology Survey, Hourly Wage Report, highlights that nearly 25% of audiologists receive a commission (American Speech Language Hearing Association, 2012). Most companies that provide consumer goods use commission structures. Remember that your patient, when completing the consultation process, is choosing to make a significant purchase. Having a skilled provider that can help a patient through this process is critical. Skilled providers should be compensated for their efforts and ability to deliver the quality that will make your practice one that patients will recommend to their friends. Commissions are paid to not only potentially increase the bottom line but to also encourage a company s growth (Granville, 2013). An efficient and effective medical model utilizes the collaboration of otolaryngologists and audiologists and having a compensation structure that is competitive is important for recruiting and retaining high quality providers. Take time to learn about the competitive levels in your region and in the country. Utilizing a resource that has helped other practices recruit quality providers will save time and improve results. Having a solid compensation structure for your audiology, dispensing, and hearing center team produces a more satisfied staff and less turnover. This will generate a better quality performance for your patients in the long run. Treating hearing loss is a face to face service. Retaining providers that build relationships with your patients increases opportunities for new patients and increases patient retention.

How long do your patients wait to receive a hearing aid evaluation or consultation? Establishing a successful patient flow process can be a timesaving solution to generate results. The average amount of time patients wait in an office to see an otolaryngologist is 24 minutes (Powers, 2011). It is crucial to also consider how long a patient waits for a hearing test, how long to discuss the results of the audiogram, and then how long before the patient has an opportunity for an in depth consultation with your audiologist or hearing instrument specialist. Wait times at all levels of the patient flow process for patients are crucial KPIs that deserve constant attention. Considering how long a patient may wait in other dispensing segments such as a big box retailer or private practice audiology clinic can provide a frame of reference. It may or may not be possible to compete with the benchmarks from other segments, depending on your current staffing structure, but the awareness of the options that hearing aid candidates have available is important. Promote the value of the consultation process with the audiologist or hearing instrument specialists. This will likely increase the patient s perception that it is worth the wait. Scheduling hearing consultations for patients at a future date with your audiologists is a valuable strategy to utilize within the medical model. Keep in mind that the hearing loss likely is not new for the patient. A significant number of patients wait up to 15 years before deciding to accept amplification (Kochkin, n.d.). The top two reported influences that contribute to hearing aid purchases by first time users are worsening hearing loss and pressure from family members (Kochkin, 2009). Considering these factors will help to set the stage for a successful consultation.

Do you feel comfortable discussing hearing aids and the benefits with your patients? Understand the costs of hearing aids to the consumer, and educate patients about the benefits. What is your approach when discussing a hearing aid candidate s hearing loss and treatment options? Staying informed about current technology and available products makes it much easier to address the initial concerns patients have about hearing aids. It is crucial for success to assure patients that quality options are available. Data shows that 90% of patients trust their hearing aid dispensing professional (Kochkin, n.d.). Practices can enhance that trust by educating the patient about the beneficial treatment options available and the quality providers that will help them select the appropriate hearing instruments. Understand the costs associated with hearing treatment in your office. Cost is an early objection brought up by patients needing treatment and addressing these concerns confidently and directly reassures the patient and expresses that you have confidence in your team. Understand how to educate a patient about hearing aid treatment. A patient s reluctance to accept hearing treatment is typically due to a lack of education about hearing aids, the benefits, and recent changes to technology (Kochkin, n.d.). Understand how to educate your team about overcoming patient objections to hearing aids. Regular education and training for your entire team is a critical component to increasing the effectiveness of your clinic in treating patients with hearing aids.

Conclusions There are significant opportunities for ENT practices to increase the number of hearing aids dispensed to patients that would benefit from hearing aids. The need for qualified providers will continue to increase as the prevalence of hearing loss continues to increase in the U.S. Understanding the impact on practice revenue from dispensing hearing aids is important. Educating your patients about the hearing care services you provide is necessary in order to capitalize on opportunities to treat more hearing loss patients. It is important to understand your current capabilities and evaluate opportunities to expand available services. Utilizing qualified providers, and having a competitive compensation structure, positions the practice for success. Understanding how to increase the efficiency of the patient flow process will lead to improved results. Education for providers is crucial to enabling educated patients. Utilizing a qualified resource to help your practice identify the opportunities and execute a strategy for growth will help generate results. Audiology Management Group, Inc., provides members hands on support to execute an effective hearing aid dispensing strategy, known as the AMG Medical Model. With our support, practices increase sales and maximize the profitability of their audiology departments and hearing centers. For additional information about the services we provide, or to schedule a free practice evaluation with one of our business advisors please contact our professionals at 866.462.3252. Please address email correspondence to info@audiologymanagementgroup.com. Audiology Management Group, Inc. 1901 Floyd Street, Suite 301 Sarasota, FL 34239 866.462.3252 www.audiologymanagementgroup.com

References: American Speech Language Hearing Association. (2012). 2012 Audiology survey report: Annual salaries. Retrieved from http://www.asha.org/uploadedfiles/2012 Audiology Survey Salaries.pdf Austin, J. (2006). Thinking of adding hearing aids to your practice? Experts dispense advice. ENT Today. Retrieved from http://www.enttoday.org/details/article/531795/thinking_of_adding_hearing_aids_to_your_ Practice_Experts_Dispense_Advice.html Granville, B. (2013, May). Sales commission structures: The untold story. The Hearing Review. Retrieved from http://www.hearingreview.com/2013/05/sales commission structures theuntold story 2/ Henkel, G. (2009) Managed correctly, hearing aid dispensing augments the bottom line. ENT Today. Retrieved from http://www.enttoday.org/details/article/496241/managed_correctly_hearing_aid_dispensing _Augments_the_Bottom_Line.html Kochkin, S. (2009, October). MarkeTrak VIII: 25 year trends in the hearing health market. The Hearing Review, 16(11), 12 31. Retrieved from http://www.hearingreview.com/2009/10/marketrak viii 25 year trends in the hearing healthmarket Kochkin, S. (n.d.). The impact of treated hearing loss on quality of life. Better Hearing Institute. Retrieved from http://www.betterhearing.org/hearingpedia/counseling articles tips/impacttreated hearing loss quality life Kochkin, S. (n.d.) Why people delay a solution. Better Hearing Institute. Retrieved from http://www.betterhearing.org/hearingpedia/counseling articles tips/why people delaysolution Lin, F. R., Niparko, J. K., & Ferrucci, L. (2011). Hearing loss prevalence in the United States. Archives of Internal Medicine, 171(20), 1851 1853. Retrieved from http://archinte.jamanetwork.com/article.aspx?articleid=1106004 Powers, M. (2011, October). Reducing patient wait times: Examine your operations to boost efficiency. ENT Today. Retrieved from http://www.enttoday.org/details/article/1362839/reducing_patient_wait_times_examine_yo ur_operations_to_boost_efficiency.html Quast, L. (2011, September). Creating incentive plans that actually incent employees. Forbes. Retrieved from http://www.forbes.com/sites/lisaquast/2011/09/19/creating incentive plansthat actually incent employees/

Sattinger, A. M. (2007). Collaboration between otolaryngologists and audiologists can benefit both. ENT Today. Retrieved from http://www.enttoday.org/details/article/526395/collaboration_between_otolaryngologists_an d_audiologists_can_benefit_both.html Sikka Software Corporation. (2014). National Trends Hearing Care KPI Ticker. Retrieved from https://www.sikkasoft.com/kpi tickers/ Strom, K. (2014, February) Hearing aid sales rise 5% in 2013; industry closes in on 3m unit mark. The Hearing Review. Retrieved from http://www.hearingreview.com/2014/02/staff standpointhearing aid sales rise 5 2013 industry closes 3m unit mark/ Taylor, B. (2013). Strategy and design in your audiology clinic. Audiology Online. Retrieved from http://www.audiologyonline.com/articles/strategy and design in your 11967