Individuals often seek the services of an audiologist to reduce communicative challenges secondary to hearing loss. Depending on the severity of the loss and previous use of hearing assistance technologies, these services may require adjusting to new technology or learning auditory skills that can enhance the benefits of technology. Audiologic rehabilitation can be offered in individual or group sessions and may be personalized for each patient to include technology, communication strategies, coping skills, speech-reading, auditory training, and knowledge of public laws requiring access to auditory information.
Designing a program to help someone with communication challenges related to hearing loss is one of the most cost-effective services offered in a private practice, especially when done in a group setting. Abrams and colleagues (2002) demonstrated a significant cost-benefit of adult group audiologic rehabilitation through the use of a cost-utility analysis and quality-of-life measures. We recommend that every audiologist in private practice include group audiologic rehabilitation (AR) programs to accomplish a number of goals.
10. Expand referrals.
When individuals see results of their investment—of both time and money—they tell their friends and physicians about their success. The opportunity to engage with others with similar challenges through AR group sessions facilitates learning in novel ways that cannot be included in textbooks or computer programs. When people get the chance to try new strategies with others who are also interested in maximizing their auditory capability, they may experience reduced anxiety and increased success. They are likely to discuss these positive experiences with others who may need encouragement to seek communication assistance.
9. Identify yourself as a unique service provider.
Although hearing-related organizations may provide an online "professional finder" by specific geographical area, consumers must select and view each audiologist to see if the provider offers AR. The lack of a comprehensive list of audiologists who offer group AR limits the consumer's access to quality rehabilitation services. Therefore, marketing a practice to patients and referral sources as one that includes AR programs identifies the audiologist as a comprehensive service provider with solutions beyond technology.
8. Reap collaboration benefits.
Because speech-language pathologists are recognized as providers of AR treatment by Medicare (ASHA, 2011)—and many private health plans follow Medicare policy—it is logical for audiologists to team with SLPs to offer AR in private practice. Of course, AR can be offered by the audiologist as a private-pay service, or through private insurance and Medicaid. AR was separated from the speech-language pathology evaluation and treatment Current Procedural Terminology™ (CPT, ©American Medical Association) codes in 2006 to emphasize that it is not a service provided only by SLPs. Because the scope of practice for both audiologists and SLPs includes AR services, it may be mutually beneficial to offer group AR through a team approach.
7. Minimize startup costs.
Unlike diagnostic or dispensing services, group AR does not require expensive equipment other than a soundfield distribution system, which may cost as little as $700. Even when space is limited, you may be able to find an area for group AR—a conference room, perhaps, or the reception area during the noon hour or early evening.
6. Provide a model for AuD students.
According to a recent MarkeTrak VIII survey, 18% of new hearing aid users attended group AR sessions, compared to only 9% of experienced users. Less than 5% received auditory training, self-help materials, or referral to a hearing loss group such as Hearing Loss Association of America (Kochkin et al., 2010). These small percentages may be a direct reflection of the experience students receive in AuD educational programs. Private practice may influence academic training if AR practicum experiences are offered and students see a successful model for group AR in private practice.
5. Boost awareness of AR benefits.
Audiology textbooks on private practice focus on establishing and running an audiology practice, even though inclusion of the cost-benefit information on group AR may influence service-delivery model design. This omission may be considered evidence that the services are deemed less valuable or beneficial. However, in a systematic review of the limited AR research available, Hawkins (2005) concluded there was reasonable evidence that audiological rehabilitation is effective, if only for the short term. According to Preminger and Yoo (2010), group AR that included psychosocial exercises, in addition to informational content, had the greatest effect on patient quality of life. Audiologists in private practice who recognize group AR programs as a necessary component of quality care should help to raise awareness of the benefits of such programs.
4. Reduce hearing aid return rates.
Although experimental studies are not available, observational studies point to AR as an effective tool to reduce return rates of hearing aids, a figure that can correlate with patient satisfaction and success. In one observational study, Martin (2007) analyzed return rates in a private practice for patients who chose to receive listening and communication enhancement (LACE) computer-based training and for those patients who did not receive the training. Patients who received LACE had a return-for-credit rating of 3.5%, compared to 13.1% for those who did not participate in LACE.
3. Save time through group instruction.
When patients are served individually, the audiologist repeats information that can be delivered once in a group format. For example, rather than explain the function of dehumidifiers to five individuals separately for a total of 25 minutes, the audiologist can explain it once—for five minutes—during a group AR session. Additionally, someone in the group may ask a question that also may apply to another participant.
2. Increase patient satisfaction.
Most patients receive about 30 minutes of counseling when they are fitted with a hearing aid, according to the MarkeTrak V survey (Kochkin, 1999). But the study also shows that more time dedicated to counseling relates to higher patient satisfaction. With group AR a patient may benefit from a significant increase in time spent with the audiologist by attending multiple group sessions. Greater patient satisfaction, then, should act as a motivation for audiologists to offer group AR sessions.
1. Meet a critical need for comprehensive patient care.
In 1978, ASHA recognized audiologists as the most qualified professionals to dispense hearing instruments, specifying that the instruments be dispensed only as part of a comprehensive rehabilitation program. A private practice that includes hearing aid dispensing without an option for group AR sessions to address communication strategies, speech-reading, and coping skills is like giving a novice photographer an expensive camera without the instruction manual: the fledgling photographer will not get the full benefits of the camera's features.
When private-practice service models are focused only on expert fitting of hearing instruments, patients may leave with significant communication challenges unresolved. Can they hear their smoke detectors, for example? Use their telephones? Audiologists should explore these and other issues to determine patients' rehabilitative needs (Thibodeau, 2008).
There are a variety of formats for offering AR in private practice, including the traditional group format, individual sessions, video-link computerized sessions, and self-paced instructional materials in both booklet and computer formats. Regardless of the format used, all individuals served in an audiology private practice not solely dedicated to diagnostics deserve an assessment and management plan that comprehensively covers their rehabilitative needs.