In two 2011 conference calls and a January 2012 meeting with hearing aid provider hi HealthInnovations, ASHA expressed concerns about hi HealthInnovations' online hearing check and direct-to-consumer hearing aid sales.
ASHA made it clear that the online "hearing test" has not been shown to be a valid assessment of hearing, especially with respect to discerning normal hearing from mild to moderate loss. Further, the exclusion of hearing health professionals in the process is likely to negatively affect many people with and without hearing loss.
In January, hi HealthInnovations released a free online hearing assessment. Based on the results of this assessment, the company provides hearing aids—with no out-of-pocket costs—to certain UnitedHealthcare Medicare Advantage members in several states. It also has begun direct-to-consumer hearing aid sales to people outside its network.
Since November 2011, ASHA has maintained ongoing discussions with hi HealthInnovations that focus on ASHA's concerns about hi Healthinnovations' approach to assessing hearing and dispensing hearing aids online. ASHA believes its concerns have not been adequately addressed; however, hi HealthInnovations is continuing to move forward with online sales.
"We believe it is in the best interest of consumers to see a hearing health care professional for a comprehensive evaluation of their hearing, which includes a discussion about the potential benefit of amplification," Vic S. Gladstone, ASHA chief staff officer for audiology, said. "An audiologist can provide the necessary support to work with the consumer to determine the most appropriate amplification and the audiologic rehabilitation necessary to achieve optimum benefit."
Conference Calls, Meeting
Two conference calls between ASHA staff and executives from hi HealthInnovations and United Healthcare (UHC, a UnitedHealth Group company) led to the Jan. 31 meeting with physician Lisa Tseng, CEO of hi HealthInnovations. ASHA's stated concerns included past failures of similar device-driven models and the lack of evidence that hi HealthInnovations' online hearing evaluation produces accurate results.
Further concerns included the lack of explicit information about the specific role audiologists might play in the program. To address this point, ASHA recommended that hi HealthInnovations' online "hearing test" be labeled a "hearing screen" that refers people suspected of hearing loss to a certified audiologist. Although Tseng said hi HealthInnovations intends to involve hearing health professionals in its service-delivery process, she was not able to describe exactly how that process will work.
ASHA concluded the January meeting by stressing a number of recommendations previously presented to hi HealthInnovations:
- hi HealthInnovations needs to label and use its online "hearing test" as a screening tool to direct people who suspect they have hearing loss to a hearing health professional. Numerous surveys and studies indicate that the communication benefits and improved quality of life from amplification are closely related to the quality of services received from a hearing health care provider. These services include evaluation in sound-controlled rooms using calibrated equipment, standard test techniques, and verification measures (e.g., real-ear measures). Hearing health care providers also provide counseling to identify any concomitant vision problems, issues with manual dexterity, or cognitive issues that may affect a treatment plan.
- hi HealthInnovations should expand its hearing benefit to include diagnostic and rehabilitation services provided by an audiologist. Medicare, for example, already covers an initial physician visit and an audiologist's diagnostic evaluation.
- hi HealthInnovations should consider working directly with audiologists who can choose to incorporate hi HealthInnovations hearing aids into their offerings for Medicare patients. Medicare will pay for a diagnostic hearing evaluation when the beneficiary is referred by a physician to an audiologist. Although no cost would be incurred by UHC, ASHA believes that patients stand to benefit from this practice.
Tseng agreed to provide details about how audiologists will be included in hi HealthInnovations' service-delivery model. Although hi HealthInnovations provided additional information, it did not address the questions ASHA raised about the role audiologists will play in its program. ASHA also has learned that Jerry Yanz, a well-respected audiologist who was hired by hi HealthInnovations to help introduce the company's line of hearing products and services, resigned after less than a month at the company.
Potential Risks to Patients
With the continuing lack of clarity about the role audiologists could play in the UHC program, the lack of audiology leadership at hi HealthInnovations, and the failure of the organization to validate its hearing assessment properly, ASHA remains concerned about potential risks to patients with hearing loss. "Unless hi HealthInnovations is willing to address ASHA's recommendations, we will have to consider other ways to let legislators, regulators, and the general public know about the risks of this program," Gladstone said. "We will also continue to work with other hearing organizations to make sure we present a strong, unified position to all our constituents."
Audiologists who have questions about hi HealthInnovations products or services, or who encounter hi HealthInnovations beneficiaries seeking assistance with their hearing aids, should contact Jennifer Stalpes, hi HealthInnovations vice president of business strategy and development, at firstname.lastname@example.org.
As ASHA gathers more information from hi HealthInnovations, updates will follow in The ASHA Leader. Send questions to ASHA staff at email@example.com.