July 31, 2012 Features

Paradigm Shift: The New World of Hearing Health Care Delivery

Health care delivery models—including hearing health care—are changing quickly, driven by many economic, technological, and accessibility factors. For hearing health care, one of the most forceful drivers of change in professional service delivery is the digital revolution.

This digital infrastructure has been in place for some time, but has been growing exponentially as the world becomes infused with mobile technology, wireless (Bluetooth) technology, and broadband connectivity combined with the popular use of social media. Today's consumers embrace technology and use it to approach health care concerns.

Increasingly, consumers are seeking health information on the Internet. More than 70,000 websites disseminate health information and more than 50 million consumers are looking to the web for online health information (Toms and Latter, 2007). The advantages of seeking information online include its ease of accessibility, interactive features, and anonymity.

Many hearing health care providers realize these advantages, and are finding ever-increasing ways to deliver services online. Manufacturers are developing consumer-oriented technology, insurance companies are entering the market, and consumers are demanding more transparency when receiving hearing health services and purchasing hearing aids. The federal government, in turn, has taken a keen interest in consumer access to hearing aids.

Government Oversight

Two federal agencies play an important role in the evolving nature of hearing aid technology and use. The Food and Drug Administration (FDA) is charged with protecting the public health by ensuring the safety and efficacy of hearing aids and hearing assessment devices. The FDA also regulates the manufacturing and marketing of hearing-related products.

The National Institute on Deafness and Other Communication Disorders (NIDCD) plays a very different role, encouraging innovative research to improve consumer accessibility and affordability of hearing health care services. Research and changing technology have created new opportunities to make automated hearing screenings and full-scale audiometry a possibility. Hearing aid programming may be possible through these emerging technologies in the near future.

To facilitate innovative ideas, NIDCD issues requests for proposals for grants to develop low-cost technologies (e.g., hearing aids and hearing screeners), and to develop new delivery systems (e.g., hearing aid fitting and management via telepractice and the Internet).

Manufacturers, Insurance, Consumers

Hearing aid manufacturers, health insurance companies, and consumers also have a stake in the hearing aid accessibility debate. Each manufacturer offers a line of products at a variety of price points, and each is producing lower-cost hearing aids. Manufacturers also are developing computer software and cell phone and tablet apps that allow consumers to program their own hearing aids. Some manufacturers are creating direct-to-consumer models that bypass consumer interaction with hearing health professionals.

Health insurance companies are a relatively new player in the delivery of hearing health services. Traditionally, insurance companies have excluded hearing aid coverage and limited coverage for hearing health services. Now they are starting to revamp their business models, including direct-to-consumer plans—rather than improve coverage—in attempts to increase accessibility and affordability while boosting enrollment in their plans. The entrance of insurance companies into the market alters the dynamic—they have the financial resources and volume to negotiate lower rates on hearing aids, an interest in developing direct-to-consumer and discounted rate models, and the financial resources to research and develop new service delivery models that may or may not include hearing health professionals.

Consumers, with increased access to information, are beginning to play a larger role in their own hearing health care and hearing aid purchases. They are demanding clear information from service providers to help them make better and more informed decisions on their purchases. They are looking for transparency of costs and differentiation between the cost of services and devices. However, many do not look beyond researching and purchasing devices, and may not realize the benefits of audiologic rehabilitation and its value in achieving optimal hearing aid outcomes.

Professionals' Role

What's missing from manufacturers, insurance companies, and many Internet sites is information on the essential value of professional audiologic services. As hearing health care providers, audiologists need to communicate that for safety and best outcomes with hearing aids, consumers should seek audiologic services prior to purchasing hearing devices—and that post-fitting services, such as audiologic rehabilitation, are an integral part of overall hearing health care.

This consumer education on the essential value of professional audiologic services should be used in all forms of marketing:

  • General information (e.g., a practice's website).
  • Patient communication: newsletters and open-house events.
  • Consumer marketing: free seminars, free hearing screenings at community health fairs, and advertising.
  • Referral sources: contact with primary care practitioners (including physicians, nurse practitioners, physician assistants, and even medical office staff), who have significant influence on their patients.

ASHA offers a number of resources to support audiology practices and webpages:

  • Consumer resources. The ASHA website has accurate and reliable information for consumers.
  • Newsletters. Audiology Information Services patient newsletters are available at no charge.
  • ProSearch. Include yourself in the ProSearch Directory. The thousands of annual callers to ASHA who want help locating appropriate services are referred to this online directory.

Technology and innovation may be changing the health care environment, but it is up to audiologists to communicate one steadfast message: hearing health care requires the expertise and skills of audiologists to ensure patients' safety, satisfaction, and best possible outcomes from hearing aid use.

Ingrida Lusis, director of federal and political advocacy, can be reached at ilusis@asha.org.

Pam Mason, ME, CCC-A, director of audiology professional practices, can be reached at pmason@asha.org

cite as: Lusis, I.  & Mason, P. (2012, July 31). Paradigm Shift: The New World of Hearing Health Care Delivery. The ASHA Leader.

New Audiology Practice Information Available Online

To help dispensing audiologists understand changes taking place in reimbursement and other hearing health care issues, ASHA's audiology practices staff has recently updated its audiology webpages with new material.

The additional information, "Practice Considerations for Dispensing Audiologists," will include pages on:

  • Hearing aid professional services guidance.
  • Insurance and hearing aids.
  • HealthInnovations practice model.
  • Telepractice model.
  • Bundled, unbundled, and hybrid practice models.
  • Marketing.
  • Health care business terms.

ASHA will continue to update content as more information on health care reform becomes available.

The Audiologist’s Question: To Bundle or Not to Bundle?

by Lisa Satterfield

Current issues in health care—including a changing reimbursement environment, new service models, and consumer access to more services online—are compelling private-practice audiologists to revisit their business practices in an effort to offer quality services and stay fiscally viable.

This scrutiny is especially true for audiologists who depend on revenues from hearing aid dispensing. Many are asking about how to charge for hearing aids: Is it best to "bundle" all services related to fitting, adjusting, and using the hearing aid with the purchase of the hearing aid, or to offer an à la carte, unbundled menu of products and services?

There is no right or wrong answer, but audiologists may want to consider several issues in making this decision.

Operating/break-even costs.
A detailed analysis of overhead expenses, hourly salaries, cost of goods, and desired profit margin—and a consultation with an accountant or finance specialist—are the first steps. Know where you are and where you want to go.

Current fee schedule.
Determine the set rate for each service and good you provide. ASHA can help with data from the Medicare Physician Fee Schedule [PDF] and other fee analyzers.

Components of the "bundle."
If you bundle your services, itemize every service and accessory included in that price: initial recommendations, fitting, verification, orientation, ongoing counseling, electroacoustic measures, repairs and modifications, reprogramming, walk-in office visits, audiologic rehabilitation, warranties, and educational sessions. An analysis of what your practice includes and how often you provide the services will provide information on the hourly rate of the bundled price and the value of your professional services.

Services you deem essential to a hearing aid purchase.
Consider a partial unbundling of services. For example, you can categorize services into basic (services that you see as non-negotiable, such as fitting, verification, and programming sessions); standard (additional services that would enhance the transition to amplification); and all-inclusive (all services, perhaps including additional classes or accessories).

Private-payer contracts.
Hearing aids and hearing aid services are not a Medicare benefit, but they are included in state Medicaid programs and some private health insurance. Make sure your current and prospective contracts are in the best interest of your practice. A good resource, developed by ASHA, the Academy of Doctors of Audiology, and the American Academy of Audiology, is Important Considerations for Audiologists When Reviewing Third-Party Payer Provider Contracts.

Learn more about bundling and unbundling.

Lisa Satterfield, MS, CCC-A, director of health care regulatory advocacy, can be reached at lsatterfield@asha.org.


Toms, E.G., & Latter, C. (2007). How consumers search for health information. Health Informatics Journal, 13(3), 223–235. DOI: 10.1177/1460458207079901.


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