Hearing Aid Industry at a Crossroads
This old medical model of dispensing was conceived, and evolved in a different era, a different century even, springing from the Veteran’s Administration’s first studies of human hearing, after World War II. Yet, even as the prosthesis/products, patients, and our entire communications, and merchant systems, have evolved totally new ways of doing business for us all, the high priests, and priestesses of Audiology have continuously taken us in a different direction.
Given that hearing loss can be an indicator of other life threatening conditions, developing simple screening methods to identify those serious, medical conditions that should be referred for further treatment was the goal of the Food and Drug Administration when it issued it’s original rules for the sale of these ‘medical devices’.
It was from this original regulatory framework that the Audiological, and hearing aid dispensing community developed, and evolved the medical model of dispensing, which is under assault from so many quarters today.
During the ensuing fifty years, these academics, scholars, and business interests did what all such individuals, and institutions do, they enshrined their importance in all manner of academic research, regulations, proclamations, and dictates about just how, where, and by whom the public was even allowed to purchase a hearing aid.
Entire, graduate level curricula were developed, as audiology split from its roots in speech pathology, and pursued doctoral status, as the entry level required, for all they deemed fit to dispense a hearing aid.
“Best Practices” became the mantra, with compliance to ever evolving protocols expected, enshrined and mandated, all in the name of protecting the public, and providing them with absolutely the best, most scientifically demonstrated, academically generated, and endorsed, procedures establishing the highest levels of service that could possibly be conceived, to be applied universally.
Now, please understand that humanity, all of us, have greatly benefitted from the dedicated research that the field of Audiology has provided. What we know about how we hear, and how we understand the complex world of sound around us, has become an incredibly rich field of information, and data, that has lead to the remarkable equipment we have today. In large part, this came about because of the dedication of academics, and industry researchers.
Along the way, licensure became the means of controlling who could sell hearing aids, as the industry went through a period of selfish expansion, and outright greed on the retail end, selling hearing aids to whomever they could be sold to, without any real protection for the consumer from, either their potential financial losses from a poorly fit, or functioning, or worse, unneeded hearing aid.
States responded, Boards were formed and minimum training, equipment, and protocols were established to protect the public from physical, and financial harm. Required licensure became the norm, with each state Board, and legislature bowing to the lobbying influences of consumers, practitioners and our ‘professional’ organizations.
This medical model served, in the era of eighty-percent custom made hearing aids. The salesmen, or women (audiologists, or specialists) were regularly performing invasive protocols involving the insertion of otoblocks deep within the ear canal, for the purpose of taking impressions which were then used to make these custom made hearing aids.
The procedure of taking an ear impression, is honestly, potentially dangerous. If, not performed properly, by trained personnel. There is the very real potential for damage to the tissues of the canal, eardrum, and even the potential for removal of the entire ossicular chain, if not performed properly.
Impression taking, and the quality of the impression is still a very much taught, and discussed procedure within industry circles, as such are still critical to the proper fit of some types, and styles of hearing aids, for some patients.
Whereas, twenty-two years ago, when I opened my practice in Melbourne, Florida the ratio of custom made, to BTE, or modular hearing aids was about 85% custom to 15% behind the ear, or modular, with even the behind the ear models requiring custom molds to fit properly. That meant that practically all of the patients I saw were exposed to the impression taking protocols.
Twenty-two years ago, academia was just exploring the new connectedness concept for computers developed by DARPA to allow our country’s communications network to survive a nuclear attack.
Twenty-two years ago, we were just beginning to see the potential of applying digital technologies to hearing loss.
Twenty-two years ago eighty-five percent of my hearing aid fittings were custom made, with most of those remaining requiring custom made and fit molds.
Twenty-two years ago one hundred percent of my fittings were analog, and ordered by a matrix of numbers describing output, gain and degree of slope.
Twenty-two years ago Kodak ruled the imaging business, BlockBuster owned the Orange Bowl, and Border’s sold millions of books.
Today, none of my fittings are analog. I’ve only taken impressions on less than five percent of the patients I saw last year, Kodak, BlockBuster and Border’s totally missed the digital conversion going on around them and went from household names to has beens, far faster than any of their esteemed Boards could envision.
Today, Amazon, Netflix, Google, Nike, Apple and the Internet all connect us in ways, and make ways of doing business available to us all, that had only been glimpsed twenty-two years ago.
So, while the high priests and priestesses of Audiology and Dispensing enshrined their model, and way of doing business in all manner of advanced education, credentialing and licensure through regulatory Boards, rules, regulations, dictates and mandates, creating their enshrined medical model, the world of commerce, our consumers, and our equipment were all moving in the other direction.
Their academic, and regulatory zeal has led to the creation of what have been described in classical economic models as, ‘market inefficiencies’. These increasingly large inefficiencies have logically led to what Adam Smith, considered the father of modern economics, referred to, in his classical work, “The Wealth of Nations”, as ‘the invisible hand of the market’ to move in and begin to address those inefficiencies.
Smith’s hand arrived in the form of Internet Sales, Vertical integration, P.S.A.P.s, or Personal Sound Amplification Products, and most significantly in the form of United HealthCare, with their purchase of HealthInnovations, and the disqualifying of every hearing aid provider under their policies.
This $122 Billion a year insurance giant simply bought their own hearing aid company and began to dispense hearing aids directly to the public via their website and call center. No appointment needed. A simple phone call, or email exchange and your new hearing aids are on the way to you.
After doing their own extensive in-house examination of the actual risks to consumers, vs. the one that had always been accepted under the old medical model, the largest health insurer in the nation simply rejected all of the long established protocols as being unneeded baggage. Their actions, taken over eighteen months ago, fly in the face of the entire orthodoxy of those high Priests and Priestesses of Audiology, who for years had made their living doing things their own way, and dictating that everyone else follow.
Though their actions violate all the practice acts of all forty-eight states that have enacted hearing aid dispensing legislation, the Nation’s largest Health Insurer is simply ignoring the various states rules, eliminating the middleman, or woman and remaking our old medical model into a market based one.
Given that I’ve received notification from both the Florida Governor’s and State Treasurer/Insurances Commissioner’s offices stating clearly, after having been informed of these ongoing violations of our practice act, that it simply, “wasn’t their job”. Effectively turning a blind eye to these activities, though in flagrant violation of both practice acts, and the felonious act of dispensing a hearing aid without a license.
This willful ignorance of ongoing felonious (Dispensing a hearing aid in the State of Florida without a license to do so, is considered a third degree felony.) activities by the nation’s largest Health Insurer, is being accomplished with a wink, and a nod from the top law enforcement officer, and chief insurance regulator in the state of Florida.
This willful ignorance by the top law enforcement officials of the State, creates a serious regulatory issue for the Board of Hearing Aid Specialists, charged with policing licensees in the state.
That issue transcends both the Florida Board of Hearing Aid Specialists regulatory, or rule making authority, and that of the entire State of Florida’s ability to make law. It rests in the fundamental principles enshrined in Section I of the Fourteenth Amendment to the Constitution of the United States of America, dealing with the guarantee of equal protection under the law.
Simply put, what’s good for the goose, is good for the gander.
Our Federal Constitution declares clearly, that you simply can’t apply laws to one group of people while ignoring them, when it comes to the activities of others. The principle is fundamental to our freedom as a people, and considered one of our protected Civil rights, as citizens of this great nation.
So, how is the current licensure, and strict compliance being enforced?
The simple answer is upon momentum, and pure bluff.
Until removed by the legislature, or struck down by the courts, the structure of the regulatory apparatus remains, but it is a truly hollow shell. Pursuit of victimless violations of protocols, paperwork, or such against anyone, licensed, or not, while totally ignoring the ongoing actions of insurance mega companies, manufacturers, and literally thousands of other violators, would clearly establish a prima facie case of unequal protection, and pose a clear violation of civil rights by those pursuing such actions.
By publicly speaking out about the state of these affairs, I become the heretic. To date the majority of professional colleagues continue to cling to the orthodoxy handed down from academia, and inherited from a storied past, that hearing aids are dangerous, the public needs protection from anyone attempting to sell them one, and that they must not be allowed to do so, for their own protection.
So, I gladly join the ranks of those deemed heretic. For, like Galileo, peering through his telescope, and noting that the universe didn’t revolve around the earth, I look out, and cannot help but see that things aren’t as our Boards, or our Professional Associations would have us believe, but an entirely different universe.
Heretical, or not, the medical model of dispensing hearing aids, has been supplanted by a market model, and wishing it were otherwise simply won’t make these facts go away.