Yes and no - it actually does decrease the cost of follow up appts and that sort of cost because typically we will see less follow up visits when REM are done because we are closer to targets to being with. BUT anytime a professional acquires equipment, the cost will usually be reflected in Hearing Instrument price. I should probably have explained myself better - thanks! 
dr. amy
At least I have thought about the issues.
Maybe 80%+ of dispensers simply want to focus on another key technical device ⌠the pen that the client will use to sign the cheque!
Thank you ghat was a good one⌠
I needed a good chuckle this evening.
You are right, I spend less time fine tuning than before⌠It actually saves moneyâŚ
most clients love itâŚ
I think Xbuilder meant technically it is a Verifit trademark or something. I use the MedRX REM/Speech map and wouldnât dream fitting any hearing aid without it. I would feel naked and blind using just the manufacturerâs settings as I have seen far too many horrible fittings where speech mapping and/or REM havenât been performed or have been performed, but by someone who does not understand what they are visualising.
I have a choice of two dentists who have offices the same distance from me. Both are excellent in all respects. One is more old school, with good equipment, but not so different than when I was younger 30 years ago. The other invested in all sorts of new equipment. Old school takes xrays with slightly painful thigamajigs in my mouth, several teeth at a time. The other sits me in a booth, puts painless strips on my teeth and a whirlygig thing goes around my head and weâre all done. Same cost for both. Guess who I go to? Old school is a relative of my partner and is struggling for more patients. New tech guy is always busy.
Amy, as a fellow health care practitioner who has a small private office, we may have something in common. As a business person, I look at return on investment (ROI). So, whenever I take expensive training or buy relatively expensive equipment or do anything that costs significant money (including advertising) I consider ROI and donât make the investment unless I get an ROI of at least 2x.
E.g., the investment may bring in new patients by broadening my services or something like that. Itâs a hit or miss proposition, but if I do my homework Iâll take the chance. If the investment leads to an increase in cost to the patient/customer, I wouldnât do it unless itâs necessary to maintain my license or something similar.
Edit to add: Is speech mapping related to word discrimination when the audi does a hearing test?
Audioscan is a 1 product company. They make a damn good product. Having used FP 35, aurical and tested an Affinity, audioscan ins the best machine out there. Speech mapping
can be done in as little as 3 min.
Looking at the fitting business from a hourly rate standpoint:
Capital equipment cost is usually offset by controlling two parameters:
Most businesses increase revenue by
a) Offering better value per hour to the customer
b) Convincing the customer that a) is the case (Advertising, information sheets and mailers explaining the superior value of your service)
c) Charging a higher hourly rate in keeping with your superior value to the customer
d) Getting more chargeable hours due to word-of-mouth referrals, advertising, etc.
Charging a fixed amount for the whole process is in my opinion a poor fit for the customer and the professional as well.
[Start of Rant to fitters and manufacturers]
It is interesting however that things as obviously important as REM, Speech Mapping, AudiogramDirect, in-situ audiometry, etc. are far below the radar of almost all hearing patients. Thatâs not the patientsâ fault. Thatâs the industryâs fault. Thatâs the practitionersâ fault.
Itâs clear that even in this forum, many are hearing about these critical services for the first time. Thatâs a failure by instrument suppliers and also a failure of the service (fitting) sector.
To be specific, itâs part of service sectorâs business to educate the customer (and potential customers) as to what will be valuable (even critical) to him. If you donât you are failing the customer and (if you do indeed supply a premium quality fitting) you are failing to adequately educate the target customer base so that the premium value of your service can be understood.
We (customers) shouldnât have to probe for this critical information.
[End of Rant to fitters and manufacturers]
All that being said we (HI users like me) do recognize and appreciate the time and effort the professionals on this forum spend each week to offset this problem and expect that in the long run, both groups (professionals and customers) will gain by it.
I failed the speech mapping.
I couldnât understand many words. The audi said it is because I need to learn the words again and I need to read to myself loud to do that . That is not realistic. Is it?
0125.HzL-20 R-20
0250.HzL-20 R-20
0500.HzL-40 R-30
1000.HzL-80 R-60
2000.HzL-90 R-90
4000.HzL-100 R-90
8000.HzL-100 R-100
you cant fail speech mapping! you mean your spech disc. is low? You might be a good candidate for aural rehabilitation. Maybe lace is something you need to do.
Looking at your audiogram maybe the Medel or the new Hybid from cochlear
could work for you
A little off post but interesting⌠(about voice pretesting)
since my wife and I are currently being fitted by different audis and were not pre-tested and she was not tested afterwards(except the auto feedback setup the Brenafon does). I asked about a standard noise CD so that she could set the voice-in-noise program, but the audi said she didnât neeed it.
⌠if all of the Audiâs/BC-HISârs in your area donât do it. So whatâs the realistic answer to the problem?.. and please donât say âprogram your ownâ because for most people thatâs NOT a option. Most HOHârs want to be able to walk into the HA office and have it taken care of by whoever is there.
So once again: âWhatâs The AnswerââŚ!!? 
Shi-Ku Chishiki
Vote with your feetâŚI reckon two or three clients going elsewhere would see an audie have a change of heart.
I agree. Patientâs should demand real-ear verification. As a person with hearing loss you should know that your hearing aids are amplifying speech above your audiogram. You cannot be sure of this without real-ear measurement.
Dr. Gus Mueller has an article on the topic in this monthâs Hearing Journal. His survey shows that about 40% of respondents report doing real-ear.
Both of you obviously didnât read my above post⌠so once again Iâll ask the question, ie:
âWhat do you do if NO ONE in your area does REMâŚ!!?â
There are some parts of the U.S. where towns/cities are hundreds of miles apart⌠and because of it you may only have one Doctor, BC-HIS, auto mechanic, A/C service person, grocery store, motel, etc., etc. in the area.
You obviously canât EASILY âwalk with your feetâ if theyâre the only one around. I know. At one time (many years ago), I lived in Southern Utah next to the Arizona state line. To go to any decent size town/city over 1,200 people you had to drive three or more hours and a couple of hundred miles⌠and even then (depending on which direction you went), it was still a small town/city of 10 or 20 thousand, which still gave you VERY LITTLE to choose from.
The ONLY way to get any half way decent results would be to travel several hours North to Salt Lake City (181,000) or West to Las Vegas (484,000)⌠which meant you had to take a day off of work. Many other Utah surrounding states are the same way. So once again I ask for a REALISTIC answer.
âWhat do you do if NO one in your area does REMâŚ!!?â
Shi-Ku (Whoâs looking for a realistic and practical answer.) Chishiki
Ask for an aid with in-situ audiometry.
Or for a Starkey aid with built-in REM.
In-situ audiometry can be done on Oticon Agils, right? Iâm not sure if my audi does speech mapping or real ear measurements. She has never mentioned it and I havenât asked. I am still having a problem with muffled sounds in my better ear with the Agils. The HIs have been replaced and my hearing was retested in that ear. There was a small change (5 dB), and my audi bumped the right aid up a bit. Now I would describe it more as distorted rather than just muffled, so I donât think it was an improvement. I am getting new ear molds made, but if that doesnât solve the problem, Iâm not sure what to do next.
Being an Australian, I know all about travelling long distances between townsâŚitâs a fact of life for many Aussies.
So âŚhow far is too far to travel for real ear testsâŚhmmm how long is a piece of string? Depends on how important you think it is vs the hassle I guess.
What do you do if you want real ear tests but youâve decided itâs too hard to get them done? âŚthe only realistic answer Iâve thought of is. âŚyou donât get them. Not very helpful no doubt but realistic.