I am an clinical and dispensing audiologist and am developing a business plan to offer hearing aids at my cost - absolutely no mark up - and charge only for my professional services for performing audiologic evaluations, hearing aid fitting and follow up appointments. This ‘unbundling’ of services is not a new concept, but is little practiced. I find it unfortunate that most dispensing audiologists play the role of hearing aid salespeople who rely on sales commissions for some or all of their income, which is paid out of the substantial retail mark-up on hearing aids.
I would welcome your comments on my preliminary plan outlined below.
There would be an initial hearing/communication assessment for $250. This would include: (1) a battery of audiologic tests, including often overlooked speech-in-noise tests that give a much better sense of how someone copes in real world listening situations; (2) a detailed discussion and history on where the problems in communication seem to be occurring at home, work, social activites, etc.(a hearing handicap assessment); (3) development of a personal communication plan that would include counseling and communication strategies (ideally involving other family members), appropriate assistive listening devices (amplified phone, tv ears, FM system, etc.), and a recommendation for hearing aids if warranted.
If a hearing aid trial is appropriate, a $250 fitting fee would be charged that would cover the initial fitting appointment and all follow-up visits for the 45 day trial period. The patient would purchase the recommended hearing aids from me at my cost.
After the 45 day trial period, subsequent visits would cost $35 each time, or the patient would have the option of purchasing a year’s worth of service for $200.
This plan frees me up as an audiologist to give the appropriate testing and counseling without regard to the commission I will make on a particular hearing aid – I am essentially being paid only as a fee-for-service consultant, and not as hearing aid salesman.
For example, after a communication assessment, Oticon Delta 4000 hearing aids are recommended as part of the personal communication plan, and the patient decides to do a 45 day trial. They pay $250 for the initial assessment, $250 for the fitting fee, and $700 for each Delta 4000 (so $1400 for the pair), for a total cost of $1900. Say the patient decides to keep the Deltas and also buys a year’s worth of service for $200, so now they have paid $2100. The regular audiology or HA dispenser practice will charge around $1800-1900 for each Delta 4000, so the same patient would pay $3600-3800 ---- $1500 - $1700 more than the $2100 under the new plan. The difference widens with higher priced hearing aids – a pair of hearing aids costing $8000 could be fit and purchased under this new plan at around $3700 total.
I see no ethical reason why an audiologist should make more money on dispensing higher priced hearing aids when the time it takes to do the initial fitting and follow-ups is the same. In fact, the better the hearing aid, the more satisfied the patient and the less problems to address at follow-up appointments.
As audiologists, we are trained to assess hearing loss and offer professional advice on a wide array of strategies to cope with hearing loss. Hearing aids are only a part of the solution, but with audiologists’ incomes tied to sales commissions, there is tremendous economic pressure for hearing aids to be presented as the only solution.
I apologise for the length of this post. I would greatly appreciate input from both hearing aid users and dispensers. I see a tremendous value to the patient who not only saves a lot of money on hearing aids, but also gets an unbiased professional opinion on what to do about a hearing loss.