Hearing Aids

Unbundling Hearing Aid Sales From Professional Services Catches On But Causes Confusion Among Audiologists

I got lot of mail about my last post on shopping for hearing aids and on how bundling of hearing exams into the end price of a hearing-aid sale can make consumers less likely to try multiple brands before buying.

As it happens, unbundling is a hot topic in the hearing aid business right now. With consumers and hearing-loss support associations advocating for more transparency in the hearing aid sales process, audiologists are looking for new approaches to fitting hearing aids and providing follow-up service. But breaking new ground by moving from the older tried-and-true approach can be a challenging and confusing task, especially as more hearing aid brands come on the market and patients start asking for more information about the differences.

“Unbundling…is not straightforward and interfaces with many other challenges in health care,” one audiologist wrote me. “There are many models, and many of us are going nuts trying to figure it out!”

The problem for the audiologist is getting paid for all the amount of care required in the fitting and follow-up. Charging one price for an expensive pair of hearing aids and providing comprehensive service before, during and after the fitting is an attractive model.

With bundled sales and service, the hearing aid manufacturer sells the hearing aids to the audiologist at a wholesale price, and the audiologist marks up the retail price to compensate for extensive service. The process is simple for consumers, who just have to pay for the hearing aids — when the process works well they get all the service they need. The downside, however, is that consumers don’t know exactly what they are paying for. They don’t know how much the hearing exam costs, how much the fitting costs, how much the earmolds (if needed) cost, and how much the hearing aids themselves cost. Very often the consumer can’t even name the brand or manufacturer of the hearing aids they are wearing, other than to say “They’re what my audiologist gave me.” It makes comparison shopping difficult.

Not knowing exactly what you are paying for is a common problem in healthcare generally. When your cardiologists says you need a stent, do you ask him what brand will be used? If health insurance pays part or all of the cost, do you ask what the cardiologist will charge, what the anesthesiologist will charge, or what your general practitioner charged for the referral? When consumers aren’t educated and fail to ask questions, it’s less likely there will be the kinds of comparisons that lead to more choice and lower prices.

With most hearing aids not covered by insurance, and with demand growing from aging baby boomers losing their hearing at a predictable rate, audiologists are hearing a lot more of these kinds of questions. And many are starting to respond.

One audiology practice, the UNC Hearing and Communications Center at the University of North Carolina, is pioneering the new practice of completely unbundled hearing aid fitting, service and sales, with as much transparency in pricing as possible. Two audiologists from the Center, Barbara Winslow Warren, Au.D., and Stephanie Sjoblad, Au.D., wrote an excellent article about their approach for HLAA’s Hearing Loss Magazine. It’s a must-read for anyone trying to understand the ins and outs of unbundling. Click here–Unbundling of Hearing Aid Costs– to download it.

As with all markets, caveat emptor — buyer beware — should be the watchword for anyone embarking on the quest for better hearing. Perhaps the best advice I got among the emails that came in was from Dennis Hampton, Ph.D., editor of Hearing HealthCare News:

I think it’s a good idea to remember that a person with a hearing loss should be “shopping” for someone who will be their hearing care provider, not for hearing aids.  Follow-up care is the critical factor in coping with hearing loss….  There are excellent hearing aid products out there (many with far more technology and bells/whistles than are necessary), and the top products are more similar than different.  But the range of professionalism and quality of follow-up care is far greater—and that is what makes the difference.

I couldn’t agree more that anyone who fears they have suffered some hearing loss should get a good evaluation from a certified hearing health care profesional. And I also couldn’t agree more that it’s in your interest to get a second, third, and even fourth opinion, when you are deciding what kind of help to get for your hearing–and from whom. And finally, the more you know about what products are out there, and which brands and manufacturers have products with the features and performance you need, the better prepared you will be to ask the right questions.

As the old saying goes, “An educated consumer is the best customer.”

Shopping Around For A Pair Of Hearing Aids Is Harder Than You Think, Starting With The Hearing Exam

Shopping around for a pair of hearing aids is harder than you think, starting with the hearing exam. Getting a hearing test resulting in an accurate audiogram is easy enough. The test only takes twenty minutes or so, and when administered by a trained audiologist or licensed hearing aid fitter, the result is usually an accurate map of your hearing profile. It’s the first essential step in getting fitted for hearing aids programmed to precisely match your levels of hearing loss at all frequencies.

But because in nearly all cases hearing exams and other audiologists’ services are bundled with the end sale of a pair of hearing aids, the hearing test very often is the first step in a sales process that applies subtle pressure on the consumer to follow through with the purchase of a pair of expensive hearing aids from the provider administering the initial test. People buying hearing aids don’t try out as many brands as consumers in other markets, lessening competition that would otherwise drive product innovation, price competition, and faster market growth.

The process should be like getting your eyes checked by an ophthalmologist, who you pay for an exam and who then gives you a prescription for eyeglasses that you can use at any retailer stocking a variety of manufacturers’ eyeglasses to choose from. Instead, when you go to an audiologist, the usual process is to get your hearing test for free, then a prescription for the one brand of hearing aids that audiologist sells, with an immediate invitation to try and then buy those hearing aids. The difference is that with eyeglasses, exams and prescriptions are usually unbundled from the sale of the eyeglasses, whereas most audiologists bundle their professional services with the price of the hearing aids they sell.

Bundling services with product sales limits consumer choice because audiologists have a strong incentive to move the consumer quickly to purchase of the manufacturers’ hearing aids they stock. It’s uncomfortable for a consumer who has gotten a “free” hearing exam to stop the process then and there, ask for a copy of the results, and use the audiogram to shop around for the best aids they can find. So many consumers fail to try different brands of hearing aids, and competition in the market is constrained.

Therefore, unbundling of hearing health services from the sale of hearing aid products in the hearing-health supply chain would increase competition, opening the way for more product choice at a broader range of price points. As in other industries where competition increases, growth in the hearing device market would accelerate as more products, including lower priced products, reached a much larger available market of users.

Several forces are at work that may dramatically disrupt this status quo in the hearing aid supply chain. First, the Hearing Loss Association of America (HLAA) came out in favor of unbundling hearing aid sales from professional services as part of its Campaign to Make Hearing Aids Affordable. Meanwhile, there are a growing number of manufacturers offering lower priced hearing aids programmed at the factory to match audiograms sent in by users who got their hearing tested but did not buy their hearing aids from the professional who administered the exam. And third, hi HealthInnovations, a newly formed subsidiary of the huge UnitedHealth Group insurance company, has started selling more affordable hearing aids direct to consumers who take a simple test that’s available on the hi HealthInnovations web site. In the coming year, we may see a new distribution channel grow in the hearing aid industry, offering more a la carte services unbundled from the final sale of hearing aids.

As I embark on my shopping expedition for a new pair of hearing aids, I will be writing about my experiences with bundled and unbundled hearing aid sales. One way or the other, I plan to try out as many manufacturers’ hearing aid models as I can. And I’ll write about my experiences with both approaches to hearing aid sales and service.

Why The Hearing Aid Industry Ignores Black Friday

Even as I get tired of all the hype about Black Friday, I wonder why the hearing aid industry is conspicuous by its absence on the biggest shopping day of the year in the U.S. Today is the big day, the day after the Thanksgiving holiday when shoppers flock to the malls as retailers cut their prices and offer the best price-cutting and one-day sales events of the year.

But while my email inbox is full of offers from every retailer and manufacturer I’ve had contact with in 2011, I haven’t heard a peep from the many hearing aid manufacturers and resellers that send me sales pitches on other days of the year.

But on reflection I realize it should be no surprise. Why? Because manufacturers only reduce prices and put their products on sale when demand is weak and there’s enough competition in their market to make them worry. A little price incentive, especially in the holiday selling season, can be a great way to win a point or two of market share in a hotly contested market.

But the hearing aid industry is more like an oligopoly. Each of the five or six major manufacturers has a comfortable market share, and price comparison shopping is a rarity. Instead, sales channels are limited mainly to audiologists and hearing-aid dispensers, each of whom often only carries one manufacturer’s product line. People shopping for hearing aids usually get a referral to a good audiologist, and if they engage and start the process of buying a hearing aid, they often simply stop shopping around.

Lack of price competition or active consumer product comparisons means the price reduction curve that we see in other industries, especially during slow economic times, is a lot less pronounced in the hearing aid business. Customers who can afford to buy hearing aids still pay many thousands of dollars, while those who can’t afford them spend what money they have looking for Black Friday deals on other less expensive goods.

I’m wondering if Black Friday in 2012 will be any different for the hearing aid industry. In 2011 we’ve seen a number of “over the counter” hearing aid manufacturers enter the market, including UnitedHealth Group insurance company’s hi HealthInnovations subsidiary. These vendors are bypassing the traditional audiology sales channel and selling direct to consumers over the internet. They are trying to reach the tens of millions of Americans with mild hearing loss that can be treated with open-fit hearing aids providing a modest degree of amplification. The new products are less expensive and easy to purchase.

Hearing aid industry groups and professional audiology groups are up in arms about the new competitors, saying that without a full hearing exam and professional fitting, hearing aids can often do more harm than good. But U.S. regulators, who several years ago gave a green light on the internet sale of Personal Sound Amplification Products (PSAPs) directly to consumers, may not be inclined to intervene.

So, don’t be surprised if on Black Friday 2012, your email inbox is full of offers not only from your favorite department stores, but also with offers from some new competitors in the staid old hearing aid industry.

W.L. Copithorne, RIP — He Left A Pile Of Unused Hearing Aids In The Dresser Drawer

My 94-year-old father died recently, and as we were going through his things we discovered a collection of unused hearing aids sitting in his drawer. So it can happen to anyone, even someone whose son has spent the last five years writing a blog about the wonders of hearing aids.

In recent years I had spent a lot of time helping Dad search for solutions that would alleviate his mild hearing loss, but I never knew how many times he had tried hearing aids in the past. Last year, I got him an over-the-counter Songbird Ultra hearing aid that used replaceable Number 10 hearing aid batteries, and a couple of years before that, I had gotten him a Songbird disposable hearing hearing aid that he never replaced after its battery ran out. Though he heard better with both these lower-cost products, he never got comfortable with them and they ended up in the drawer.

At that time, I knew there was already another pair of hearing aids in his drawer. Shortly after my mother died 10 years ago, he went to an audiologist for a full workup and came home with a nifty pair of completely-in-the-canal (CIC) hearing aids that set him back several thousand dollars. But he stopped using that pair, complaining about feedback and discomfort. But it wasn’t until I cleared out his home that I found yet another pair of hearing aids he had purchased a number of years earlier and never used.

In spite of the fact that he had a son who’d long gotten past the stigma of wearing hearing aids, and who was a walking example of how helpful hearing aids can be once you get up the learning curve with them, he never found a pair that did the trick for him.

You would think that in this day and age of comfortable, open-fit hearing aids with sophisticated sound processing and advanced feedback cancellation, the unused-hearing-aids-in-the-dresser-drawer syndrome would be a thing of the past. But it’s not. I chalk it up to the fact that until you really, really need hearing aids, you’ll often find it easier to cope with poor hearing on your own than going through the learning curve required to use hearing aids effectively.

It takes a while for your brain to adjust and get used to the amplified sound coming into your ears, and a lot of users don’t realize that the brain eventually filters out the distracting sounds of your feet sliding on the carpet or the keys jangling in the ignition that you first experience with a new pair of hearing aids. And even with today’s much easier-to-use hearing aids, older users like me father in their 80s and 90s still often have some dexterity issues getting the hearing aid placed correctly in their ear and the volume adjusted to their liking.

In the final decade or more of his life, my father, like so many others, suffered with less than adequate hearing and never found a pair of hearing aids that he liked. It’s too bad, as it’s been shown time and again that users of all ages who make the effort and get up the learning curve end up with much better hearing and a higher quality of life.

But there’s good news to this story, too. Alongside my dad’s unused hearing aids were two pairs of my long-deceased mother’s hearing aids as well. When she hit her late sixties she decided to do something about the mild hearing loss that she had suffered for years. She went to Sears and got a pair of inexpensive Miracle Ear in-the-canal hearing aids and wore them at church and dinner parties. Among the collection I also found a nicer, and newer, set of Phonak hearing aids that were clearly hers as well — she must have graduated to a more expensive set along the way without my having noticed.

So while Dad never got the hang of his hearing aids, they seemed to work well for Mom. Maybe she had more patience than he did. Or maybe she was just a better listener!

ExSilent Ytango Is First Behind-The-Ear Hearing Aid To Place Both Microphone And Speaker In The Ear Canal

ExSilent, an independent hearing aid company which was an early entrant in the invisible hearing aid market, has expanded its product line with the Ytango, the first behind-the-ear (BTE) hearing aid to integrate both the microphone and speaker in an earpiece that sits within the ear canal.

By placing the microphone with the speaker in the ear canal while letting the small unit that sits on the ear handle all the digital sound processing tasks, the Ytango lets the concha and the ear canal provide the ear’s more natural acoustic sound-enhancing properties. The patented design enables the wearer to better pinpoint where sound comes from, experience less wind noise and better understand conversation in noisy situations.

ExSilent calls its new technology “MaRIC,” for Microphone and Receiver in the Canal. Many other companies have put the hearing aid’s speaker (receiver) in the ear canal, but none to date have also put the microphone there in a behind-the-ear device. In addition to acoustic benefits, eliminating the microphone from the behind-the-ear processor unit reduces its size and improves its cosmetic appeal. The module in the ear fits deeply, so it is nearly invisible as well. ExSilent has also developed a new soft dome that, like other manufacturers’ receiver-in-the-canal products, does not require a custom ear mold impression.

A Ytango Pro model adds AirTAP™, another technology first from ExSilent that was first introduced on its Qleaf Pro CIC in February 2011. AirTAP lets you select programs with a slight touch or pat on ear. The AirTAP switch lets users move smoothly through four personal preset programs to adapt to different listening situations. The Ytango Pro-T also adds a telecoil, that transfers signals from mobile phones, MP3 players and other audio equipment, through a Bluetooth-enabled neck loop directly into the user’s hearing aids.

ExSilent is demonstrating the Ytango at the American Academy of Audiology (AAA) AudiologyNOW conference in Chicago this week and will start shipping the new product this spring. At a show marked by fewer major new technologies and new-product introductions from hearing aid manufacturers than in previous years, the new ExSilent Ytango behind-the-ear hearing aid should stand out.

New Siemens Aquaris Hearing Aids Are Waterproof

The new Aquaris waterproof hearing aids from Siemens Hearing Instruments have taken the recent industry trend toward more durable, water-resistant hearing aids to a whole new level. Siemens says the Aquaris hearing aids are fully waterproof to depths of three feet for up to 30 minutes.

The new hearing aids promise to eliminate the repair problems associated with sweat, dirt and humidity, in addition to expanding their functionality: Siemens has even developed a sound-processing program that can be switched on while swimming to help the hearing aids adapt to the sound of water splashing and other acoustic challenges.

The company describes the technology developed for the new waterproof hearing aids in its news release:

A scratchproof, rubber-like surface holds the device securely behind the ear and prevents it from slipping. The battery compartment is equipped with a waterproof but air-permeable membrane. As a result, environmentally-friendly zinc air batteries can be used, which always require “air to breathe”. The cover clip is attached to the top of the casing via ultrasound. It also protects the waterproof but acoustically transparent microphone membrane, which was specially developed for Aquaris. A nano coating and a seal protect the earpiece.

As with its other latest-generation hearing aids, Siemens equipped Aquaris with its BestSound Technology, which improves speech understanding, the wearer is able to make adjustments using Siemens “Tek” and “miniTek” remote operation, and the hearing aids link wirelessly with modern communication and entertainment electronic devices.

ReSound’s Water-Resistant “iSolate Nanotech” Coating Is On Cutting Edge Of A Revolution In Hearing Aid Materials

ReSound’s announcement that its iSolate Nantotech protective coating has reduced moisture-related repairs to its hearing aids by 50 percent since its introduction six months ago is the latest example of a quiet revolution in modern materials that is transforming the hearing aid industry.

As the spotlight has been shining on new sound processing systems and other software-driven bells and whistles that have improved digital hearing aids enormously in the past two years, the leading manufacturers have also been experimenting with nanotech-based materials, water-resistant coatings, and ceramic housings that have made hearing aids more comfortable, more durable, and far less likely to require repairs. In an industry historically marked by unusually high product return rates and high numbers of customers who stop wearing their hearing aids shortly after buying them, this revolution in materials is driving higher levels of customer satisfaction with more comfortable and reliable products.

ReSound’s iSolate nanotech coating, now used in all of ReSound’s hearing aids, establishes a thin protective layer that bonds at the molecular level with the internal and external components of the hearing aid, shielding them without affecting their performance. The application process, which is done in a vacuum chamber, ensures global coating of all components inside and out. Liquids or moisture coming into contact with the hearing aids simply roll off without being absorbed.

Because moisture related failure is one of the main causes of hearing-aid returns, the innovation has had a dramatic impact on product reliability. ReSound said that in a review of 50,000 hearing aids sold in the first six months since its introduction, it found that the iSolate nanotech protective coating decreased moisture and debris related repairs by 50 percent.

ReSound’s innovation is only the latest in a series of new materials and manufacturing processes announced by industry leaders.

• Starkey Laboratories’ Advanced HydraShield moisture protection system “integrates nano-coating, unibody construction and smart component placement,” which the company claims “provides 100 percent resistance to water, humidity, perspiration and corrosion, both inside and out.”
• Phonak’s “high-tech ceramic housings” are more attractive and comfortable because they are scratch resistant, they adapt to body temperature more quickly and help prevent perspiration in or behind the ear, they are hypo-allergenic, and they are shock-resistant.
• Oticon says its new super-power Chili hearing aid’s “unique shock absorbing receiver mounting prevents it from breaking should the instrument be dropped or fall off the ear,” while a “full body nano-coating” and internal seal protect the electronic parts from water, moisture, and dirt.
• And Cochlear Ltd says its Nucleus 5 cochlear implant, made with high-tech materials including water-resistant batteries, can be submerged in water for up to 30 minutes without failing.

And we can expect to see more announcements like these–although ReSound is the first manufacturer I know of who has actually documented the benefits of new materials by tracking a reduction in repair rates–because reliability is a critical factor in the success of any new in-ear or behind-the-ear product. Any audiologist or hearing aid designer can tell you that the inner ear is one of the most hostile places on the planet for miniature, high-performance, digital electronic devices. It’s wet, humid, and full of potential infectious agents. And because the devices themselves are so tiny, they are far too easy for large human fingers (especially for those of us who are “all thumbs”), to drop on the floor and otherwise abuse. Therefore the space-age materials that are making today’s hearing aids more durable and comfortable than ever before may be as important to their acceptance by more users as their ability to provide high-quality amplified sound.

Miracle-Ear Mirage Is The Latest Entrant In The Burgeoning Market For Invisible Hearing Aids

With its introduction this week of a very small digital hearing aid that sits deep enough within the ear canal to disappear from sight, Miracle-Ear is the latest entrant in the burgeoning market for “invisible hearing aids.” The Miracle-Ear Mirage is a digital hearing aid with many of the advanced features customers expect in full-featured digital aids, including feedback cancellation and digital noise reduction, programmable settings, intelligent peak smoothing, and “SoundBoost” volume control.

Miracle-Ear hearing aids have been on the market since 1948, when Ken Dahlberg, a World War II aviator turned electronic inventor, started manufacturing the first in-the-ear hearing aid, which he called “The Miracle Ear.” Since then the company has not been known as an innovator in digital hearing aids, but with the backing of corporate parent Amplifon, it has maintained a strong presence in retail channels including an exclusive relationship with Sears Hearing Aid Centers.

Today the entire line of Miracle-Ear hearing aids extends from entry level devices to the high-end ME-1 hearing aids with advanced noise reductdion, speech enhancement, Bluetooth compatible connectivity, optional remote control, multiple listening programs, and other features.

Other invisible hearing aids include the SoundLens and other branded solutions from Starkey Laboratories, Lyric Hearing’s extended-wear invisible hearing aids, ExSilent’s QLeaf invisible hearing aids, and ReSound’s Alera Remote Microphone hearing aid.

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