Audiology Resources
Monthly News & Updates
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I am so tired.
The best thing for me and my business:
- Never volunteer my time or money to the profession.
- NEVER speak up and put myself out there in my ideas, presentations, writings, or social media posts,
- Sell my soul, like many of my colleagues, to a hearing aid manufacturer, buying group, or TPA and, most importantly,
- STOP TRYING TO FIGHT FOR A FUTURE FOR AUDIOLOGY AND AUDIOLOGISTS WHEN THOSE WHO THIS TRULY AFFECTS DO NOT CARE ENOUGH TO ENGAGE.
I am not trying to be a martyr HERE (although I know I sound like a really whiny one) but I am burned out. I have been trying to move the needle for over 15 years now. I do not know how much headway has been made given the things I still see happening in our profession every day. It saddens me to see just how many folks have lost sight of our collective "why" and how our care and delivery models still look a lot like they did in 1992.
Maybe I should give up? Take a break? I do not know if I can quit when the stakes are so high but I also do not know how much more FIGHT I have in me either.
I think I may know how Charlie Brown feels. Maybe a need a vacation...
Kim
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Monthly Coding and Reimbursement Tips
Services to Hospice Patients
Hospice patients have unique billing challenges because Hospice care typically falls under Medicare Part A, skilled nursing, or hospital billing limitations.
If you see a hospice patient, you may want to consider using modifier GW which informs the payer that the services provided are not related to the hospice patient’s terminal condition. This modifier should be added to all of the medically reasonable and necessary services provided on that date of service.
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Journal/Resource Spotlight
It is time for us to explore the expanding research in the pharmaceutical prevention, treatment, or management of hearing loss and the companies who are exploring this new, exciting medical frontier.
Pharmacological Agents and Hearing Loss
- https://soundpharma.com/
- https://www.decibeltx.com/
- https://www.frequencytx.com/
- https://aurismedical.com/
- https://www.otonomy.com/
- https://www.news-medical.net/news/20210107/Repurposed-drug-can-treat-hearing-loss-in-humans.aspx
- https://pubmed.ncbi.nlm.nih.gov/21924333/
- https://www.sciencedirect.com/science/article/abs/pii/S0140673617317919
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Hearing Aid Manufacturers: Friend or Foe? |
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I am again revisiting the issue of our relationship with manufacturers, which I wrote about four years ago! The areas of concern have increased exponentially since 2017.
Please do not get me wrong. I do not hate hearing aid manufacturers. Throughout my career, they have provided me, and in turn my patient, with some life-changing products and some incredible advancements in technology. I do not think they are all inherently evil (like the people who make mass produced beer or vegan cheese, but I digress). I know some incredible people from within industry and some of the best audiologists I have ever met work in this space. They have a needed role as our industry partner. My issue is that the relationship has gotten skewed and, to make an analogy, we need to get the seemingly “friendly” fox out of the henhouse.
The ONLY role (and, in my opinion, it should be the only purpose) of hearing aid manufacturers is to supply hearing aid providers with the products we need to mitigate hearing loss. THIS is their core role and audiologists need to recognize that they are in the business of selling as many hearing aids, auditory osseointegrated devices, cochlear implants, earmolds, and pieces of test equipment as is possible. Every hearing aid manufacturer (except for the privately held companies) have a LEGAL obligation to their stockholders to sell products, grow their businesses, and make a profit. They are in the business of making money by any means necessary. Vertical integration is their new mantra. They want to control every aspect of the distribution chain, from production to patient delivery. I, for one, do not begrudge them for this in the least. If and when they go over the counter, I will applaud them as this is what they do: create and sell amplification solutions. I also applaud when these solutions become more accessible and affordable.
This vendor/customer relationship though has gone completely off the rails. Somewhere along the way, providers lost sight of this dynamic and what the relationship should be. We started thinking of them as our friends, business partners, protectors and benefactors rather than our suppliers and, in many cases, our competition. We started depending on manufacturers for everything, well beyond supplying a product. They saw advantage in our dependence and went with it.
We needed them to provide us with free continuing education, beyond training on the specific products, and in a location and setting that afforded us a vacation. Instead of us having them train us on the specifics of their product, we wanted them to train us on EVERYTHING. We wanted them to help us run and grow our practices or businesses. In this case, we often even gave them unfettered access to our business’ financial information in an attempt to get from Point A to Point B. We wanted manufacturers to help us market, both creatively and financially. And, we expected them to fund our conventions, foundations, and professional endeavors. We became dependent on manufacturers for everything and failed, as a result, to stand on our own as a profession. This has been building over the past 45 years. Much of this “nanny state” contributes to the higher cost of amplification to the provider. The Veteran’s Administration, third-party administrators and Big Box retailers do not require all of these “extras” and, as a result of this and their substantial purchasing power, they have significantly lower prices than the rest of us. All of us, myself included, have fallen victim to this at one time or another in our careers. These decisions have put us at a competitive disadvantage.
Too many audiologists believe that hearing aid manufacturers always have our best interests at heart and wholeheartedly believe the rhetoric and propaganda. We need to understand that they do support us but only when it is beneficial for them as well. Audiology is a means to an end for them. See, from my vantage point, while they have done many positive things (sold us products, propped up associations, provided training and support), they have also done MANY things that are or could be detrimental to audiology and private practice. In some ways, things that have more long term negative consequences than over the counter hearing aids. We have applauded them while they have quietly, on the back end, been undermining us.
Consider their:
- Ownership of or significant investment in buying groups. They are making money off of your purchases of their products and the products of their competitors. They are, in some ways, buying from each other.
- Ownership of or significant investment in third-party administrators. They ignored your relationship with an insurer and undercut it, by offering products at costs you cannot touch (because you cannot get them at that price from the same manufacturer) while still asking you to provide the work product. They also can direct patients to their own corporate owned or partner clinics first. Again, this is yet another opportunity to purchase products from each other.
- Misleading and misdirected guidance about the enforceability of the Food and Drug Administration, Federal Trade Commission and state hearing aid dispensing laws that create an unfair playing field for providers, while allowing over the counter, direct to consumer entities to grow and thrive.
- Failure to adequately police and mitigate, despite their assertions of the horror of over the counter hearing aids, direct to consumer enterprises, both in the US, Canada and abroad, that distribute manufacturer hearing aids, both current products and older models, through online entities and eBay.
- Clinic ownership and, as a result, direct distribution, both through purchasing existing clinics and creation of new clinics. They have created or own your competition.
- Supplying top of the line products to big box retailers at a fraction of the cost any private entity can purchase a comparable product.
- Creation of free or low cost “conventions”, which diminish support of and attendance at state and national professional meetings. They will only attend, as exhibitors and sponsors if they can justify their return on investment.
- Assistance with practice business development where they have the right of first refusal (and, as a result of the business development activities, they know a great deal about the financial aspects of your business). You are helping build a corporate competitor of private practice audiologists.
- Support of the growth of the hearing aid dispenser sector, because of their own clinic staffing needs.
- Blaming providers for the high cost of amplification (they indicate that we account for two-thirds of the cost) to anyone who will listen (the media and consumers) while failing to acknowledge the price providers pay for goods, especially high end hearing aids. They do this while, in provider circles, claim to be our saviors.
As I hope you can see, we have created now an unholy alliance.
This situation, though, can be remedied. Audiologists need to band together and get some control of this relationship. We need to be the customer and not the consumer. We need to stand on our own two feet. There are MANY examples, especially in academic and large healthcare settings, where manufacturer involvement is reduced yet the practice thrives. We can regain control from a variety of means:
- Funding our own continuing education. There are lots of means of lower cost continuing education, including state association meetings (which need your support), association offerings, and online courses. Manufacturer trainings can isolate their customers from divergent ideas and competitive products.
- Funding our own travel. It will be an audiology free zone and your will be more rested as a result.
- Running our own businesses. There are many private, unaffiliated entities out there (lawyers, accountants, financial planners, web designers, marketing consultants, event planners, billing companies) who you can hire to assist you with your needs. The Small Business Administration also has valuable resources available.
- Keeping our business information private. Businesses should not share proprietary information with other businesses, especially ones that might someday be their competitor.
- Funding and creating our own marketing plans and marketing AUDIOLOGY and not a specific product or price. If every audiologist did this in their own community, you would have a national audiology marketing campaign.
- Funding our own business needs. Local banks and the Small Business Administration are excellent funding sources.
- Examining our existing product mix and vendor relationships. No product cures hearing loss and no current hearing aid manufacturer has a magical product that cannot be improved or expanded upon. No product is irreplaceable. Look at every vendor. Explore other options and products, maybe even some over the counter. Find a value based solution, whatever is it and whoever it is from, to compete with online, over the counter and third-party administrator offerings.
- Negotiate the best possible invoice price and forgo the “perks”. It should be all about cost of goods and patient centered extras (warranties) and nothing else.
- Have every manufacturer relationship and contract vetted by YOUR OWN legal counsel. Anti-kickback and conflicts of interest must always be ruled out.
- Always ask, when audiologists defend the status quo and manufacturers in public venues, what their personal or financial relationships are to industry. Potential conflicts of interest should be disclosed so individuals can make informed decisions.
- DEMAND to know whom owns whom. We need sunshine on this industry.
- SUPPORT ourselves and our profession and do not delegate that right and responsibility to any third-party, especially one that is, in many ways, our competition.
- BIND together with other audiologists for the long-term success of AUDIOLOGY. Only WE truly care about our future. They care about sales.
- Take a long, hard look in the mirror and see how YOU fall in your industry relationships.
The time is now to change the relationship in a way that benefits audiologists, manufacturers and consumers. This is about regaining our independence. Let’s stop prostituting our profession for our manufacturer pimp and take over our own destiny.
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