Demant, Copenhagen, Denmark, has announced the introduction of Philips branded hearing aids to the global hearing aid market, according to a press release from the company. A new player, the Philips brand is entering the hearing healthcare market with a complete range of premium hearing aids, accessories, and applications to best serve hearing aid users. Demant states Philips Hearing Solutions will quickly become a trusted brand with hearing care providers and users, as it has great potential around the world to present unique opportunities for hearing care professionals in an ever-evolving market.

In August, Demant  announced a licensing agreement with Philips, which is headquartered in Eindhoven, The Netherlands, to bring Philips-branded solutions to the hearing healthcare market.  Demant (formerly William Demant Holding) is the parent group of Oticon, Sonic, and Bernafon hearing aids, as well as Oticon Medical.

“Based on a shared vision of improving the lives of people through innovative healthcare this new cooperation will not only change the way we see hearing healthcare, but also widen the definition of hearing healthcare, supporting healthier lifestyles and active aging,” said Spencer Ramsey, Senior Director of Brand Licensing, Philips, in the press statement. “Combining Demant’s world-leading hearing aid technology with Philips’ global brand presence in healthcare, the cooperation will enrich the hearing healthcare experience.”

The new premium Philips hearing aids—named Philips HearLink—are now available for hearing care professionals in selected countries. The look and feel of the Philips HearLink hearing aids is designed to cater to today’s baby boomer generation with design and usability developed for this expanding market. Philips HearLink users will benefit from connectivity between their hearing aids and the devices they use in their everyday life, such as smartphones and televisions. The hearing aids will reportedly be manufactured by Demant using the Velox-S and Velox platforms, and will be available in a complete range of styles, including RICs, BTEs, ITCs, CICs, and IITs.

Søren Nielsen

“The Philips hearing aids will provide users with an innovative, future-proof hearing solution,” says Demant President & CEO Søren Nielsen. “We live in an age where user engagement and digital services are shaping the future of healthcare technology. More and more people are conscious of taking control of their own personal healthcare and are using electronic devices to do so. In this light, Philips Hearing Solutions offers new and exciting premium solutions alongside Philips’ healthcare ecosytem, which will attract interest and generate significant benefits to users, ultimately supporting our valued customer base of hearing care professionals.

“With this partnership, we take connected hearing healthcare to the next level and offer new and exciting solutions within integrated healthcare services to the benefit of both professionals and people suffering from a hearing loss,” continued Nielsen. “Health, caring, and innovation are cornerstones in the vision of both Demant and Philips, which makes the partnership a great match for the future. Furthermore, it will strengthen and add value to both companies’ ambition to improve people’s lives.”

The Philips brand is something of a “back to the future moment” for more seasoned dispensing professionals. Philips was a well-known hearing aid brand in the 1990s, and the company embarked on a technical collaboration with Telex then exited the market just before the turn of the new century when Beltone purchased Philips’ hearing aid technology. The Hearing Review published numerous news and technical articles about Philips technology in the 90s.

Traditionally, hearing aid branding has not played a large role in hearing healthcare; MarkeTrak 9 suggested that less than half of hearing aid users (43%) could identify the brand of their device. However, many experts in the industry believe this is due to change, as more consumers are expected to enter the market and there is continued competition and aggressive marketing among dispensing chains, pharmacies, mass merchandisers, and online retailers. The Philips brand brings with it one of the world’s best known and trusted healthcare and consumer electronics brands.

For further information about Philips Hearing Solutions and a full presentation of the Philips HearLink product range, visit: hearingsolutions.philips.com

“Depression, Hearing Loss, and Treatment with Hearing Aids” by audiologist and educator Victor Bray, PhD, is a new white paper, produced by The Hearing Review and sponsored by Hamilton^® CapTel^®, that presents a comprehensive overview of what we know about this subject, and provides a strong case for the partnership of audiologists and mental health experts in the battle against chronic depression.

In the article, Dr Bray challenges some of our traditional “cause-and-effect type” explanations for how hearing loss may increase the risk of depression, revealing why the situation may be more complex than previously thought. He reviews previous landmark studies—along with many recent exciting findings—and provides insights into specific patient populations whose lives might be positively transformed with appropriately fit hearing aids, cochlear implants, assistive devices and captioned telephones, and/or auditory training and hearing care services. The article also offers intriguing commentary on what might be viewed as an extremely important future area for hearing healthcare professionals.

The article is a summary of Dr Bray’s webinar of the same title.

Click here to download the article.

Maico Diagnostics, MPLS, MN, an Eden Prairie, Minn-based global manufacturer of hearing instruments since 1937, announced the launch of  easyScreen with BERAphone®.

The easyScreen is said to unite AABR, OAE, plus the patented technology of BERAphone, a no-cost, disposable newborn hearing screening device.

Introducing the new easyScreen BERAphone®

Built on the legacy of the MAICO MB 11 BERAphone®, the easyScreen BERAphone is said to allow hearing care practitioners to perform ABR screening without the expense and waste of disposables. The reusable electrodes and ear cushion are built right into the instrument. The technology helps achieve fast test times with the patented CE Chirp® stimulus and response detection algorithm, according to the company’s announcement.

easyScreen BERAphone incorporates features requested by our customers

• Button on the BERAphone handle allows you to start, pause, and stop the test right where you are, at the baby’s side.
• Red and blue LEDs indicate the selected test ear to assure test accuracy.
• LEDs provide feedback about measurement quality during the impedance test and ABR data collection.
• Oval, semitransparent ear cushion helps you see the placement around the ear and provides superior fit on small heads.

Contact MAICO for more information on the easyScreen BERAphone by phone at 888-941-4201 or by visiting: www.maico-diagnostics.com/us

Source: Maico Diagnostics

Images: Maico Diagnostics

Responding to published concerns by the Federal Communications Commission (FCC) that captioned telephone services (CTS) are being utilized by people who are not appropriate candidates—leading to potential funding deficits of this critical service—the American Academy of Audiology (AAA) and the American Speech-Language-Hearing Association (ASHA) announced that the two audiology organizations have jointly developed proposed best practices for determining eligibility for the program.

CTS are designed to help people with hearing loss place and receive telephone calls by allowing them to speak directly to the called party and then listen and concurrently read captions of what the other party is saying. These vital services are paid for by the Telecommunications Relay Service (TRS) Fund and administered by the Federal Communications Commission (FCC).

Under the Americans with Disabilities Act (ADA), CTS is offered free of charge to people who are deaf or hard of hearing. However, FCC regulations prohibit the use of CTS by people who do not have a hearing loss, including those with no hearing loss who reside in the same household as the person with hearing loss, as well as people with hearing loss whose hearing loss is adequately addressed by other amplification or services. The use of CTS by individuals who have the capability of using conventional phone systems unnecessarily increases the cost of providing the TRS programs.

“The challenges associated with using the phone can contribute to isolating people with hearing loss, as well as negatively impacting educational opportunities, employment, and safety,” said ASHA 2019 President Shari Robertson, PhD. “This underscores the critical need to protect Captioned Telephone Services for those who truly need it. As such, ASHA is very pleased to collaborate with the American Academy of Audiology on these best practices, which will provide guidance to the members of our respective organizations as they care for their clients and patients.”

“Audiologists play a vital role in evaluating and treating hearing loss to ensure that our patients can continue to work, go to school, or interact with family and friends at home,” said AAA President Lisa Christensen, AuD. “As the expert on hearing loss and inner ear disorders, the audiologist is most qualified to evaluate whether a patient would be an ideal candidate for a captioned telephone. These best practices should serve as guidance to audiologists when determining the effectiveness of a captioned telephone for a certain patient. We thank ASHA for collaborating so effectively in developing these suggested best practices and look forward to continuing this work as the FCC continues to evaluate the CTS program.”

Nine suggested best practices are presented by the groups in this document. Among them are the following:

• Individuals seeking CTS should have communication impairment that significantly affects speech understanding, even when using amplification devices and a conventional phone.
• Individuals being considered for CTS should undergo an appropriate, comprehensive assessment to determine the need for assistive communication technologies, including CTS.
• The patient history should include questions designed to determine the disability associated with telephone use and the availability of existing telephone technologies (e.g., smartphone, visual communication options such as FaceTime, availability of amplified systems, etc.), and desired patient outcomes.

The suggested best practices are intended to cover both analog and Internet-provided phone captioning. Analog CTS is landline based, available over conventional phone lines. The Internet Protocol Captioned Telephone Service (IP CTS) is an Internet-based system that uses an existing voice telephone and a computer—or other Internet-connected device—rather than the conventional phone network to provide the link and captions between the individuals who are deaf or hard of hearing and another party. It can also be used as an app with a smartphone. In 2007, the IP CTS was approved by the FCC as a form of relay service that may be compensated from the Interstate TRS Fund.

AAA and ASHA note that the organizations “support the availability of the CTS, including the IP CTS, to allow individuals who have the degree, type, or configuration that prevents traditional telephone use, to still be able to access telephone services. These same organizations also understand the necessity to restrict this service only to persons who are deaf or hard of hearing and support efforts to reduce the use of the service by those who do not have hearing loss in order to preserve the service.”

The complete suggested best practices are available here.

FCC continues to look for ways to reduce costs in TRS Fund. Captioned telephone services are extremely important in meeting the communication needs of people with hearing loss, and it is well known that telephone use for those with hearing loss, including those with hearing aids and implantable devices, can be very difficult or impossible.

However, the FCC has been looking for ways to improve the efficiency and reduce costs related to IP CTS. TRS now represents almost 80% of the total minutes compensated by the FCC’s funding for the program, and the Commission reports that it is taking steps and explore ways to reduce waste of the TRS Fund and expand the Fund’s contribution base to ensure the continued viability of IP CTS for people with hearing loss who need it.

In July 2018, it proposed automating phone captioning, indicating an interest in utilizing automated speech recognition (ASR) as an alternative to live captioning assistants (CAs) for Internet Protocol Captioned Telephone Service (IP CTS), making the use of CAs optional.

On February 14, the FCC announced it was integrating IP CTS into the TRS User Registration Database, a centralized system of records currently used in the Video Relay Service (VRS) program.  The Commission says including IP CTS user registrations in this database would help it verify the identity of IP CTS users, audit and review IP CTS provider practices, and substantiate provider compensation requests.  In addition, the Commission proposed requiring IP CTS providers to add user account identifiers to call records submitted for compensation with the intent to combat misuse of funds and ensure money is used appropriately to support hard-of-hearing Americans.

The Commission also proposed simplifying the handling of 911 calls by no longer requiring IP CTS providers to serve as an unnecessary intermediary in connecting 911 call centers and IP CTS users.  If a mobile and web-based IP CTS user has a telephone number that enables the delivery of captions when an emergency dispatcher needs to reconnect a disconnected call, the Commission is proposing to relieve the IP CTS provider of the need to involve its captioning assistants in reconnecting such calls and to transmit additional data such as an ID and callback number for the person providing captions.

Patient Care | May 2019 Hearing Review

An improvisational approach to patient-centered care can be beneficial for all 

By Michael A. Harvey, PhD, ABPP

Patients will often remember and appreciate your “bedside manner”– or the way you relate to them in a personal and caring way–over your knowledge, skill, education, and professionalism. Using an improvisational approach to the patient interview may, at times, be cumbersome. However, it is also likely to make your approach to their hearing-related problems more interesting, genuine, and meaningful—for both the patient and you.

Motivational Interviewing (MI) is a goal-directed, patient-centered approach to elicit emotional “change talk” from patients and increase their adherence to recommendations.¹ After a workshop I conducted on motivational interviewing, an audiologist commented that he could see how MI could benefit his patients, but added that “It’s cumbersome.” I think I responded with something like, “Yeah, it’s a new skill but it gets easier with practice.”  It was one of those comments that, in retrospect, you regret because you know it was an opportunity missed. This article is my attempt to more completely respond to his comment, and to describe some benefits for Hearing Care Professionals (HCPs) of doing what initially may feel cumbersome.

Improvisation in Music..and Counseling

I had always wanted to play the hammered dulcimer, a percussion-stringed instrument that consists of strings stretched over a trapezoidal resonant soundboard. So I signed up for a week-long, intensive hammered dulcimer training session. Because it was marketed as “chord camp,” I assumed it would be fun, an adult version of eating s’mores around a campfire, a reprieve from the routine of my psychology practice.

I was wrong. I found myself barraged by too much new and difficult material too fast  (eg, “What the heck is an inverted chord?”), constantly anxious about playing the wrong notes or the wrong order of notes, falling flat on my face in front of the teacher and other students, etc.

During that very long week, my mind wandered back to more familiar territory, including the audiologist’s comment about MI being cumbersome. (He should attend chord camp!) But what most poignantly brought me back to our exchange was when the dulcimer teacher talked about the value of improvisation: “Playing different notes keeps it new and interesting for both the audience and performer,” he said.

I then realized how I should have responded to the audiologist: “Although adhering to a standard patient interview protocol with the same ‘notes’ may be comfortable for you in contrast to improvising with MI ‘notes’ which would be cumbersome and perhaps even anxiety-provoking, your improvisation may make the interview more interesting for you and your patients.”

I could have referenced a discussion among audiologists at the Ida Institute (https://idainstitute.com), an independent, nonprofit organization in Copenhagen, Denmark, that works to integrate person-centered care in hearing rehabilitation. The audiologists emphasized the value for themselves of using motivational interviewing:

“It’s also fun to have a completely different conversation with the client,” one audiologist began. “It’s not just the nodding client and the blabbering audiologist. It feels like a nice conversation, during which you get a lot of information in a short period of time.”

“So, it has benefited you, too?” he was asked.

“Yes, it certainly has. When I think about the way I used to consult, it may have appeared to the professional that I understood what I was doing. But they weren’t individual consultations. They were standard and they sounded good…I just wanted to appear professional on the outside.”²

Engaging with Patients

Inviting patients to articulate their motivation for improved hearing inevitably is also inviting patients to articulate a slew of raw emotions associated with self-identity and peer/familial/work relationships—often years of missing words and conversations, anxiety, and fear about inadequacies, loneliness, etc.  Moreover, in an earlier publication, I described how the context of the audiologic visit inevitably sets the stage for more intimate patient self-disclosure.³  As an example,  a mother recalled that, “While Dr Smith was showing me how the hearing aid worked, I couldn’t help blurting out that it’s so unfair for my poor little girl and I started to cry.”

As another example, Jill was a middle-aged woman who requested hearing aids around the time that her father was diagnosed with terminal cancer. When Dr Jones asked her the “Why now?” question, her response was short and to the point: “I want to make sure I understand everything my dad’s oncologist says.” Then, when he fitted her with hearing aids, seemingly out of  nowhere, she suddenly began sobbing uncontrollably. Later, Dr Jones would understand that inasmuch as this procedure catalyzed joy and gratitude for her improved hearing, it had also catalyzed post-traumatic flashbacks of scenes that portrayed years of estrangement from her dying father.

The Changer and the Changed

There is a Buddhist saying that when the student is ready, the teacher will come. For our present discussion, the HCP becomes the student while the patient becomes the teacher. The HCP is given an invaluable growth opportunity by bearing witness to patients’ emotional self-disclosures. One audiologist described her profession as giving her life more contrast and texture:

“Sharing in the growth and development of another person as they cope with hearing loss is an honor, a life-altering, spiritual experience for those who are open to it. Our clients’ resilience promotes our increased respect for the human spirit.

“We have the experience of knowing intimately people we would otherwise not have known, and of sharing vicariously in others’ life choices and struggles, their most intimate feelings, needs, and concerns which get sparked by their loss of hearing. Our connections with clients through humor, love, and pain contribute enormously to our growth as individuals, add complexity to our lives, and increase our capacity for empathy and understanding.

“At times we have had glimmers of wisdom resulting from our work. Our clients teach us the things we might have learned from grandparents, wise elders. Sharing joy and sorrow, laughter and pain, wisdom and ideas with another person is at the heart of what it means to be human.”

Contrast and texture notwithstanding, there are professional concerns regarding eliciting patients’ emotions: that attending more to patients’ emotions in an “improvisational” manner runs the risk of “opening a can of worms,” going beyond professional boundaries, and consumes too much appointment time. Consider the following perspective:

“I think part of being a good audiologist is recognizing when an individual with hearing loss and/or family member is having a tough time coping with the hearing loss and making an appropriate referral to a psychotherapist who is trained to deal with these issues. You can only wear so many hats and we shouldn’t beat ourselves up if we can’t solve all of a given patient’s problems.”

These are valid points. Moreover, to return to the improvisation metaphor, playing notes in a random, haphazard manner typically produces dissonant noise (aka, a “can of worms”), is poor musicianship (aka, violating professional boundaries), and wayward performances (aka, consumes too much time).

Guidelines for eliciting emotional material in an effective and ethical manner have been provided elsewhere.^4-10 Briefly, these include asking patients bounded open questions (eg, “In the limited time we have, would you give me a snapshot about how you’re feeling?”); validation and normalization of patients’ emotions; delineation of your role as a HCP (not a psychotherapist); and carefully making a therapy referral, as needed.¹⁰ Moreover, effective counseling can be incorporated into most clinical practice settings in an efficient and effective manner, without negatively impacting the time constraints of the practicing audiologist.¹¹

Of course, I am not suggesting the elicitation of patients’ emotions solely because it would be more interesting and beneficial to the HCP. What I am suggesting, however, is that it can be a win-win; that the elicitation of a patient’s emotions, or “playing different notes,” can be psychologically beneficial for the patient and increase the effectiveness of the HCP. This is exemplified by the following report from an audiologist:

“Many letters have come from patients thanking me for changing their lives, or saving their marriage because of my kind, sincere, caring bedside manner. My patients really seem to remember those characteristics over how much knowledge, skill, education, or professionalism I have. I have had several patients say to me with full gratitude that I am the first person who has so much patience to listen to them, and understand them more than anyone else. It’s what keeps me warm on a cold winter’s day.”

After my MI workshop, I could have said to the audiologist that practicing MI, although initially cumbersome, could keep him warm on a cold winter’s day. That is, in the words of Carl Jung, “Find out what a person fears most [finds most cumbersome] and that is where he will develop next.” And I could have told him about the value for me of improvising with my hammered dulcimer —after explaining what a hammered dulcimer is.  Maybe he’ll read this article.

References

1. Miller WR, Rollnick S. Motivational Interviewing: Preparing People for Change. 2nd ed. New York, NY: The Guildford Press;2002.

2. Ida Institute. Motivational engagement [videos]. Talks presented at: Skodsborg, Denmark; September 2009. https://idainstitute.com/what_we_do/seminars/motivation.

3. Harvey MA.  The transformative power of an audiology visit. Hear Jour.2000;53(2), 43-47.

4. Beck DL, Harvey MA. Motivational interviewing. The Hearing Professional.2018;58-65. https://ihsinfo.org/IhsV2/CEUs/pdf/2018%20THP%20Q3%20p58-65+67.pdf.

5. Beck DL, Harvey MA. Creating successful professional-patient relationships. Audiology Today.2009;21(5):36-47.

6. Beck DL, Harvey MA, Schum DJ. Motivational interviewing and amplification. Hearing Review.2007;14(11):14-20.

7. Harvey MA. When a patient requests hearing aids but doesn’t want them: Psychological strategies of managing ambivalence. ADA Feedback. 2003;14(3):7-13.

8. Harvey MA. Audiology and motivational interviewing: A psychologist’s perspective. Audiology Online. October 20, 2003. https://www.audiologyonline.com/articles/audiology-and-motivational-interviewing-psychologist-1119.

9. Harvey MA. How to refer patients successfully to mental health professionals. Hearing Review.2008;15(7):22-26.

10. Clark JG, English KM. Counseling-Infused Audiologic Care. 3rd ed. Cincinnati, OH: Inkus Press;2018.

11. English K. Integrating new counseling skills into existing audiology practices. Audiology Online. January 4, 2001. https://www.audiologyonline.com/articles/integrating-counseling-skills-into-existing-1265.

Correspondence can be addressed to Dr Harvey at: mharvey2000@nullcomcast.net

Original citation for this article: Harvey MA. Playing different notes: The benefits of motivational interviewing in hearing healthcare. Hearing Review. 2019;26(5):22-23.

Marketing | May 2019 Hearing Review

Four relatively simple, inexpensive, and effective ways to boost your patient base 

By Rob Kennedy

With the continued rise of third-party payers in hearing care, you may wonder whether it’s possible to target and attract more private-pay patients. Yes, it is! The key? Tap into core elements that help drive private-pay patients, who typically have greater freedom than their insured counterparts in selecting a provider. Here are four areas your business can focus on to bring more private payers through your doors and into long-term relationships with your practice

Generally, all hearing healthcare providers have access to the same technology, so how do you stand out from the rest of the players in your market? Brand yourself as the expert in your area who not only generously shares crucial hearing healthcare knowledge but is committed to delivering remarkable patient experiences:

• Local expertise. Becoming your market’s trusted advisor in hearing care gives community members a go-to resource for any questions or concerns they have, which allows them an easy path to make informed decisions. Rather than associating you only with hearing aid sales, prospects are able to see you as a credible source of information on issues affecting their or a loved one’s hearing health and wellness.
• Remarkable experiences. Providing a superior experience at every touch point helps create a patient for life, in turn, spurring additional referrals from your existing patient base. Practices tend to invest most of their efforts in attracting new patients, but retaining their existing private payers by nurturing strong patient-provider relationships is much more cost effective.

Boost Your Visibility

Private-pay patients typically initiate their provider search online, making it critical that your website appears at the top of Google search results. Help make it happen with:

• Search Engine Optimization (SEO). Organic—versus paid—search results depend on Google rankings that consider myriad factors from keyword usage, content originality, and spelling, to mobile friendliness, site speed, links, and more that affect the user experience. SEO works to improve your site’s visibility by staying atop—and congruent—with Google’s algorithm. Online directories are another key to attracting targeted traffic to your website and, ultimately, to your practice. A well-rounded SEO program should include a listing service in its offerings.
• Paid search. Paid search also plays an important role in web search results, providing the ability to target specific keywords your patients are using and deliver specific content relevant to those searches. You can also target your local geographic area, ensuring you’re attracting more qualified patients within your own practice boundary. Another benefit: Paid search levels the playing field, helping you more easily compete with the major players in the hearing care space and advertise alongside big-box stores and manufacturers.
• Blog posting. Publishing topical and informative blog articles on a regular basis ties together important factors in differentiating and branding your practice. For one, it easily and effectively communicates your expertise to the community, helping you stand out as a reliable resource. It also supports your search engine rankings, with Google potentially viewing your constantly updated content as more current and relevant than that of other websites.

Handle Those Online Reviews

When patients find you online, do they like what they see? First impressions matter—especially when it comes to patients’ health and wellness—and that includes your online reviews. Having too few reviews, below-average or poor ratings, or negative comments can send prospects running to a competitor. However, some simple steps can help turn that around.

Rob Kennedy

First, focus on improving your online review program. Online reviews are one of the most efficient ways to attract new patients, because satisfied patients do your marketing for you. An easy way to start building more feedback is to simply ask your patients to review your services online. A stronger approach is to consider using an online review service to help.

It’s also important to monitor your reviews as they come in. Doing so allows you to uncover any common complaints that can be addressed within the practice. It also helps you respond to any negative reviews in a positive and helpful manner. This shows you care about the service you provide and are willing to correct any unpleasant experiences.

And remember: Don’t just focus on the negative reviews you might receive; it’s equally important to respond to positive reviews, demonstrating that your practice is responsive, is gracious, and cares about its patients.

Connect With Your Community

Community engagement plays a big role in attracting new and existing patients, so consider these tried-and-true approaches for your marketing mix:

• Social media. Facebook and other social media platforms make it a cinch to educate your followers. Easy options include highlighting your recent blog posts, linking to medical studies that relate to hearing healthcare, and communicating new technology offerings. Share news, events, and other interests unrelated to hearing health, too; offering relevant and entertaining information outside of hearing care topics helps attract patients beyond your social circle. When followers share or like your posts, their social circle is also exposed to your practice, further expanding your audience. Consider assigning a social media captain in your practice to stay responsive to followers’ comments and questions.
• Live events. Engaging the community needn’t be limited to digital tactics. You can also connect with your market and position yourself as the go-to educational resource by hosting seminars or reaching out to the primary care physicians in your community. Both will lead to new patient flow, and aid in attracting referrals.
• Media exposure. Newspaper, TV, and radio can also help brand you as the expert in your market. Advertising in these media can prove expensive, but aiming for free exposure is well worth the time. You can accomplish this by providing educational and relevant news releases to local media on a regular basis. Doing so helps increase the chance that one of your releases will be published, broadcast, or otherwise acted on, exposing your expertise and practice to a much wider section of the community.

Stay Aware of Your Market

Regardless of your marketing methods, remember:

• It’s important to regularly review them. As markets change and shift, some previously successful approaches may need revisiting. Other strategies and tactics may be performing better than they were before.
• There is no silver bullet to attracting private-pay patients. It takes a balanced mix of targeted tactics that, working in concert with each other, generate the essential patient flow needed to meet the growth goals of your practice.

What Should YOU Do?

Which of the tactics discussed here are you currently doing? From that list, identify the ones you’d like to further focus on and improve. Add in another tactic that you’re not currently performing but want to consider, and start working on it. With a targeted plan, you can bring more private-pay patients through your doors!

Correspondence can be addressed to Rob Kennedy at: rkennedy@nullaudigy.com

Original citation for this article: Kennedy R. Winning in hearing care: 4 ways to attract private-pay patients. Hearing Review. 2019;26(5):24-26.

By Karl E. Strom, editor

Jazz legend Lionel Hampton and poster-child Rachel Chaikof educated the public and were featured on the cover of the May 1994 edition of The Hearing Review for Better Hearing & Speech Month.

May is Better Hearing and Speech Month (BHSM). In the 1980s and ‘90s, BHSM was a pretty big deal. Not only did all the professional organizations in hearing healthcare band together to promote it, but a lot of dispensing offices made a concerted effort to appropriate marketing dollars for May—knowing full well their competitors would be doing the same thing. The results were often impressive. For a relatively small field, we made some big noise throughout the country during May—locally and nationally—by promoting hearing healthcare through advertisements, TV and radio PSAs, newspaper articles, poster-children, and endorsements by everyone from comedian Lesley Nielsen to musician Lionel Hampton.

BHSM for the 21st Century. There is now a movement afoot to breathe new life into BHSM and recast it for the 21st Century—and social media. In the past year, all the national professional organizations (AAA, ASHA, ADA, and IHS), along with the nation’s largest consumer advocacy group for people with hearing loss, Hearing Loss Association of America (HLAA), and one of the nation’s most influential groups related to cochlear implants, the ACI Alliance, have signed onto a public awareness campaign designed to bring hearing healthcare to the forefront. Sponsored  by the Hearing Industries Association (HIA), the campaign and support materials can be found at www.hearwellstayvital.org, and this year it uses two simple hashtags with two simple messages:

• #HearWellStayVital: Hearing well allows people to engage in those activities that inspire passion—things that make life fun and meaningful—and hearing healthcare is a crucial component in maintaining vitality.
• #CheckYourHearing: One of the first steps to hearing well is to check your hearing every year and seek help if you have a hearing loss.

Get your message out! The hearwellstayvital.org website contains a great variety of materials you can use to piggy-back your own promotions on BHSM, while broadcasting the two key messages above. The FREE downloadable materials, found at www.hearwellstayvital.org/support-materials, include:

• A social media toolkit;
• Broadcast videos (with and without closed captioning);
• 15-, 30-, and 60-second web clips (in .mov and .wmv file formats);
• A great assortment of images and posters, and
• Icons and short messages for social media.

Mark your calendar and/or schedule your posts on May 1 and May 15! In particular, on May 1 and May 15,  the HearWellStayVital campaign is asking all hearing healthcare stakeholders to post these two unified messages on Facebook, LinkedIn, Instagram, and other social media:

On May 1:
Good hearing affects our overall health and wellness. Be proactive during #BetterHearingMonth in May. #CheckYourHearing with a hearing care professional as part of your annual wellness check. Learn more at www.hearwellstayvital.org. #HearWellStayVital #BHSM [link message to :30 second campaign video]

On May 15:
#HearWellStayVital. Hearing loss affects 1 in 8 people in the US. Maintaining hearing health helps keep us vital so we can enjoy the things we love most. #CheckYourHearing wellness every year. Learn more at www.hearwellstayvital.org. #BetterHearingMonth #BHSM [link to :30 second campaign or choice of :15 second character video]

Let’s refresh BHSM and get a unified message to consumers: May is for better hearing!

About the author: Karl Strom is editor of The Hearing Review and has been reporting on hearing healthcare issues for over 25 years.

Widex USA, Inc announced the launch of #KeepMakingWaves, a campaign said to be designed to shine a spotlight on the stories and successes of independent Hearing Healthcare Professionals and their patients.

“Widex understands that the independent Hearing Healthcare Professional is the true hero of every better hearing story,” said Michael Tease, senior vice president of marketing, Widex USA. “Every day, our audiologists, partners, and customers make waves of positive benefits for their patients by delivering superior hearing care and technology. These waves—heightened confidence, happiness, memories, and more—ripple through the family and friends of each patient.”

By participating in #KeepMakingWaves, patients and prospects can read stories of success. According to Widex, they can get insight into best practices, things to ask their doctor or clinician, and, overall, how to play a better role in their own hearing health. Widex’s announcement goes on to say that participation also helps give the independent Hearing Healthcare Professional the opportunity to share their passion for helping people, as well as the ability to increase their social engagement with patients and prospects in a positive forum.

To make a wave, simply click the “Submit Your Story” button on the WidexWaves.com homepage and complete a short form. Hearing Healthcare Professionals can personalize their pages with their practice logo, photos of the team, and contact information. Stories from the Widex Waves page can also be shared on their own independent social media channels.

As an added benefit, each quarter Widex will award the Hearing Healthcare Professional with the most submissions with a VIP Marketing Package to help them further expand their brand in the market.

“We encourage all of our colleagues in the hearing care community to come together to make #KeepMakingWaves a positive social movement,” said Tease. “A place where those with hearing loss can go to get information, overcome their fears and the stigma of hearing loss, and see how improving their hearing with today’s technology can improve their quality of life.”

Source: Widex

Image: Widex

Quarterly hearing aid unit sales (2014-2019) with private/commercial sector sales shown in blue and VA dispensing activity shown in red.

According to statistics generated by the Hearing Industries Association (HIA), Washington, DC, hearing aid net unit sales in the United States increased by 2.5% during the first quarter (Q1) of 2019, totaling 1,000,653 units—the second time unit volume has ever exceeded 1 million in a quarter (the first time was in Q2 2018). Sales in the private/commercial sector increased by 1.5%, while dispensing activity at the Department of Veterans Affairs (VA), which made up 19% of the entire market, increased by 6.7%.

Last year, hearing aid sales rose by 5.7% in the first quarter, and 5.3% for the full year (for the private sector, 7.2% for the first quarter and 5.95% for the full year), so the Q1 sales statistics reflect a fairly strong base from the year before. In general, the market has been increasing by about 2-4% annually. (Click here for a review of 2018 US hearing aid sales.)

More than three-quarters (76.6%) of all hearing aids sold in the first quarter were receiver-in-the-canal (RIC/RITE) type devices, which are a sub-type of behind-the-ear (BTE) hearing aids‚ and 10.4% were traditional BTEs. Thus, BTE-style hearing aids made up 87% of the US market in the first quarter. In 2018, BTEs made up 85% of the total market, with RICs constituting 72.5% of all hearing aids dispensed.

Amplifon, the parent company of Miracle Ear and Elite Hearing Network, and Amplifon Hearing Health Care in the United States, published impressive first-quarter 2019 financial results on Tuesday (May 7), showing outstanding revenue growth of 25.4% (at constant exchange rates) driven by solid organic growth and an large contribution from their mergers & acquisitions (M&A). Amplifon reported consolidated revenues of 392 million euros (US$439 million) in the first quarter of 2019, with above-market organic growth of 3.9% and M&A growth of 21.5%, mostly from the mid-2018 acquisition of the GAES hearing aid dispensing network which is primarily located in Spain and Portugal, as well as other acquisitions in France and Germany.

Recurring EBITDA reportedly rose 30.3% in the quarter to 56.3 million euros (US$63 million), with the margin up 40 basis points compared to the first quarter of 2018, even after the consolidation of GAES and the continuous investments in marketing, which also reflect the change in the perimeter related to the consolidation of GAES. According to the company, the network expansion program continued in the first quarter, both organically and through acquisitions, with the addition of 49 stores. The acquisitions of 34 stores were made mainly in France and Germany for a total cash-out of 14.4 million euros (US$16.1 million).

Enrico Vita

“We have begun the year with excellent results, characterized by a solid organic growth and an extraordinary contribution from acquisitions, particularly GAES,” said Amplifon CEO Enrico Vita in a press statement. “The integration of GAES is progressing quickly and successfully as shown by the first results which are decidedly better than expectations in terms of both revenues, which showed double-digit growth, and profitability, which improved significantly…We continue to look ahead with great optimism to the execution of the strategic plan for 2020 thanks to the results we expect from our strong innovation program focused on the continuous improvement of the customer experience and, above all, the unique opportunity stemming from the integration of GAES.”

Performance by Region

EMEA. Amplifon says the results achieved in the quarter reflect the solid performance posted in all the geographic areas. The company characterized its growth as outstanding in Europe, Middle East and Africa (EMEA). Revenues in Europe increased by 31.4% at constant exchange rates.

Americas. Good performance was posted in Americas due to above-market organic growth and the sizeable contribution of acquisitions related to the consolidation. The company reported an increase of 13.9% in local currency and 21.9% at current exchange rates, driven by 3.1% organic growth and 10.8% M&A (mostly from Latin America due to GAES business). Additionally, the foreign exchange effect had a positive impact of 8.0%, and it reportedly had additional contribution from the excellent performance of Miracle-Ear and Canada’s external growth contributed to Americas’ solid performance. According to statistics generated by the Hearing Industries Association (HIA), hearing aid net unit sales in the United States increased by 2.5% during the first quarter of 2019, and by only 1.5% in the commercial/private market.

APAC. Strong growth in revenues (8.6% in local currency) was reported in the Asian-Pacific region that reflects solid organic growth that significantly outpaced the market, taking place mainly in Australia, as well as the contribution made by the first Chinese joint venture. A strong performance was reported in Australia driven by sustained organic growth which accelerated consistently since the beginning of the year. Revenue growth in New Zealand was largely unchanged due to the anniversary of the regulatory change that took place in 2013. Excellent revenue growth in China, supported by a double-digit organic growth reported in M&A.

Outlook

Amplifon expects the favorable trend in revenues to continue through 2019, outpacing the market, thanks to the contribution of all the geographic areas in which it operates and driven by solid organic growth, as well as the contribution of M&A, particularly GAES. The company also expects to proceed at a steady pace with the execution of its strategic plan for 2020 due to both the integration of GAES and the progressive roll-out of the Amplifon Product Experience in the other core markets.

MedRx Founder Ron Buck was a hearing aid dispenser in Florida prior to developing and marketing the company’s first video otoscope.

Innovation, research, continuity, and reliability have been keys to MedRx’s success over the last 25 years, according to the company. MedRx, Largo, Fla, was established in 1994 by Ron Buck who, at that time, had worked in Florida for more than 10 years as a hearing aid dispenser. As a practice owner, he decided he needed a video otoscope but found the market solutions were too costly. Instead of giving in, Buck decided to develop a video otoscope for his offices. He pulled an engineering friend out of retirement, and they started development on his video otoscope ideas. By the time the project was complete, they had three of the most expensive video otoscopes known to man. At that point, he decided to take his video otoscopes to market. MedRx was born. And the result was incredible: $5 million in a single year with a team of three people.

MedRx OtoWizard

MedRx continued its innovations with the introduction of the OtoWizard in 1997. The OtoWizard was the first all-in-one computerized audiometer, real-ear measurement, and otoscope, neatly packed onto a rolling cart that could be moved around the office. MedRx built the OtoWizard with products required in the hearing aid retail model—determined to produce solutions that help clinics explain hearing loss easily to patients and visually show the benefits of hearing aids.

In 2005, MedRx introduced the portable Avant series of audiometers and real-ear measurement products, featuring a small lightweight design which allowed the owners to easily travel with the equipment. The Avant audiometer and real-ear devices opened new opportunities for practice owners. This allowed clinicians to travel into nursing homes, retirement facilities, remote locations, and even complete home testing and fitting.

By 2017, MedRx had rounded off its modern product line. Their products became easier to install and operate. The need for drivers has disappeared, and what the company views as the ultimate portable audiometer and real-ear device was created: Avant ARC. The Avant ARC contains both an audiometer and real-ear device combined in a single unit (hence the name). MedRx has since expanded into clinical units with a high-frequency audiometer and the Tinnometer, a device designed specifically to assess and diagnose tinnitus.

MedRx as a company prides itself on a family atmosphere with a fun, lively work environment. The company has many employees who have been with the company 15+ years, with 3 having been with the company over 20 years. MedRx holds regular company events like painting, go-kart racing, and escape rooms which keeps everyone tight-knit.

Today, MedRx has 25 employees and distributes its products in more than 60 countries worldwide. MedRx maintains its focus on helping the clinician explain, and the patient understand, their hearing loss. The MedRx product line has expanded to screening, diagnostic, and clinical audiometers, tinnitus assessment devices, binaural and monaural real-ear measurement, hearing instrument test boxes, hearing aid cleaning devices, and, of course, a video otoscope.

MedRx reports that the company looks forward to the next 25 years and thanks the industry for their support. To celebrate, all purchases in May will come with a 25-month warranty.

HR thanks long-time MedRx employee Carole Harris for this article.

Final Word | June 2019 Hearing Review

By Dennis Van Vliet, AuD

In a busy office dealing with hearing and hearing-related products, troubleshooting occupies much of our time. The other day, a woman made an appointment with a complaint of not hearing well on one side. She offered concerns that she did not know if it was the hearing aid, her ear, or her imagination, but it didn’t seem like she could hear as well as she had in the past from her left ear.

The first rule of troubleshooting an inanimate device is to do a good visual inspection. Dealing with humans, we have a few additional options. In this case I asked the woman to expand on her perception of the issue. How long ago did the problem become apparent, and was it a gradual onset or a sudden change? It turned out it was a recent problem, and since she was a walk-in visitor added to my already busy schedule, I opted for shortcuts to get to the bottom of her problem as soon as possible. The hearing aid produced audible feedback in the hand, and otoscopy revealed no cerumen occlusion or other obvious abnormalities.

I had evaluated her hearing a few months ago. Suspecting a change in her hearing, I decided that a quick pure-tone air conduction threshold search would be appropriate at this point. It turned out that her thresholds were the same or better in the affected ear when compared to the most recent audiogram.

At this point, I turned back to the hearing aid for a more thorough look and noted that the wax trap was partially occluded.  Cleaning up the hearing aid and replacing the wax trap took care of the problem with no further delays.

There were no major negative consequences to my missing the easy solution at the initial assessment, but it caused me to reflect upon my approach and how it took an extra 15 or 20 minutes to get to the right answer. Being comprehensive in our approach to care is often at odds with being efficient. If I made several efficiency errors in a day, it could create bigger problems.

At a session of the recent American Academy of Audiology convention, Jay Hall, PhD, opined that we should be more efficient in our approach that follows decades of tradition rather than doing the steps that need to be done to get the information we need on the day of the visit. He questioned if word recognition testing in quiet and other traditional parts of the standard of care assessment were necessary for patients that had no reason for medical referral and needed hearing aids. The context of the session was billing and Medicare, but it caused me to think more about efficiency and patient care. The troubleshooting problem I encountered was simply another example of how I might gain efficiencies by taking a good look at how I am approaching problems that patients bring in for solutions.

I suggest we start by looking at how we describe the results of assessment we perform on patients who come in looking for opinions on what to do about the hearing difficulties they are experiencing. I don’t drag out an audiogram and orient them to the figures unless they indicate that they have some familiarity with the nomenclature. Instead, I offer a verbal description of the practical problems that I expect they are having as a result of the hearing loss.  My description for a typical sloping age-related hearing loss with a pure-tone average of about 40 dB HL might include the following: “…your test results indicate that you may be aware of normal conversational speech, but you may not receive enough information for you to understand what is being said without visual input and a great deal of listening effort.” The reference anchor is normal conversation, and the topics of visual input and listening effort are introduced into the conversation. The problem is addressed directly without taking the time to define terms and symbols, and leads directly into a rehabilitative discussion.

The Final Word?  A good look at traditional practices and our own habitual approaches to patients is a healthy exercise for any professional. Smart, time-saving approaches to patient care must be efficient and not sacrifice the elements of good practice, but we shouldn’t doggedly stick to a prescribed routine that calls for rote completion of procedures when they yield little of the information needed to manage patients’ needs. We may need to redefine some elements of “Best Practice” as we go forward, and that will be healthy for everyone.

Dennis Van Vliet, AuD

About the author: Dennis Van Vliet, AuD, is Senior Clinical Educator for the Bloom Hearing Specialist Network, based in Miami, Florida. He provides clinical services in Dana Point, Calif, and has been a prominent clinician, educator, and leader in the hearing healthcare field for over 40 years. His professional experience includes working as an educational audiologist, a private-practice owner, VP of audiology for a large dispensing network, and senior director for a major hearing aid manufacturer. As a columnist, his work spans three decades.

Correspondence can be addressed to HR or: DennisVanVlietAuD@nullgmail.com

Citation for this article: Van Vliet D. Re-evaluating best practices for patient needs. Hearing Review. 2019;26(6)[Jun]:34.

By Sarah McQuate, Science Writer | University of Washington News & UW College of Engineering

Ear infections are the most common reason that parents bring their children to a pediatrician, according to the National Institutes of Health (NIH).

This condition occurs when fluid builds up in the middle ear behind the eardrum and is infected. This buildup is also common in another condition called otitis media with effusion. Any kind of fluid buildup can be painful and make it hard for children to hear, which can be especially detrimental when they are learning to talk.

Both conditions are hard to diagnose because they have vague symptoms: Sometimes children tug on their ears or have fevers, and sometimes there are no symptoms. In addition, young children may not be able to describe where they hurt.

Dr Randall Bly, an assistant professor of otolaryngology-head and neck surgery at the UW School of Medicine who practices at Seattle Children’s Hospital, uses the app to check his daughter’s ear. Photo credit: Dennis Wise/University of Washington

Now researchers at the University of Washington have created a new smartphone app that can detect fluid behind the eardrum by simply using a piece of paper and a smartphone’s microphone and speaker. An article detailing the app’s functionality is posted on the University of Washington’s media portal, UW News. The smartphone makes a series of soft audible chirps into the ear through a small paper funnel and, depending on the way the chirps are reflected back to the phone, the app determines the likelihood of fluid present with a probability of detection of 85%. This is on par with current methods used by specialists to detect fluid in the middle ear, which involve specialized tools that use acoustics or a puff of air.

The team published its results May 15 in Science Translational Medicine.

“Designing an accurate screening tool on something as ubiquitous as a smartphone can be game changing for parents as well as health care providers in resource-limited regions,” said co-author Shyam Gollakota, an associate professor in the UW’s Paul G. Allen School of Computer Science & Engineering. “A key advantage of our technology is that it does not require any additional hardware other than a piece of paper and a software app running on the smartphone.”

Once diagnosed, ear infections can be easily treated with observation or antibiotics, and persistent fluid can be monitored or drained by a doctor to relieve symptoms of pain or hearing loss. A quick screening at home could help parents decide whether or not they need to take their child to the doctor.

This app works by sending sounds into the ear and measuring how those sound waves change as they bounce off the eardrum. The team’s system involves a smartphone and a regular piece of paper that the doctor or parent can cut and fold into a funnel. The funnel rests on the outer ear and guides sound waves in and out of the ear canal. When the phone plays a continuous 150 millisecond sound—which sounds like a bird chirping—through the funnel, the sound waves bounce off the eardrum, travel back through the funnel, and are picked up by the smartphone’s microphone along with the original chirps. Depending on whether there’s fluid inside, the reflected sound waves interfere with the original chirp sound waves differently.

“It’s like tapping a wine glass,” said co-first author Justin Chan, a doctoral student in the Allen School. “Depending on how much liquid is in it, you get different sounds. Using machine learning on these sounds, we can detect the presence of liquid.”

When there is no fluid behind the eardrum, the eardrum vibrates and sends a variety of sound waves back. These sound waves mildly interfere with the original chirp, creating a broad, shallow dip in the overall signal. But when the eardrum has fluid behind it, it doesn’t vibrate as well and reflects the original sound waves back. They interfere more strongly with the original chirp and create a narrow, deep dip in the signal.

To train an algorithm that detects changes in the signal and classifies ears as having fluid or not, the team tested 53 children between the ages of 18 months and 17 years at Seattle Children’s Hospital. About half of the children were scheduled to undergo surgery for ear tube placement, a common surgery for patients with chronic or recurrent incidents of ear fluid. The other half were scheduled to undergo a different surgery unrelated to ears, such as a tonsillectomy.

“What is really unique about this study is that we used the gold standard for diagnosing ear infections,” said co-first author Dr Sharat Raju, a surgical resident in otolaryngology-head and neck surgery at the UW School of Medicine. “When we put in ear tubes, we make an incision into the eardrum and drain any fluid present. That’s the best way to tell if there is fluid behind the eardrum. So these surgeries created the ideal setting for this study.”

After parents provided informed consent, the team recorded the chirps and their resulting sound waves from the patients’ ears immediately before surgery. Many of the children responded to the chirps by smiling or laughing.

The system uses a regular piece of paper cut and folded into a funnel to guide sound waves in and out of the ear canal. Photo credit: Dennis Wise/University of Washington

Among the children getting their ear tubes placed, surgery revealed that 24 ears had fluid behind the eardrum, while 24 ears did not. For children scheduled for other surgeries, two ears had bulging eardrums characteristic of an ear infection, while the other 48 ears were fine. The algorithm correctly identified the likelihood of fluid 85% of the time, which is comparable to current methods that specialized doctors use to diagnose fluid in the middle ear.

Then the team tested the algorithm on 15 ears belonging to younger children between 9 and 18 months of age. It correctly classified all five ears that were positive for fluid and nine out of the 10 ears, or 90%, that did not have fluid.

“Even though our algorithm was trained on older kids, it still works well for this age group,” said co-author Dr Randall Bly, an assistant professor of otolaryngology-head and neck surgery at the UW School of Medicine who practices at Seattle Children’s Hospital. “This is critical because this group has a high incidence of ear infections.”

Because the researchers want parents to be able to use this technology at home, the team trained parents how to use the system on their own children. Parents and doctors folded paper funnels, tested 25 ears, and compared the results. Both parents and doctors successfully detected the six fluid-filled ears. Parents and doctors also agreed on 18 out of the 19 ears with no fluid. In addition, the sound wave curves generated by both parent and doctor tests looked similar.

“The ability to know how often and for how long fluid has been present could help us make the best management decisions with patients and parents,” Bly said. “It also could help primary care providers know when to refer to a specialist.”

See a related story from NPR.

The team also tested the algorithm on a variety of smartphones and used different types of paper to make the funnel. The results were consistent regardless of phone or paper type. The researchers plan on commercializing this technology through a spin-out company, Edus Health, and then making the app available to the public.

“Fluid behind the eardrum is so common in children that there’s a direct need for an accessible and accurate screening tool that can be used at home or in clinical settings,” Raju said. “If parents could use a piece of hardware they already have to do a quick physical exam that can say ‘Your child most likely doesn’t have ear fluid’ or ‘Your child likely has ear fluid, you should make an appointment with your pediatrician,’ that would be huge.”

Rajalakshmi Nandakumar, a doctoral student in the Allen School, is also a co-author on this paper. This research was funded by the National Science Foundation (NSF), the NIH, and the Seattle Children’s Sie-Hatsukami Research Endowment.

Original Paper: Chan J, Raju S, Nandakumar R, Bly R, Gollakota S. Detecting middle ear fluid using smartphones. Science Translational Medicine. 2019;11(492):eaav1102.

Source: UW News, Science Translational Medicine

Images/Media: Dennis Wise, University of Washington

Tech Topic | June 2019 Hearing Review

By Mark Sanford, AuD, and Lizz Jensen

One of the world’s foremost clinics that provide Lyric extended-wear  hearing aids offers perspectives on its evolution and its potential to change a practice—as well as all hearing healthcare

Lyric, the first and currently only extended wear hearing device, was first fit commercially in January 2007 after 8 years of development. An article published in the April 2009 Hearing Review¹ described candidacy, dispensing models, necessary equipment, scheduling, and a subsequent 2014 study looked at these same issues and compared Lyric 1 and 2 devices.²

Lyric has had multiple upgrades during the past 10 years from Lyric 1 to 2.1, 2.3, 3.0, 3.1, and 3.2. The effect of these upgrades have ranged from small to large. For example, a completely new chip in Lyric 3 changed Lyric from input compression to output compression. The changes in Lyric have improved the product, though there have been growing pains, as well as ups and downs during the past decade.

Lyric is dispensed in 14 countries on four continents, and there continues to be a opportunity for worldwide growth. Upgrades in product retention and the addition of two sizes in the past year now allow up to 91% of patients in our clinic to have a trial fitting with Lyric.  

A Look Into the CSG Lyric User Base

Lyric is an excellent opportunity for providers willing to learn the skills of insertion and removal of the device, fit the product consistently, and to set themselves apart as a unique hearing specialist in their community. There are patients who have been paying over $3,000+/year for 10 years to wear Lyric bilaterally. This indicates these patients preference and desire to have a hearing product that allows 24/7 hearing functionality, as well as convenience, ease of use, cosmetic invisibility, natural sounds without occlusion, and does not remind them of their hearing loss at least two times/day as daily-wear devices will. 

In this article, we present updated data on our experience with Lyric, how it has continued to change our business, our knowledge of related ear and skin health, and how our patients’ preferences continue to drive new business. 

Demographics

The following data is based on 2,481 ears fit with Lyric. Since 2012, 80% of patients were fit binaurally and 20% monaurally.

Age. From 2012-2016, the average age for Lyric users was 74.9 years (Figure 1), while our practices’ daily-wear devices users is 69 years of age and has increased from 66 years in 1996. Considering Lyric was the first completely invisible device in the hearing industry—which some thought would attract younger users—this seems counter intuitive. We have fit many patients in their 90s, and more than 20 patients over 100 years of age with Lyric. The excellent sound quality, ease of use, not having to change batteries, not misplacing or losing device(s), hearing 24/7, normal telephone answering, and potential improvement in brain health are many of the reasons patients choose Lyric. 

Figure 1. Average age and percentage of males and females of Lyric users at CSG Better Hearing Centers, 2012-2016 (n=2481 ears).

The average age of 74.9 years of Lyric users provides a unique awareness of being a Lyric provider. Older patients tend to have more physician visits, surgeries, and scans (eg, MRIs) where Lyric will be discussed by other medical professionals who may not know Lyric exists. One family care physician told a patient, “I have 10 patients who are happy with their hearing aids and they all wear Lyric. The others aren’t happy. Go and get fit with Lyric.” 

We have also fit teenagers as young as 13, as well as adults in every decade of life. People younger than age 60 prefer Lyric for all the same reasons as our older adults, with some bias towards cosmetics and the ability to partake in sports without worrying about their hearing device.  

Gender. The percentage of males wearing Lyric ranged from 52-55%, and females 45-48% during this 5-year study period (2012-16), with an average of 53.3% male and 46.7% female (Figure 1). 

New Patients

Trial success rates. A major source of new patients wanting to try Lyric is referral and word of mouth from family or friends of existing users. But it should also be pointed out that many who tried Lyric unsuccessfully still recommended Lyric to their family and friends. 

The number of patients who want to try Lyric has not decreased over time. In fact, patients who tried Lyric in the past unsuccessfully have been refit successfully due to improvements in audiologist skills and knowledge as well as product improvements. For example, Lyric 1 was 16 mm long, and Lyric 2.1-3.2 was 12 mm (25% shorter) and narrower in design. With the five size options in Lyric 1,  we could fit 54% of ears. When Lyric 2.1 was introduced, we increased the fit percentage to 85%. Today, with the seven sizes of Lyric 3.2, we are able to fit 91% of ears.  

Fitting an ear with Lyric for a trial is not the same thing as a successful fitting of Lyric, where a patient opts to subscribe for the product and service. The number of ears fit with Lyric and the eventual number of Lyrics that a patient subscribes is called the trial to subscription rate or trial success rate (TSR). Our TSR has continually improved from 41% to 59% from 2012-2016, as shown in Figure 2.  Improved audiologists’ skills and product improvements are the main reasons for this improvement. 

Figure 2. Percentage average renewal rate (gray line), trial success rate (blue line), and those patients who exchanged their Lyric hearing aids for daily-wear/traditional hearing aids (orange line), 2012-2016.

Opting for traditional hearing aids. The number of patients who try Lyric unsuccessfully and then change into a daily wear device varies from year to year, as shown by the orange line in Figure 2. The range from 5% to 20% is broad, with an average of 10.2% during the 5 year period. Often, patients who have been wearing daily-wear devices for many years realize their device(s) are becoming outdated and they are ready to try something new. They may try Lyric unsuccessfully and return to daily-wear devices. There are also Lyric patients who wear Lyric for a number of years who then change to daily-wear devices due to severity of hearing loss, financial reasons, or ear health issues.

Increasingly, new patients who come to our office know of Lyric and want to try it first to see if it can work for them versus a daily-wear device. Of these, a total of 61% of our patients who could be fit with Lyric ended up becoming users of the product/service, while 39% chose daily wear devices. Patients and their family members chose Lyric for the reasons mentioned above, with natural and excellent sound quality being the primary reason and the 24/7 hearing/convenience a close second. 

Lyric as a loaner device. One option for a new patient who wants to try custom daily-wear devices or a receiver-in-the-ear (RITE/RIC) device with a custom mold is to be fit with Lyric while the new device(s) are being made. These patients’ transition to daily-wear devices is made easier by hearing sounds 24/7 for 1-2 weeks before being fit with their traditional aids. Another provider option is to size and fit Lyric for a patient whose daily-wear device is being repaired. This allows a patient to try Lyric in their daily life and compare the differences. Although most patients retain their daily-wear devices, they often tell others about Lyric. Some subscribe to Lyric, then use their repaired hearing aid as a backup.

Monaural Lyric users. Although the benefits of binaural hearing are well documented, we do have Lyric subscribers who use Lyric in one ear for 45-60 days and then switch to the opposite ear for the next period of time. This may be due financial reasons or ear and skin health issues. We also have subscribers who use Lyric on one side and a daily-wear device on the other due to asymmetrical hearing loss or ear and skin health issues on one side. This may also allow for a “best of both worlds” type of option in the selection process: the 24/7 hearing benefit of Lyric, combined with wireless connectivity, noise reduction, directionality, etc.

Renewals and Non-renewals

Renewals. Patients who renew their yearly Lyric subscriptions represent recurring revenue, adding greater stability for a business. Additionally, renewals cause satisfied Lyric users to become “cheerleader advocates” for the business, increasing referrals and new patients—some of whom in turn choose Lyric, while others choose daily-wear devices. 

A key metric to track is the renewal rate, as well as the number of Lyric users who then change to a daily-wear device (Figure 2). Our renewal rate has been 78-90% during the 5 years studied, with an average of 85%. Patients who chose not to renew did so because they elected to wear a traditional device (10%), passed away (3%), or moved away (2%). 

Figure 2 also shows the percentage of our patients who convert from Lyric users to daily-wear users each year. Understanding this, we can calculate renewal rates and know that approximately 10% will be making this conversion each year. Therefore, this is budgeted into our business (ie, business growth of 10% in hearing aid purchasers minus the loss in Lyric revenue subscriptions). 

Non-renewals. Figure 3 shows the reasons patients do not renew their subscriptions at some point after using Lyric for at least one year. The Top-4 reasons why patients do not renew their Lyric subscription are: 1) Preference for a different hearing device (32%); 2) Discomfort (25.4%); 3) Feedback (10.2%), and 4) Death (13.4%). Other reasons patients do not renew their subscriptions include: the patient moved (8.5%), too expensive (5.1%), medical issues (2.3%),  occlusion (2.3%), and migration in ear canal (0.1%). 

Figure 3. Reasons for non-renewals of Lyric subscriptions in the clinic during the 5-year study period (2012-2016).

Marketing Lyric and Practice Differentiation

From the beginning, Lyric marketing has been proven to attract new patients with hearing loss—people who have never worn a hearing device,  as well as current hearing aid users from our own and competitors’ practices. Many new patients make comments like “I don’t want to wear a traditional hearing aid, but I would like to try Lyric.” It is amazing (and disconcerting) to see people of all ages, particularly professionals, who have obviously struggled with significant hearing loss for years—and should be daily-wear device users—who will come in to try Lyric only. For whatever reason (eg, stigma, denial, convenience), it appears to be an option that breaks down barriers in resisting audiological hearing help.

In general, existing daily-wear device users try Lyric to see if they can hear better and to experience 24/7 hearing. Many are surprised by the excellent sound quality, convenience of not having to insert/remove the devices or batteries, as well as hearing their spouse or children/grandchildren, pets, phone, or alarm at any time during the night. Perhaps UK Audiologist Rob Davies said it best: “Lyric patients are not reminded of their hearing loss every day as daily wear users are at a minimum two times a day.”

Our experience has been that Lyric marketing via direct mail, newspaper, website, or other digital media has always had better response rates than daily-wear devices. Lyric is a specialized product that offers the cosmetics of an IIC, but is the only device that can offer 24/7 functionality. In marketing it comes across as something completely different than daily-wear devices. 

In this respect, Lyric marketing is a differentiator, setting a business apart from competitors—and requiring skills that are truly different from most hearing aid dispensing offices and all big-box, online, or mass merchandisers. For those familiar with the tenets proposed in Jim Collin’s book Good to Great, Lyric providers offer something patients with hearing loss want and the competition doesn’t.  

Our mindset on Lyric was stated best by audiologist Helena Solodar, AuD, of Audiological Consultants in Atlanta: “Every patient is a Lyric candidate until proven otherwise.” ² This perspective ensures that patients know we “give it our all” to make Lyric work for them (and not lure them into our practice to provide another device). If they came to us with an interest in Lyric, it is our duty to try to make that happen safely for them, if possible, during a trial period. This may mean trying different sizes, determining how many days a patient initially should have Lyric in the ear before a refit, and seeing patients for multiple programming adjustments. 

Ear Health and Skin Issues

A provider fitting Lyric has to use all their clinical skills and learn new ones not taught in graduate audiology courses. These skills include using a microscope or head loupes, having soft or “non-brick” hands for the gentle insertion and removal of the device, identifying patients who are good candidates, and being knowledgeable about ear/skin health issues of patients. Clinicians who fit Lyric also must also be knowledgeable about ear anatomy in the deeper part of the ear canal, the angle of the tympanic membrane, the bony cartilaginous juncture, humidity in the ear, skin health, and its optimal placement. All of these factors together determine if a patient can become a successful user and what the patient’s experience with Lyric will be like.  

Patients’ skin ranges from very dry or “Sahara”-like (ie, lower humidity levels translating into longer days of wear of Lyric) on one end of the scale to wet, oily, or “rainforest”-like (ie, higher humidity levels translating into shorter days of wear). Patient skin health can be effected by certain drugs, such as blood thinners, chemotherapy and or radiation treatments (past or present), and other illnesses or chronic conditions (eg, diabetes). These issues influence how Lyric works for each patient and the clinician must be willing to learn how best to treat these patients as individuals. 

Although our patients average 70 days of wearing time per device, the range of wear time is large. There are patients we schedule for replacement every 30-45 days, because that is what their ear/skin health can tolerate; other patients can wear Lyric for 60, 75, 90 days, or longer. The lifestyle of the patient and the climate can also affect the ear health and longevity of Lyric. Wet climates and activities can negatively affect service life.

Ear health issues decreased significantly from Lyric 1 to Lyric 2.1-3.2. The bony cartilaginous juncture in some ears with Lyric 1 was a problem,² causing bony erosions to occur more frequently than today. The shorter, narrower versions (Lyric 2.1, 2.3, 3.1, 3.2, and 3.3) have nearly eliminated this issue which occurs less than 0.5% of the time in our clinics (Figure 3).  Nevertheless, a Lyric provider must have an excellent ENT referral source in the rare case of a patient with a bony erosion or other significant ear health issue. 

The majority of health issues (eg, pain, discomfort, moisture accumulation, blisters) are resolved with time and a break from use. Depending on the ear health issue, most resolve in 1-7 days with the Lyric absent from the canal. After this short healing period, Lyric can usually be worn successfully again by the patient. Even patients who have used Lyric for years can start to have a skin or ear health issue for a period of time, which usually then stops as quickly as it appeared. In our practice, less than 1% of Lyric subscribers who do not renew are due to ear health issues.  

Future Possibilities

A recent study by Biggins et al described the mental health benefits of Lyric users.³ We have seen patients diagnosed with early dementia or Alzheimer’s disease start to wear Lyric and then are reassessed to find their cognitive decline was not as severe as previously though or even misdiagnosed. 

Lyric is a unique device that, for most of our clinical population, supplies continuous stimulation to the auditory system and brain. Although we stress there is no scientific evidence, we believe the hearing system and brain adaptation period is faster with Lyric since it is worn 24/7. Over 80% of our patients are not turning Lyric into sleep mode or off at night. This means these patients are constantly receiving stimulation all day, everyday, compared to daily-wear users who use their devices 2-16 hours per day.  Our hope is that a future study examines Lyric usage and dementia along the same lines as studies undertaken by Frank Lin and colleagues.⁴

We are beginning a new study that may allow more patients to use Lyric successfully by removal and self-insertion, which has helped solve a number of ear health issues for our existing Lyric users. It has also increased Lyric’s longevity for some patients, and allowed users to scuba dive and partake in other activities. 

A decade after its introduction, Lyric continues to improve and be a solution for many patients with hearing loss. We have over 1,100 ears subscribing to Lyric in our 5 locations, with some patients using the technology for 10 years. For an industry that changes people’s life every day by improving their communication ability with family, friends, and co-workers, it is unfortunate that Lyric is under-utilized around the world. The good news is that Lyric, after 10 years, keeps evolving and the opportunity for growth remains massive.

Mark Sanford, AuD, is President of CSG Better Hearing Centers with five private-practice offices in the San Francisco Bay Area and is an Editorial Advisory Board member of Hearing Review. Lizz Jensen, is a librarian at Carmel Harrison Memorial Library in Carmel, Cal, and has worked on research projects collecting and analyzing data for CSG for several years.

Correspondence can be addressed to Dr Sanford at: csgbetterhearing@nullaol.com

Citation for this article: Sanford M, Jensen L. Lyric after 10 Years: New data and perspectives from a private practice. Hearing Review. 2019;26(6):26-28.

References 

1. Arbogast T, Whichard S. A new hearing aid class: The first 100% invisible extended-wear hearing aid. Hearing Review. 2009;16(4):20-27.

2. Sanford MJ, Anderson T, Sanford C. The extended-wear hearing device: Observations on patient experiences and its integration into a practice. Hearing Review.2014;21(3): 26-31.

3. Biggins A, Singh G, Solodar H. Lyric shows significant psychosocial benefits. Phonak. https://www.phonakpro.com/content/dam/phonakpro/gc_hq/en/resources/evidence/field_studies/documents/fsn_lyric_psychosocial_benefits.pdf. August 2017.

4. Lin FR, Metter EJ, O’Brien RJ, Resnick SM, Zonderman AB, Ferrucci L. Hearing loss and incident dementia. JAMA Neurology. 2011;68(2):214-220.

A woman-led medical device company whose product helps diagnoses viral and bacterial ear infections in children, has just won WomenCorporateDirectors Foundation’s (WCD) inaugural Launch Zone competition in Silicon Valley.

Winner OtoNexus Medical Technologies, led by Chair and CEO Caitlin Cameron, presented its pitch along with five other startups before a panel of judges emceed by Sue Siegel, Chief Innovation Officer at GE and CEO of GE Ventures. The audience was said to be comprised of 200 women corporate board members from 23 countries—attendees of the 2019 WCD Global Institute, said to be WCD’s largest membership gathering of the year. Both attendees and judges voted, and concurred on the winner.

Pictured left to right: Theo Schwabacher; Dr Nola Masterson; Una Ryan; Caitlin Cameron, chair and CEO of OtoNexus, winner of WCD’s Launch Zone; Mary Jo Potter, and Bodil “Bo” Arlander.

With only 2.2% of total venture capital investing going to female-founded startups last year, Siegel said, WCD wanted to “showcase women entrepreneurs who are putting forward something they believe in, also giving them the opportunity to get in front of the right people. Women are just not getting funded at nearly the levels they should be.”

When asked about how she felt pitching to a group of women when the vast majority of those to whom she must direct her fundraising pitches are men, Cameron responded, “It’s so wonderful to present to a room full of women. It’s just a different dynamic: Their questions, their engagement, the things they care about. One of the key things that seems to be different is that women are more engaged and engaging. Women tend to ask thoughtful questions and while they are very interested in the financial risk and the market opportunity, they are also interested in the big picture.” She continued: “We have six board members and three of them are women.”

OtoNexus is a Seattle-based firm working to “bring the process of diagnosing ear infections into the 21^st century.” Ear infections, Cameron said, are “the number one reason for both surgery and antibiotic use in children.” According to the company, OtoNexus’ winning device helps shorten treatment time, reduce misdiagnosis, and avoids unnecessary antibiotic use through the innovative use of Doppler ultrasound technology. Commercialization of the product is expected to begin this year.

In addition to Sue Siegel, judges included:

• Bodil “Bo” Arlander, Founding Partner, Moxie Capital
• Dr Nola Masterson, Founder, CEO and Managing Director, Science Futures, Inc 
• Mary Jo Potter, CEO and Managing Director at Healthcare Angels
• Una Ryan, Managing Director, Golden Seeds
• Theo Schwabacher, Executive Director, Morgan Stanley

WCD members are directors of public and large, privately held company boards. Many are currently CEOs or in other C-level positions, and heavily involved in corporate innovation, investments, and acquisitions.

Source: WomanCorporateDirectors Foundation

Image: WomanCorporateDirectors Foundation

Lawmakers in Ohio are supporting a bill that would require insurance companies to cover the cost of hearing aids for those age 21 and under, according to an article in The Columbus Dispatch.

House Bill 243—sponsored by Rep. Casey Weinstein, D-Hudson and Rep. Allison Russo, D-Upper Arlington, would make it mandatory for insurance companies to pay up to $2,500 per hearing aid over four years, according to the Dispatch article. The cost for hearing devices—which is paid out-of-pocket by many families—is considered “cosmetic” and not a medical necessity by many insurance companies who deny coverage. According to Carrie Spangler, an educational audiologist with the Summit Educational Service Center who was quoted in the article, not having access to hearing devices can affect a child’s future academic performance and spoken language ability.

Ellie Warren, a 16-year-old who spoke in favor of the bill, said her family’s expenses for hearing devices can exceed $13,000 (two other siblings also have hearing loss).

Earlier this year, legislators in California and Nevada introduced bills requiring similar coverage for children’s hearing aids. Both Idaho and Illinois have made insurers responsible for covering the cost of hearing aids for children.

To read the Dispatch article in its entirety, please click here.

Source: The Columbus Dispatch

It appears that the US Food and Drug Administration’s (FDA) first public step in the rule-making process for establishing over-the-counter (OTC) hearing aid regulations will take place in November of this year, according to a recent document published online by the agency.

A Notice of Proposed Rulemaking (NPRM) for a “category of hearing aids to promote the availability of additional kinds of devices that address age-related hearing loss” is cited as having an action date of 11/00/19 in the document. The OTC Hearing Aid Act of 2017 that was passed by Congress and signed by President Trump on August 18, 2017 requires the FDA to create and regulate a category of OTC hearing aids for adults with “perceived” mild-to-moderate hearing loss and to ensure the devices meet the same high standards for safety, consumer labeling, and manufacturing protection that all other medical devices must meet.

The legislation requires the FDA to establish an OTC hearing aid category within 3 years of passage of the legislation, and finalize a rule within 180 days after the close of the comment period—or an August 18, 2020 deadline for the proposed rule—although some have speculated that the NPRM would come sooner. NPRMs explain what the FDA intends to require or do, as well as its scientific and/or policy reasons for the decision. An NPRM also solicits comments from the public, and these are generally submitted via the Federal Government’s electronic docket site, available at Regulations.gov. FDA can also issue Advance Notice of Proposed Rulemaking (ANPRM), announced in The Federal Register, for formulating its rules.

So, the announced date of November for the NPRM does not necessarily mean a final OTC regulation will be established soon or even much long before the August 18, 2020 deadline; there could be lengthy public commentary and/or hearings, and it’s probable the FDA wants to give itself appropriate time for deliberation and final rule-making. At the 2017 ADA Convention, Srinivas “Nandu” Nandkumar, PhD, the branch chief of the FDA’s Division of Ophthalmic and Ear, Nose, and Throat Devices, warned about factors which work against an accelerated timeline. Traditionally, hearing devices have received a lower priority in comparison to other life-saving medical devices, and the FDA continues to have a backlog of issues requiring attention. Additionally, under a new law, the Agency now has to find two regulations to delete for every one it adds.

Since the passage of the OTC Hearing Aid legislation, the FDA and the US Federal Trade Commission (FTC) have been gathering data and listening to stakeholders—which include consumer, professional, and industry groups—in preparation for the proposed rules concerning OTC hearing devices. Presumably, FDA will also consider findings from the October 2015 President’s Council of Advisors on Science and Technology (PCAST) and June 2016 National Academies of Sciences, Engineering, and Medicine (NASEM) reports regarding the accessibility and affordability of hearing aids. The FTC also held a workshop in April 2017 titled “Now Hear This” devoted to OTC hearing aids and their regulation.

But, it now appears the “OTC regulatory debate” could potentially follow the same general timeline as the 2020 presidential race—with proposed rules by the FDA in November of this year and a period of comments and debate to follow into 2020.

Hearing Review sought comments from the FDA, but did not receive an immediate reply.

Also see…

Stakeholders Weigh in on PCAST Letter

CDC Study: 1 in 4 US Adults Who Report Good Hearing Already Have Hearing Loss

NASEM Committee Looks at Regulations for OTC Hearing Devices

National Academies of Sciences Release Report on Hearing Aid Accessibility, Affordability

FTC Workshop Looks at Hearing Aids and OTC Hearing Devices

HIA Comments on FTC “Now Hear This” Workshop and OTC Hearing Aids

OTC Hearing Aid Consensus Statement Published by AAA, ADA, IHS, and ASHA

New Self-fitting Hearing Aid Class and Special Controls Described by FDA Letter

The American Speech-Language-Hearing Assn (ASHA), Washington, DC, has published a new survey showing that the annual median salary of an audiologist in 2018 was $80,000 to $83,843, depending on if they were employed in a clinical services or academic setting.

The survey data were gathered from 1,756 audiologists who responded to the ASHA 2018 Audiology Survey. Of the 1,615 respondents who reported how they were paid, more than 4 in 5 (81%) respondents were employed as clinical service providers. Median calendar year salaries ranged from $79,095 for clinical service providers to $104,293 for administrators, supervisors, and directors.

ASHA also points out several interesting highlights in the survey. Median salaries for audiologists who work on a calendar (non-academic) year were:

• $80,721 for audiologists with a master’s degree; $79,072 with an AuD; and $112,705 with a PhD;
• $72,000 for those with 1–3 years of experience;
• $80,000 for women and $91,925 for men;
• $84,000 for private practice owners;
• $82,872 for audiologists who were paid primarily by commission.

The median academic-year salary was $84,982 for audiologists who were university faculty and clinical educators ($80,000 for women).

To read the full report, visit: https://www.asha.org/uploadedFiles/2018-Audiology-Survey-Annual-Salaries.pdf

While most practices have neither the Imagineers nor unlimited financial capabilities to create an audiology clinic for a “Disney experience,” practice managers should realize that every patient visit to the clinic has to be an unexpected positive experience to turn them into a loyal, repeat customer.   

Business Management | July 2019 Hearing Review

By Robert Traynor, EdD, MBA

Understanding and analyzing three clues that define a unique patient experience

If you think that patients simply come to your clinic just because you are there, something is wrong with your perspective.  Yes, you may have a Doctorate in Audiology or other credentials, be licensed or have special certifications, and have many years of experience in hearing care and hearing rehabilitation. But the whole picture is not about you. While rapport and trust are an essential part of the patient visit, the whole picture is not just about the professional or the state-of-the-art products or the best practice services offered; it is the patient’s experience while providing superior hearing healthcare.

In fact, it is the patient’s total unexpected experience in your clinic that may be most important to success. Creating the unexpected experience involves strategic initiatives focused on a competitive advantage. This experience is fueled by a sum of the clues given before, during, and after the clinic visit.

Value and the Unexpected Experience: A Prerequisite for Future Success

Most will agree that Disneyland or Disney World is a clued-in, total customer experience (Figure 1). As a person involved in creation and development of the Disney Imagineers, Carbone¹ describes a visit to a Disney theme park as a total customer experience that truly creates value and builds preference for the Disney theme parks over the competition. He describes how Disney works hard to create these special experience—right down to the temperature of the ice cream and what is going on while guests are in line for rides and other activities.

Figure 1. Since its inception, Disney has been a master at creating the unexpected experience.

An example of this special attention is, when entering Florida’s Magic Kingdom, a look down Main Street toward Cinderella’s Castle makes the castle look farther away than it really is due to the subtle angling and relative heights of the buildings. This increases anticipation in the hearts and minds of their customers, old and young. Later, at the end of a long day with crying children and hurting feet, mom and dad can stand at Cinderella’s Castle and look back toward Main Street and the Main Gates, and again, the building angles seem to minimize the walk to the parking lot. The day is a totally managed unexpected experience—“Imagineered” to bring customers back time after time.

Walker Inc,² a customer experience consulting firm, reports that as we move through the 21st century, patients will be more informed and in charge of the experiences for everything they receive: products, services, and, yes, even clinic visits. After decades of discourteous receptionists, long forms to fill out, excessive waiting room times, and apathetic clinic staff who do not take the time, energy, and effort to know them, patients now expect practices to know their individual needs and personalize their experiences while proactively addressing their current and future desires. If any type of practice or business does not meet these needs—especially when not covered by insurance or other funding sources—those seeking products and services will find them elsewhere, no matter how competent the clinician and staff.

While most practices have neither the Imagineers nor unlimited financial capabilities to create an audiology clinic for a Disney experience, practice managers should realize that every patient visit to the clinic has to be a positive unexpected experience to turn them into a loyal repeat customer. Obviously, it would be difficult and expensive to modify an exam/treatment room or soundbooth to create a total patient experience like Disney.

However, becoming a clued-in practice is less involved.

Clues that Frame Customer Experience  

Berry et al^3,4 offers three types of clues in any business that frame the total customer/patient experience: Functional, Mechanic, and Humanic (Figure 2). In a practice, the unexpected experience is the total of the positive and negative clues perceived by each individual. Carbone¹ shows that the Functional clues are related to the products and/or services offered by the practice, the Mechanic clues are the environment in which the products and services are offered, and the Humanic clues are those related to professionalism of the clinician and their staff. During a patient’s visit to the clinic, each patient sensation (positive or negative), is a clue that contributes to the cumulative sense or feeling of the total experience.

Figure 2. Functional clues (eg, Can they help me with my hearing?) relate to rational perceptions. In contrast, Mechanic clues (eg, the appearance, sound, and smells of the office) and Humanic clues (eg, patient reactions to staff members) appeal to emotional perceptions. Image adapted from the work of Berry and colleagues.^3,4

Not all clues are created equal, as they can be sensed and valued differently by different people. Since people are from different backgrounds, with various personal styles, lifestyles, and generations, the way a specific patient puts these clues together may be somewhere between largely insignificant to very significant in their assessment of the total experience. As the patient’s mind combines all these stimuli/clues, their total unexpected experience is formulated, and their preferences are created and amended.

Functional Clues

These clues are the obvious rational perceptions. Carbone¹ states that functional clues register with the patient’s rational thought process, with their meaning and value interpreted by the brain’s logical circuitry as it assesses the functionality of the goods and services being provided. As its name implies, functional clues are all about functionality, which might include “Does the car start?,”  “Does the faucet still drip?,” or  “Can I hear?”  Functional clues answer the patient’s questions of:

• How detailed was my hearing evaluation?
• Is this clinic capable of accommodating my needs?
• How professional are they, really?
• Can they achieve better hearing for me?

Additional functional clues might be degrees and qualifications (eg, AuD) or licensing and certifications from your state or professional organizations. Further clues are a best practice hearing evaluation procedure and quality products.

Most audiology clinics handle functional clues about the same.  The unexpected—such as documenting product performance and patient outcomes, detailed hearing evaluation, and other unexpected functional clues—will win them over easily. For success, however, functional clues must at least be as positive as the competition.

Mechanic Clues

These clues come from the environment in which the professional products and services are provided. Mechanic clues to patients come from the physical surroundings such as the sights, sounds, smells, and textures. For these clues, care must be exercised to keep the clinic clean, and sounds must be subtle and engaging.

Some practices that are savvy to mechanic clues have fresh baked cookies and coffee delivered to the practice each morning.⁵ While fresh baked cookies, coffee, and other subtle smells and treats are great in some venues, practice clientele and culture may dictate other requirements. For example, if you specialize in pediatrics, a playroom with videos and possibly treats for kids, may be a necessity.

Additionally, care should be taken to ensure that furniture and fixtures and other physical surroundings are in the best possible condition (Figure 3). Frays in the soundroom carpet or other areas, torn wallpaper, light bulbs out, and worn waiting room chairs can be negative clues to patients as to how you will ultimately take care of them.

Figure 3. Worn and shabby waiting room and office furniture can produce an instant negative Mechanic clue in patients.

Humanic Clues

Humanic clues are the stimuli produced by people, such as the way patients perceive choice of words, tone of voice, cadence of voice, voice level, enthusiasm, gestures, actions, body language, and other human factors. For example, it has long been an unwritten law in practice that the attitude of the receptionist for the first phone call, reception process, the amount of paperwork, waiting time to see the audiologist, the amount and quality of time spent with the clinician, the detail of the evaluation, the discussion, a high- or low-pressure sales presentation, the fitting techniques, discussion of the hearing results, the exit, follow-up, and continued contact are all part of the ultimate unexpected experience.

Putting It Together

Clues are seemingly small things, but when added up—summing both the positives and negatives—they may often represent the important difference between patients receiving an positive unexpected clinical experience and one that is substandard, or just average.

Baby Boomers expect more. From the time their generation began, institutions and products have been created just for them. New products were created; theme parks and schools were built; colleges expanded and specialized foods were created just for them. Now we see long-term care and other facilities being created just for them. Therefore, audiology clinics need to cater to them as well by offering an unexpected experience where the positive clues far outweigh negative clues.

Windmill et al⁶ found that audiology clinics will not run out of patients anytime soon with a huge supply of prospective patients until 2040. While there will be many more patients, the commoditization of amplification will take its toll. The idea that “all hearing aids are the same” supports the mindset “just get the cheapest one.” Thus, patients who perceive that the Functional clues are the same from one clinic to another (and/or Big Box and online options) makes the Mechanic and Humanic clues even more essential for success in private practice.

Figure 4. The overall patient experience is largely defined by the Functional, Mechanic, and Humanic clues, all of which are controlled by the owner/manager’s experience management system. Image adapted from Carbone (p 83).¹

Recall that the Mechanic and Humanic clues become the great clinic equalizer. Clinicians need to ask, How is my clinic different? Do we offer unmatched Mechanic and Humanic clues that create an unexpected patient experience, or do we offer only the functional clues that suggest we are the same as all of our competitors?

Correspondence can be addressed to Dr Traynor at: bob@nullroberttraynor.com

Citation for this article: Traynor R. Are you “clued-in” to offer the ultimate patient experience? Hearing Review. 2019;26(7):25-27.

References

1. Carbone LP. Clued In: How to Keep Customers Coming Back Again and Again. 1st ed. Upper Saddle River, NJ:FT Press;2004.

2. Walker, Inc. Customers 2020: The future of B-to-B customer experiences. https://www.walkerinfo.com/Portals/0/Documents/Knowledge%20Center/Featured%20Reports/WALKER-Customers2020.pdf. Published 2013.

3. Berry LL, Seltman KD. Management Lessons from Mayo Clinic: Inside One of the World’s Most Admired Service Organizations. 1st ed. New York, NY:McGraw-Hill Education;2017.

4. Berry LL, Carbone LP, Haeckel SH. Managing the total customer experience. MIT Sloan Management Review. April 15, 2002;43(3).

5. Kasewurm G. Dr Gyl’s Guide to a Successful Hearing Care Practice. 1st ed. San Diego, CA:Plural Publishing;2019.

6. Windmill I, Freeman JS, Hall JW III, Freeman BA. Audiology and Medicare: Where economic reality collides with hearing care.  Paper presented at: AAA 2019 Annual Convention; March 27-30, 2019; Columbus, Ohio. https://www.eaudiology.org/products/aaa-2019-audiology-and-medicare-where-economic-reality-collides-with-hearing-care-03-tier-1aaa-ceus#tab-product_tab_overview.

Bittium Wearable Platform with Philips EmoGraphy & CardioSense solution is one of the five winners in the innovation contest “Transform the Future of Self-care,” organized by GlaxoSmithKline (GSK) Consumer Healthcare, Bittium announced. In the winning solution, Bittium integrated Philips EmoGraphy and Philips VitalSigns Optical technologies into a wearable device that reportedly calculates stress levels by measuring cortisol contribution from skin conductance. This device will also monitor heart rate and provide predictions of a person’s future stress level an hour ahead, according to the company’s announcement.

“We are truly honored for being recognized by GSK and selecting our Bittium Wearable Platform with Philips EmoGraphy & VitalSigns Optical solution as winner of the GSK Transforming the Future of Self-Care Challenge in the Digital Health Technologies category,” said Jani Lyrintzis, Bittium USA Vice President and General Manager. “The solution can be tailored for different user needs and objectives, and utilizes unique sensor technology and algorithms from Philips, not only to measure the user’s current emotional, fitness, and stress level, but also predicting the user’s future stress level, giving the user an opportunity to proactively influence their physical and emotional state and well-being.”

To measure and analyze emotional fitness Bittium has developed the Bittium Wearable Platform consisting of a wearable device called “BitWear” and an intelligent analytics tool, “SafeMove® Analytics.” The company reports that Philips EmoGraphy and Philips VitalSigns Optical technologies have also been integrated into BitWear wearable devices. Philips EmoGraphy SW is said to measure stress level and calculate cortisol contribution from skin conductance. Philips VitalSigns Optical SW is said to complete the measured data by adding parameters from the Heart Rate sensor. With measured data, users are reportedly able to practice self care and optimize their cognitive performance accordingly to maximize performance and safety, according to Bittium.

Additionally, Philips EmoGraphy SW is said to be adding a feature that will help users “predict future stress” by up to an hour, Bittium says. Measured sensor data is said to be shown to users in real time on the BitWear display, on a mobile phone app, and is also available for further analysis from SafeMove^® Analytics.

Philips, one of the world’s largest consumer and healthcare products companies, recently entered into a branding partnership with Demant, the maker of Oticon, Bernafon, and Sonic hearing aids. Philips hearing aids started being distributed globally in April of this year, including at Costco in the United States.

For further information about the contest and the winners, please visit: https://innovation.gsk.com/product-healthcare/innovation-contest.

For further information about Bittium Wearable Platform, please visit: https://www.bittium.com/rd-services/bittium-wearable-platform.

Source: Bittium

Image: Bittium