Yes, we carry OTC, and we do it better than anyone

Brian Taylor, Au.D.

The title of this editorial should be the mantra of every clinical audiologist in America. After all, there are several important reasons to champion the arrival of over-the-counter hearing aids. One, they provide an option for the 90%-plus of patients with mild hearing loss who do not currently own hearing aids – many who are unlikely to make an appointment to see an audiologist but nevertheless struggle communicating in challenging social and workplace situations. Two, research from the past decade clearly indicates that even mild untreated hearing loss is associated with several other serious medical conditions, and as mild hearing loss gradually declines, it tends to make people more disconnected from others as well as less socially active and less mentally sharp. Three, the ability to purchase hearing aids over the counter has the potential to mitigate these effects because, as early data show, it lowers the age of first-time amplification use by about 15 years.¹ Simply stated, more people wearing regulated hearing aids, regardless of how they purchased them, is good for society and good for the profession.

Answering Three Patient Questions

Even though we can agree OTC hearing aids are likely to have broad appeal for those individuals who wouldn’t find their way to your clinic, let’s not fool ourselves into thinking that the status quo won’t change. It will and we need to have a plan. Persons who buy OTC hearing aids, or who, by chance, visit the clinic asking about them, will benefit from the expertise of an audiologist in at least three ways, and are likely to ask audiologists three questions.

“What’s best for me?” In this scenario, during an in-person, routine assessment, a patient asks about the availability of OTC. When this occurs, the job of the audiologist is to educate the patient about the advantages and limitations of an unbundled, pay-as-you-go model compared to comprehensive service packages bundled with the sale of a pair of prescriptive devices. Chances are good, when effectively educated on the differences, patients who ask this question will select a bundled service package, even though those packages cost more up front compared to the pay-as-you-go OTC devices.
“Is this right for me?” In this second scenario, the patient has already purchased OTC devices, perhaps as a gift from family, and after extensive trial and error, they can’t get the devices to function properly. Now they are in your office, possibly frustrated, annoyed, and even agitated, willing to spend a little extra money to get their nominal investment to operate correctly. The job of the audiologist is to identify the root of their problem, conduct some quality control measures (2 cc coupler and real-ear measures) and provide a personalized plan for successful use.

Of course, the audiologist’s verdict might be, “You need to upgrade to prescriptive devices, and we have those here.” Like the answer to the first question, after patients are thoroughly educated on their options, many will likely opt for the more comprehensive service package albeit at a higher price point. When patients ask this second question, audiologists need to have a menu of services they provide (along with accompanying fees) that will answer this question.
“How do I get the most from this, now and next year?” The third scenario involves patients who are more proactive about their hearing health and are willing to spend some extra time and money squeezing more benefit from their existing OTC device purchase. Individuals who ask this question are likely to benefit from extended warranties and annual service packages that include occasional clean and check appointments.

Patients who fall into this third category are probably satisfied with the “good enough” benefit of their OTC purchase, buy want some added peace of mind, and are willing to pay a little extra for that. Down the road, maybe in a couple of years, these patients could purchase a pair of prescription hearing aids. In this scenario, OTC was an effective entry into hearing care, likely at a younger age, compared to the traditional prescriptive model of care.

Preparing for OTC, Next Steps

If you think OTC Is a good idea and you are willing to tell your community, “Yes, we carry OTC, and we do it better than anyone,” these three tasks can get you one step closer to leveraging OTC as an opportunity to grow your business and help more people:

Create educational materials that compare pay-as-you-go OTC to your existing good-better-best service/device packages. These materials need to clearly illustrate to patients that emerging data² suggests there are several barriers to existing OTC device satisfaction and benefit, including cosmetic concerns, physical discomfort, lower than expected speech understanding in noise and a general lack of perceived benefit associated with OTC use. These barriers are more likely to be successfully addressed when an audiologist is involved early on in the buying experience.
Conduct a time vs. cost analysis of your practice. This serves as the foundation of how much you will charge for services and for the types of services you will be charging for. The result of this process is a menu of services, allotted in 30-minute increments, with a corresponding fee for each service. Examples of these service options, listed on a menu, could include:

Clean and check: 30 minutes
2 cc coupler measures only: 30 minutes
Real ear and 2 cc coupler measures, including counseling: 60 minutes
Personal adjustment counseling: 30 minutes
Device assessment (troubleshooting): 30 minutes
Annual hearing assessment: 30 minutes

Develop a patient profile of individuals who are more likely to require prescription hearing aids. This third step will be particularly effective during an in-person appointment when patients are wondering if they can save some money by purchasing OTC devices. Perhaps the best way to educate patients is with a checklist like the one shown below. The checklist covers many important considerations that help patients navigate the differences between OTC and prescriptive treatment approaches. Armed with this checklist, the audiologist sits down with the patient and discusses each of these points:

Hearing Profile: Do you have more than a mild hearing loss or a medical condition?
Non-hearing variables: What are your hand capabilities, cognitive functioning?
Listening needs (goals) and device features: What hearing aids features do you need based on your daily activity levels?
Cost: Is cost your number 1 priority?
Perceived handicap: What affect does hearing loss have on social abilities and emotions?
Tech Savviness: Are you a regular smartphone user who likes to use apps?
Personality and motivation: Are you willing to work on your own to learn new skills? Are you positively motivated to try hearing aids on your own?
Expectations: Do you have high expectations about how hearing aids will work?
History of hearing aid use: Have you ever worn hearing aids?
Attitude toward hearing loss and getting treatment: Do you have a generally positive attitude about seeking treatment and/or using hearing aids?
Willingness to work with provider: Are you willing to follow the guidance of a professional or do you wish to work on your own without professional help? How willing are you to seek the services of a professional if something goes wrong or you have a question?

With some careful planning and execution, any audiologist can stand out from the OTC crowd and say with confidence, “Yes, we carry OTC, and we do it better than anyone. But first, let’s see what might be best for you.” ■

Footnotes

https://hearinghealthmatters.org/thisweek/2022/otc-hearing-aids-manufacturer-opinion/
Auriemma, C. , Wu & Ricketts. Examining the barriers to satisfaction in adults receiving OTC hearing aids. Poster presented at the 2022 American Auditory Society meeting, Scottsdale, AZ