2016: Will It Be the Year of the Disruption? Gosh, I Hope So.

Author: Kim Cavitt, Au.D.

So, did my provocative title get you to keep reading? Please say yes, because it is important for readers to learn more about the disruptive forces at play in our industry.

Unlike many contributors before me, I see the audiology and hearing aid industry differently. I do not fear the disruption. I welcome it because there are a few key facts that I cannot deny. The risks of untreated cognitive issues, dementia, depression, and, if you believe the preliminary research, early mortality, far outweigh the relatively small risks of a small percentage of later diagnosed, but treatable otologic conditions being diagnosed later or missed entirely. At this writing, per NIDCD, “Among adults aged 70 and older with hearing loss that could benefit from hearing aids, fewer than one in three (30 percent) has ever used them. Even fewer adults aged 20 to 69 (approximately 16 percent) who could benefit from wearing hearing aids have ever used them.” These are statistics we should be just as concerned about. We KNOW we are currently leaving these hearing-impaired individuals behind. The 10-15% of hearing loss that is related to medically or surgically treatable otologic conditions only have the possibility of being missed with over the counter offerings.

Consumers for the past decade have been clamoring for lower cost amplification solutions, improved accessibility to technology, transparent, unbundled delivery and pricing options, and access to assistive listening devices and aural rehabilitation. But, let’s be honest, we, as an industry, have not responded. We have instead focused on increasing the average selling price and maintaining the status quo. Consumers, in turn, have been searching for technologies that could meet their needs. They have gravitated towards Big Box retailers and various online solutions, such as personal sound amplification products (PSAPS), FDA regulated hearing aids, third-party administrated discount programs, and managed care-sponsored solutions. Our failure to evolve and reach more of the hearing-impaired populace helped fuel these disruptions. We are not merely victims of circumstances.

First, and I cannot say this loud enough, to consumers, hearing aids are NOT really medical devices. They are consumer products. Now, before you shoot the messenger, hear me out. When we market, via direct mail, newspaper, TV, radio and the internet, hearing aid price promotions (rather than services and audiologic care), this and that for “free” or “complementary” (merely a classier way to say “free”), “buy one, get one’ promotions and “trade-in” programs we made a FDA regulated medical device a retail product. So, now we have to pay the piper and play in the retail sandbox. That sandbox just happens to be chockfull of disruptive innovations. Now, while I doubt most of you want to read the quintessential text on disruptive innovation, Clayton Christensen’s book The Innovator’s Dilemma, I do encourage you to read a short piece from the Harvard Business Review on the topic as it captures the key elements of Christensen’s work. This will illustrate that audiology, as a profession, is a bit late to the type of disruption that has faced many other businesses.

For a profession based on science and evidence-based practice, we tend to ignore research when it does not serve our purposes. I strongly encourage you to read the recent works of the Hearing Aid Research Lab at the University of Memphis, the work of Amyn Amlani, PhD at University of North Texas , and all of the proceedings from the National Academies of Science, Engineering and Medicine as it relates to accessible, affordable hearing care (https://iom.nationalacademies.org/Activities/HealthServices/HearingHealthCareForAdults.aspx).

All of this work points to the fact that there are value-based products currently available in the marketplace, both provider-driven and direct-to-consumer, which can remediate hearing loss in an easier, more cost effective manner. In my work, both on my own and through my student mentorship at Northwestern University, I have touched, listened to, and/or studied many of these disruptive products. I just did not assume they were crap because they were non-traditional, not picked by me or did not come from one of six companies; I sought to find out the answers myself. What I learned is that there are many excellent value-based or direct-to-consumer products that can effectively fit mild to moderate, sensorineural hearing losses at much lower price points. These do not replace traditional hearing aids; they expand the market. Heck, I firmly believe that many of them will be a gateway to more advanced, traditionally delivered technologies. This is what happened to the prescription lens industry when reading glasses hit the market. I encourage all of you to learn about these products, test them, and experiment on them with your patients. I have created a list for your review, but please note because the technology is rapidly changing, there are more than a few I may have missed.

Now, all is absolutely not lost for the audiology profession. First, almost all of you have already dispensed a PSAP. You just call it a Pocketalker. Many of these new entrants into the market should be approached no differently. They offer the consumer an accessible, low cost alternative when their situation or needs warrant it. Actually, these disruptions, if we respond accordingly, afford us many opportunities to reach a new, untapped group or demographic of hearing impaired individuals. Disruptive entities cannot provide the gold standard: an audiologic, diagnostic evaluation. They cannot provide a comprehensive case history and review of systems, the otoscopy and bone conduction testing required to diagnose a conductive versus a sensorineural hearing loss, speech-in-noise testing, real-ear measurement/speech mapping, aural rehabilitation, a personalized hearing aid inventory or a hands-on hearing aid fitting. We can and should offer these things. Research shows, time and time again, that when we practice evidence-based care, patient performance with amplification, improves. We simply have to provide this level of care, consistently. If we provide this type of service-driven care and embrace consumers who procure their aids by non-traditional means, we will always have a valuable, irreplaceable role in the amplification delivery process. Let us seize this opportunity by being engaged in these disruptions, rather than fighting them. The train has left the station folks. Are we going to get on?    

This article was posted at the Hearing Health & Technology Matters (HHTM) blog in February, 2016. It was republished with permission.
Disruptive Technologies in 2016