Integrating Value-Based Solutions

Author: Kim Cavitt, Au.D.

Folks have been asking me, how do I integrate value-based solutions, including value-based hearing aids (less than $500 each), over the counter hearing aids, personal sound amplification products (PSAP), and assistive listening devices, like the PocketTalker and smart phone applications, into my practice?

First, you need to familiarize yourself with the available products in the marketplace that you might want to provide in your practice. The vast majority of the products currently available have liberal return for credit policies. Research products and order those you find the most appropriate for your practice. I strongly encourage people to run an electroacoustic analysis, listen to them, manipulate them, and have friends try them. This will give you personal experience with and knowledge of what is out there in the marketplace, even if you opt not proceed with offerings any of the products.

If you want to offer a provider-driven delivery or patient engagement and compete against discount programs through third-party administrators and online hearing aid and PSAP vendors, you will need to deliver care in an unbundled manner. Bundling, or having the patient pay for everything related to the evaluation, fitting and long-term management of the device, regardless of what that device is, will make the cost disproportionate to the other delivery channels.

The patient care process would begin with all new patients receiving an evidence-based communication needs assessment/hearing aid consultation. This will help you best determine the patient’s audiologic and communication needs and if a value-based option is viable for their situation. The communication needs assessment would contain the following:
  • Assess chief complaint and history of chief complaint.
  • Review of diagnostic audiologic test results.
  • Perform most comfortable loudness, uncomfortable loudness, acceptable noise level and speech in noise measures.
  • Assess with patient, via case history and hearing handicap inventories, and communication partner(s) the patient’s lifestyle, their cosmetic desires, and the psychological, medical, educational, emotional, social, and/or vocational impact of chief complaint.
  • Assess patient’s dexterity.
  • Screen patient’s cognitive status.
  • Counseling patient and their communication partner(s) on their plan of care, including but not limited to:
    • A review of all diagnostic, rehabilitative and screening measures.
    • Presentation of treatment options, as it pertains to the patient’s lifestyle, their cosmetic desires, their dexterity, their cognitive status and the psychological, medical, educational, emotional, social, and/or vocational impact of chief complaint.
  • Hearing aids, provider driven and over the counter.
  • Personal sound amplification products.
  • Assistive listening devices, including FM systems.
  • Aural rehabilitation.
  • Tinnitus management.
  • Auditory prosthetic devices.
    • Basic instruction or information dissemination and counseling regarding plan of care.
    • Earmold impression, as needed.
The patient or their insurer, if they have a non-inclusive hearing aid benefit, would be billed for the comprehensive audiologic assessment (92557 or S0618), hearing aid examination and selection (92590/1 or V5010) and the earmold impression, each, if warranted (V5275).

Based upon the outcome of the communication needs assessment, your plan of care could include value-based options. You could stock them in your office and fit them, using evidence-based delivery, for a fee, or the patient could purchase them off directly off of your shelf. You will always need to research state dispensing laws for any laws or regulations that guide a purchase such as this. You might need a bill of sale or a waiver similar to online retailers for those who choose the off the shelf purchase.

You could offer focused training classes, such as device use, device cleaning and maintenance, communication strategies, aural rehabilitation, etc. for those who purchased over the counter options. These classes could be done in individual or group settings and could be provided by audiologists or their assistants. The patient would pay a flat fee for each course offering.

You could also offer service plans for those individuals who purchased over the counter offerings. Essentially service plans allow you to re-bundle long-term follow-up care and service. You could have simple plans that only include service visits or premium plans that include batteries, training, loaners, etc. You and your practice can personally build your delivery model and style to best meet the needs of your patients and demographic.

This type of model also requires the following:
  • Staff training and acceptance.
  • Well defined informational websites.
  • Informational office pieces and forms that explain and list your pricing and process.
  • Social media driven marketing campaign.
  • Physician referral program that outlines the differences of your approach to patient outcomes.
This type of model affords the patient expanded choice and affords the audiologist a means to compete with disruptive entities. My hope is that this piece provides food for thought for those considering alternative approaches to device delivery and care.

Please contact Kim Cavitt, AuD at with any comments, questions or concerns.    
Dr. Kim Cavitt was a clinical audiologist and preceptor at The Ohio State University and Northwestern University for the first ten years of her career. Since 2001, Dr. Cavitt has operated her own Audiology consulting firm, Audiology Resources, Inc. She currently serves on the State of Illinois Speech Pathology and Audiology Licensure Board. She also serves on committees through AAA and ASHA and is an Adjunct Lecturer at Northwestern University.