The Use of Hearing Aid Technicians to Improve Clinical Efficiency



Author: Lindsay Bauman, Au.D.

Clinical efficiency improvements are essential for success in today’s healthcare environment. Clinical efficiency can be improved in a number of ways to increase patient access, reduce appointment wait times, and enhance the overall patient experience associated with a clinical encounter.

One way to enhance clinical efficiency is the use of a “top-of-license” strategy for aligning provider responsibility with scope of practice potential. The top-of-license concept is the simple idea of having providers practice to the full extent of their education and training, while spending less time on related tasks that could be done effectively by someone else. In the healthcare environment, this has led to a flourish of advanced-practice providers, such as physician assistants and nurse practitioners, and of support personnel, such as medical assistants and scribes, involved in the active care of patients during a clinical encounter.

In audiology, this top-of-license strategy has been growing for a number of years with the use of audiometric technicians, audiology assistants, and/or hearing aid technicians to provide services that are supportive of the audiologists’ practice of diagnosis and treatment of communication disorders resulting from hearing loss. On the diagnostic side, technicians are often used for the routine gathering of clinical information relating to hearing sensitivity or other hearing and balance testing. On the treatment side, technicians are commonly used to support the various components of care pertaining to the delivery and ongoing maintenance of successful hearing aid use.

This article outlines how the Henry Ford Health System Division of Audiology employs hearing aid technicians to help handle the day-to-day challenges of addressing the hearing care needs of a growing adult hearing aid patient population.
Background
Henry Ford Health System is a large health system located in the metropolitan Detroit area that provides services to a region with more than four million people. Our health system has five locations that provide Audiology and ENT services. Two of our locations are hospital-based practices, while the other three locations are satellite, out-patient facilities. The Henry Ford Health System Audiology Department employees over 20 professional staff, including full-time audiologists, contract audiologists, and audiology externs. We also employ five full-time hearing aid technicians. In addition, the staff provides clinical education to between five and ten second year Doctor of Audiology students enrolled at Wayne State University.

Each of our locations provides an array of audiologic services, including the dispensing of hearing aids at all five locations. While we do not use technicians for diagnostic services, we do employ a very active staff of hearing aid technicians. Our rationale for both practices relates primarily to the nature of our clinical population. On the diagnostic side, we are a tertiary care provider in a very busy medical practice. The gathering of diagnostic data is seldom simple, and we believe the engagement of top-of-license audiologists is the most effective and efficient way to ensure excellence in clinical data collection and decision making. On the treatment side, however, there are many tasks relating to hearing aid dispensing and follow up care that can be adequately and excellently handled by non-audiologist providers. Our primary use of technicians, whom we refer to respectfully as “hearing aid techs”, is to offer support to our hearing aid patients within our dispensing practices.

Our main objective in using hearing aid techs is to give our patients the best quality care possible by optimizing our provider talent. This allows more time for the audiologist to focus on essential audiologic activities, including the provision of diagnostic and treatment services to new patients, clinical education and other teaching responsibilities, and other administrative tasks. The goal, unquestionably, is to provide excellent patient care and satisfaction. To the extent that hearing aid techs can help us deliver convenient, thorough, and precise care, we can enhance patient satisfaction and enjoy all of the benefits of a happy patient base.

Hearing aid technicians within the Henry Ford Health System are involved in several important components of care, including walk-in patients, administrative responsibilities, and new-patient outreach.
Roles of our Hearing Aid Technicians
Hearing Aid Walk-In Patients
The main responsibility of our hearing aid techs is to handle all hearing aid walk-in patients. We believe that offering a walk-in service to our patients contributes to the best quality of care we can offer them. The alternative to a walk-in clinic, of course, is to have a patient wait until an audiologist has an opening on the schedule, which may be the same day, but is more than likely a week or more after the problem occurs.

Like most audiologists, we counsel our patients to wear their hearing aids all day, every day. Because of this counseling approach, we reinforce the importance of consistent, daily use. Thus, because we expect patients to rely on their hearing aids every day, we must be available quickly if they experience a problem with their devices. In our experience, patients appreciate being able to get into the clinic quickly to have their hearing aid problems or questions resolved.

We offer a hearing aid walk-in clinic at all five of our Henry Ford Audiology locations, with most sites’ walk-in clinics being open 40 or more hours per week. Our hearing aid techs see patients on a first come-first serve basis. Most patients are comfortable waiting their turn, as they are satisfied with being seen the same day they experienced an issue. Most walk-in appointments take between 10 and 15 minutes.

Patients are encouraged to visit a walk-in clinic if they experience a problem or concern, such as a hearing aid not working or not sounding normal. If a hearing aid needs to be sent in for repair, the hearing aid tech will send the hearing aid(s) into the appropriate manufacturer, and then dispense the repaired aid when it arrives back to the clinic.

Also, patients are encouraged to visit the walk-in clinic if they have questions about their hearing aids, need additional practice with insertion and removal of the devices, have cleaning and maintenance issues, or have battery insertion questions. They can also use the walk-in service if they need hearing aid supplies such as batteries, wax guards, domes, etc. In addition, we have seen increased walk-in traffic resulting from issues relating to connectivity between patients’ hearing aids and Bluetooth devices or cellphones.

At each hearing aid walk-in appointment, the hearing aid tech is also responsible for performing otoscopy on the patient. If otoscopy reveals cerumen or any other abnormality, they will schedule the patient for an appointment with an audiologist or an otolaryngologist. The technicians also ask each patient if they are pleased with their hearing aid programming and the overall performance of the hearing aids. If necessary, they will schedule the patient for a hearing aid programming appointment, or an updated hearing test with their audiologist. At the end of each walk-in visit, the hearing aid tech must also write a note into the electronic medical record system, and bill the patient or the insurance accordingly.

It goes without saying that a hearing aid walk-in clinic will not be successful if the patients are not aware of the service. We make a point of informing each patient of our walk-in services at each of their scheduled hearing aid appointments with their audiologist. The walk-in clinic services are also listed in our brochures and on the Henry Ford Health System website. Furthermore, the front desk staff and contact centers are trained to inform patients of the hearing aid walk-in clinic if they receive a phone call from a patient with one of the complaints mentioned above.

By offering a hearing aid walk-in clinic where these services are performed, we believe we are providing each hearing aid patient with professional, thorough, and timely services that they appreciate and continue to use as needed.

Administrative Responsibilities
In addition to their work with walk-in hearing aid patients, the hearing aid technicians assist in the preparation of each audiologist’s schedule for the following day. This includes pulling hearing aid charts, making sure all hearing aids needed for the following day are in the office, and checking all patients’ insurance coverage to verify hearing aid benefits. By having each patient’s hearing aid benefit information prior to the patient visit, the audiologist is able to accurately counsel the patient on costs of hearing aids and any hearing aid benefits at the time of visit.

The hearing aid technicians also check-in new or repaired/remade hearing aids when the devices arrive in the office. They verify that correct aids were received, program the aids with the corresponding software, fill out any paperwork, charge rechargeable hearing aids, perform a listening check, and call the patient to schedule an appointment, if necessary. Of note, our hearing aid technicians do not perform any programming changes on hearing aids for patients. When they check hearing aids in, they are only saving the programming that was previously set up by the audiologist.

Henry Ford’s hearing aid techs also handle many patient calls and emails. These are typically calls transferred from a front desk staff member if they are unable to answer the question the patient has.

New Patient Outreach
Finally, the hearing aid techs assist with bringing new patients into the office. They assist with health fairs, free hearing aid cleaning events, lunch and learn style events, and calling potential new patients from a referral list. This is an important way to keep the practice busy and growing, and the hearing aid techs are integral in making this goal a reality.
Why We Use Our Hearing Aid Techs the Way We Do
Some practices will use hearing aid technicians for other tasks than those already discussed. These tasks may include: hearing or balance testing, neonatal testing, and even fine-tuning and dispensing hearing aids. As alluded to earlier, Henry Ford Health System’s stance on why audiologists are only allowed to conduct these tasks can be broken down into two main reasons:
  1. Because we are a major hub medical center, a high number of our patients are otologically complex. We believe that testing and hearing aid dispensing by audiologists offers a more thorough, accurate, and efficient evaluation of these patients.
  2. We are a teaching facility. As mentioned before, we train many second year Doctor of Audiology students and fourth-year externs. These students benefit tremendously from exposure to a professional approach to these complex cases.
Private practices, or medical centers that employ audiologists and otolaryngologists, may choose to divide professional responsibilities differently and allow hearing aid technicians (or audiology assistants) to participate in other aspects of care, such as hearing or balance testing. As a general rule, it is advisable to check with your individual state concerning how assistants or technicians are credentialed, certified or licensed.
State Requirements for Hearing Aid Technicians
It is important to note that each state is different regarding requirements for hearing aid technicians. Some states require specific licensure, where others require certification or registration. Still, other states do not have any set regulations regarding the training, education, or usage on hearing aid techs. It is important to check with your state licensing board on the specifics for your state requirements prior to utilizing a hearing aid technician.

Table 1. A summary of four training programs for hearing aid technicians/audiology assistants.
Training Program Corresponding Website
Nova Southeastern University healthsciences.nova.edu/audiology/aud_assistant/index.html
Audiology Academy www.audiologyassistants.com
Council of Occupational Hearing Conservationists (CAOHC) www.caohc.org
Certification Program for Otolaryngology Personnel (CPOP) www.entnet.org/content/certification-program-otolaryngology-personnel-cpop-course


Michigan is a state that does not have any requirements regarding training, education, or certification for hearing aid technicians. The Henry Ford Health System finds value in taking a hands-on training approach in educating our five hearing aid technicians. Thus, the Audiology department personally hires and trains each hearing aid technician. Other practices have chosen to enlist the services of an organization to assistant in the training of their assistants and technicians. Many of these programs are web-based and require a licensed audiologist sponsor the prospective technician during the training. A summary of four such training programs is outlined in Table 1.

Regardless of your specific clinical model, hearing aid technicians and audiology assistants, when carefully selected and trained, can lower the cost of care and participate in delivering outstanding patient outcomes--both of which are necessary in improving clinical efficiency in markets where there is a growing number of older adults in need of hearing-related services and/or a shortage of qualified licensed audiologists. This article provides one example of how a “top-of-license” strategy employing assistants or technicians can make a clinic more efficient.    
Lindsay Bauman, Au.D. is Senior Staff Audiologist at the Henry Ford Health System Division of Audiology, which serves the metro Detroit area. Dr. Bauman can be contacted at lbauman2@hfhs.org.