Audiologists: As Hearing Aid Competition Stiffens, Show How Your Services Add Value

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Hearing aid consumers have an ever larger pool of hearing aid providers to choose from, with Internet dispensers, discount networks and Big Box retailers offering lower-cost options.

Patients may choose these options voluntarily to save money or because their insurers limit them to such options—but, given that such options rarely involve audiologists, the result is often improper, poorly fitted devices and unsatisfied clients, said audiologist Harvey Abrams, director of audiology research at Starkey Hearing Technologies, at a session on health reform and audiology at ASHA’s 2013 Annual Convention.

This is far from news to audiologists, who of course know that their health care training is necessary for proper selection and fitting of hearing aids. But the value-added of an audiologist’s services is often unrealized by consumers. Thus, said Abrams, as distribution channels expand, the key is to demonstrate that the audiologist channel is the quality channel because it’s centered on the patient and focused on positive outcomes. To differentiate their services and ensure that they meet these standards, Abrams recommended that audiologists:

  • Develop a comprehensive treatment plan that lays out strategies for patients to follow.
  • Administer a patient-focused income measure such as the Client Oriented Scale of Improvement to determine what the patient considers his or her most important treatment needs.
  • Use meaningful tests such as speech-in-noise assessments
  • Establish patient-specific treatment goals based on what the patient wants to achieve, using goals that are specific, measurable, attainable, relevant and timely, or SMART. Identify with the patient what he or she would define as success: For example, being able to carry on a conversation with a spouse in a relatively noisy restaurant.
  • Select hearing aid features on the basis of treatment goals.
  • Verify the hearing aid parameters with probe microphone instrumentation (real-ear verification measures): an objective, evidence-based way to fit hearing aids. Treat but verify.
  • Validate the hearing aid fitting. The definition of treatment success is how well patient goals are met.
  • Prescribe hearing assistive technology, such as FM systems, infrared systems and induction loop systems.
  • Provide post-hearing-aid-fitting aural rehabilitation services in the form of auditory training and/or group aural rehabilitation. Don’t just hand the patient a DVD!
  • Itemize your fees. Building them into the cost of the hearing aids just diminishes your value as a professional because they’re not then seen as payment for professional services, said Abrams. “If you commoditize your services, your patients will shop around, possibly online or at places like Costco,” he explained.


Bridget Murray Law
is managing editor of The ASHA Leader.

Harvey Abrams, PhD, CCC-A, is the director of audiology research at Starkey Hearing Technologies in Eden Prairie, Minn. He has served in various clinical, research and administrative capacities with the VA and DoD. He is an affiliate of ASHA Special Interest Group 7 (Aural Rehabilitation and Its Instrumentation).

Kid Confidential: Hearing Loss, Classroom Difficulties, and Accommodations

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(photo credit: sound waves via Bigstock)

Ah, the familiar sounds of rustling papers, fast paced walks from meeting to meeting room, and that all too common groan, a mixture of frustration and exhaustion in equal parts, remind me that it is that time of year in the schools.  It is “IEP season”.

In honor of the countless hours of reassessment, data collection, and paperwork completion you will be doing over the next few months, I thought I’d write a post to help out those of you who are once again, hitting the keyboards and staring at that blank section on your IEP.  You know the one I’m talking about.  You spend a lot of time thinking about it only after all the data and classroom observations are compiled.  You know it needs to be completed but after writing your student’s present level of performance, his goals and objects and of course his service time, who has the energy left to even think about classroom accommodations and modifications.  Well that is where I step in, at least for those of you who have students with hearing loss on your caseloads.

Last year at this time I had a few students with hearing loss managed with both hearing aids and cochlear implant (CI) on my caseload.  As a multidisciplinary team, we had to do some research to find appropriate accommodations and modifications for those students.  However, I recently read the book Children with Hearing Loss: Developing Listening and Talking Birth to Six, by Elizabeth Cole and Carol Flexer which provided some clinically useful information on the specific deficits a child with hearing loss might have in the classroom setting.  I wish I had read this last year while I was struggling with the multidisciplinary team to write an appropriate IEP.  But now that I found this information, I thought I would adapt parts of it and compile that information into a table for quick reference in the future.

The accommodations and modifications in the graphic below are suggestions of possibilities you may attempt to provide for your students.  This is by no means an exhaustive list nor would every student benefit from each suggestion.  Therefore, I recommend you use this list as a guide only while working collaboratively with your multidisciplinary team to determine appropriate accommodations and modifications for each student on an individual basis.

You will notice that the first accommodation for any hearing loss is the use of an FM system alone or in conjunction with auditory management (e.g. hearing aids, cochlear implant, other technology).  Research has shown the use of individual FM systems positively impact students with hearing loss of any severity level AND that classroom or sound field FM systems benefit ALL students.  One can’t help but wonder how different a student’s behavior would be in a classroom where the speech to noise ratio was in fact the recommended +15-20 dB rather than the typical +4 dB (Cole, Flexer 2007).  That is why the recommendation of an FM system is first as it is not only practical but very beneficial even for a child with very mild hearing loss.

Here are the levels of severity, classroom difficulties and possible accommodations and modifications for children with hearing loss.

You can download your copy of the above materials here.

I hope these materials help guide you and your multidisciplinary team when writing IEPs for your students with hearing loss.  Do you have additional modifications or accommodations you would add to this list?  Let us know by commenting below.

Thanks for stopping by and reading our second installment of Kid Confidential.  If you have any topics you would like us to discuss here, feel free to share.  You just might see your topic suggestion in one of the upcoming columns.  I’ll meet you back here on the second Thursday of next month.

Until then, remember, knowledge is power, so let’s keep learning!

References:

  • Cole, Elizabeth, and Carol Flexer. Classroom Accommodations for Students with Hearing Impairment. San Diego, CA: Plural Publishing, Inc., 2007. Print

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Maria Del Duca, MS, CCC-SLP, is a pediatric speech-language pathologist in southern, Arizona.  She owns a private practice, Communication Station: Speech Therapy, PLLC, and has a speech and language blog under the same name.  Maria received her master’s degree from Bloomsburg University of Pennsylvania.  She has been practicing as an ASHA certified member since 2003 and is an affiliate of Special Interest Group 16, School-Based Issues.  She has experience in various settings such as private practice, hospital and school environments and has practiced speech pathology in NJ, MD, KS and now AZ.  Maria has a passion for early childhood, autism spectrum disorders, rare syndromes, and childhood Apraxia of speech.  For more information, visit her blog or find her on Facebook.