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AUDIOLOGY
EXECUTUIVE SUMMARY
About 17 percent of adults in the United States, 36 million, report some degree of
hearing loss. At age 65, one out of three people has a hearing loss and 60 percent of the
people with hearing loss are either in the work force or in an educational setting. While
people in the workplace with the mildest hearing losses show little or no drop in income
compared to their normal hearing peers, as the hearing loss increases, so does the
reduction in the compensation. About 2 3 of every 1,000 children are heard of hearing
or deaf and it is estimated that 30 school children per 1,000 have of hearing loss.
(National Information Center on Deafness and Other Communication Disorders.
National Institutes of Health, Council of Aging - June 2010, and the MarkeTrak VIII: 25Year Trends in the Hearing Health Market November 2009)
The profession of Audiology had its origins in the 1920s when audiometers were
first designed for measuring hearing. Interest in this profession surged in the 1940s
when soldiers returned from World War II with noise induced hearing loss due to near-by
gunfire or to prolonged and unprotected exposure to machinery noise. Others had
psychogenic (non-organic) hearing loss as a result of severe emotional and mental stress.
The Veterans Administration took a lead role in providing hearing testing and
rehabilitation through hearing aids, auditory training, and speechreading (lipreading)
programs. Since the 1940s and 1950s, the study of hearing, hearing loss, and audiologic
rehabilitation, has expanded and now is a vital healthcare profession.
New tests of hearing have been developed including evaluations of functions of
the outer ear, middle ear, cochlea, acoustic nerve, and related brain areas. Techniques
1
using physiologic measurements that were in the research stages 20-30 years ago are now
routine. Modern technology and computerization have dramatically influenced hearing
aids. Hearing aids have changed from "boxes" in shirt pockets and "cords" to the ear to
highly sophisticated "completely-in-the-ear canal" aids. Virtually any kind of hearing loss
can be improved by a hearing aid. Cochlear implants are increasingly common and
successful.
Today, audiologists and the practice of Audiology have widespread visibility.
Audiology has a presence in public schools, health care centers, private practices, nursing
homes, community agencies, the military, hospitals, colleges and universities, hearing aid
dispensing centers, hearing and speech centers. They test hearing and listening ability;
they fit hearing aids and assistive listening devices; they provide training and
rehabilitation programs for individuals with hearing and listening disorders; they
participate on health care and educational teams to plan and provide the most appropriate
services.
I received a PhD from the University of Michigan in 1977, and have been trained
as a clinical Audiologist and hearing scientist and have been employed in the following
settings 1) a University Audiology professor, 2) hearing scientist and a specialist in inner
ear anatomy, 3) Clinical Audiologist employed by Otolaryngologists, 4) Audiologist
employed by hearing aid professionals and 5) my own audiological practice.
1.1 Objectives
Establishing its own Audiology Department.
space for storage, repairing hearing aids and for the preparation of hearing
aids for delivery.
Medicare will pay for the audiological testing, as seen by the sample
Medicare Audiology Superbill, while private insurances, including but not
limited to Blue Cross Blue Shield of Michigan, will contribute toward
reimbursement for rehabilitative treatment.
1.2 Mission
The primary goals of the Audiology program are medical and rehabilitative
management of the patients. As such, all of its patients should receive, as part of the
treatment plan, diagnostic audiological testing, which may include both ABR and
VNG/ENG testing. The hearing rehabilitation clinic would also reach out to greater
population surrounding the three clinics.
$36.08
b)
$34.04
c)
$32.00
TOTAL =
$102.12
The total time typically required performing these basic audiological testing is no
more than 45 minutes. Assuming there is a full day of work, the average number of
patients seen would be 8-10 depending on the scheduling. As seen from the Audiology
Superbill there are many audiological tests that can be performed. These tests would
include the ENG test battery, ABR testing and Otoacoustic Emissions testing. Michigan
Neurology Associates already bills for the ABR testing and ENG test battery and already
has calculated Medicare payments. The testing for ENG/VNG, ABR and OAE should
not take more than one hour forty-five minutes assuming no patient or equipment
problems
The primary profit center for the Audiology Department is hearing aid dispensing
and rehabilitation. The costs of operating this division of the department would include
the purchase of an otoscope, videotoscope, laptop, suction for cleaning hearing aid,
Dremel drill for hearing aid repairs and special equipment for cerumen management
(optional). Hearing aid dispensing services, as now practiced, provides hearing tests and
rehabilitative hearing aid adjustments for patients at no cost. Hearing aid wearers also
need batteries, hearing aid drying devices, assisted hearing devices, and earplugs that also
can be marketed. Medicare would cover the audiometric tests that support hearing aid
dispensing.
There is a very close relationship between the operation of a hearing aid
dispensing clinic and hearing aid manufacturers in that the manufactures provide close
support and training to an Audiologist to operate and program their hearing instruments.
This also would include free seminars.
Hearing instruments sell at a reasonably high cost as compared to the providing
of medical services. This fact has caused much consternation in light of the fact that a
hearing instrument is not a cure for a hearing loss. It would be important to include a
more comprehensive rehabilitation program for patients to help each patient and their
family to cope with a hearing loss and the use of hearing instruments. There are some
programs available nationally. This area requires additional research and it must be
determined if a more complex program is cost effective, or even necessary for every
patient.
A substantial profit can be made when dispensing hearing aids. Typically the cost
of hearing instruments should be no greater than 30-40 percent of retail cost. Therefore,
if a hearing instrument is marketed for $2,000 the cost of the instrument to the
Audiologist should be no greater than $500 - $600. Of course, cost structure depends on
the needs of the patient and the degree of sophistication of the hearing instrument in
attacking specific communicative problems.
Also, more than 80% of all patients who need hearing aids suffer from
permanent sensorineural (8th nerve) bilateral hearing loss. It is very common for both
ears to have similar hearing losses. Research has shown that wearing two hearing
instruments are very important because of the ability to communicate is enhanced.
Especially in a noise and other communicative environments (etc family gatherings,
church, TV). Two hearing instruments are recommended because many times, with a
binaural hearing loss, one instrument causes more problems in that one ear is now
significantly better than the non-treated ear causing communicative inbalances in sound
directionality and a breakdown in speech comprehension.
Hearing instrument dispensing requires a constant source of patients because not
every patient over 60-65 years of age would benefit form a hearing aid and those that do
benefit do not purchase hearing instruments for a variety of reasons including but not
limited to denial, vanity, cost and the basic inability to make decisions. It is also critical
that family members and/or friends accompany the person who may need a hearing
aidwhen this persons hearing is tested. There are many reasons for this that goes beyond
emotional support. For instance, a spouse may essentially insist that the other spouse
needs hearing instruments. Therefore, the counseling process in the purchase of hearing
instruments can be as long as one hour to one and a half hours which would many times
include the basic audiological testing of pure tones and speech.
Hearing instrument returns are problematic but nationally there should be no more
than 10-15% return rate. The return rate is many times related to buyers remorse.
There is much hand holding in managing a successful hearing instrument practice but a
successful proactive would be an important profit center for Michigan Neurology
Associates.
In order to have a successful practice an effective referral system must be
developed which would require physician staff involvement prescribing hearing
instruments to their own patients. The best referrals, of course, are from successful
treatment of patients of Michigan Neurology Associates.
Because of the intense need for qualified patients that would benefit from hearing
instruments, at least 15-20 patients per week, at ages above 65 years must be tested.
Then of that amount at least one- third of the patients, weekly, should be a qualified
hearing aid candidate. The conservative monthly gross for a start-up practice should be
over $20,000 a month. This, of course, depends upon the amount of time that can be
committed to this part of the Audiology Department.