As a hearing care practitioner, you have likely treated patients whose hearing loss can no longer be sufficiently addressed by hearing aids. Depending on the patient’s age, condition, and financial situation, they may be a candidate for a hearing implant known as a cochlear implant (CI).
This puts the patient and the audiologist at a crossroads. The patient may wish to stick with amplification devices. This could mean delaying optimal hearing. They may ask for a referral to a CI center, never to return. Ideally, they will want you to continue as their primary hearing care provider while they explore implantable technology.
Whatever course of action they choose, they will need options for treatment and financing, and they are likely to seek your advice. Properly motivated and equipped, you can offer expert counsel to your patients while minimizing interruptions to their ongoing treatment and protecting their hearing.
Amplification and Stimulation
In an article they penned for The Hearing Review, audiologists Allison Racey and Melissa Riess discussed the challenges of “bridging the gap” between hearing aids and implant devices. They listed a number of signs that it might be time for a given patient to consider an implant, including:
- An inability to function on the telephone with hearing aids in place
- A device-aided word-recognition score of less than 60%
- An expressed curiosity about implant devices
As the authors explained, hearing aids rely on acoustic amplification to improve hearing. On the other hand, CIs provide electric stimulation, delivering a unique hearing experience through a combination of external and surgically implanted parts.
As manager of clinical research for MED-EL, Racey oversaw the US clinical trial of the Electric-Acoustic Stimulation (EAS) System for which her company earned FDA approval in 2016. The EAS System was designed to combine the low-frequency gains of acoustic amplification with the high-frequency gains of electric stimulation.
By educating themselves on the functionality and suitability of a range of implant devices, audiologists can coach patients through the decision-making process. Perhaps more importantly, should they choose to proceed with an implant device, audiologists who understand the procedures, risks, and benefits the patient will encounter can work in concert with the patient’s CI surgeon to provide the best possible treatment.
Using EAS as an example, Racey and Riess described a number of advantages enjoyed by patients who continue to see their audiologists. Among them are a sense of comfort and familiarity with a hearing care professional who understands their history and concerns. Audiologists are also a reliable source of information about emerging technology. It is also convenient to address implant and hearing aid needs in one appointment.
“Our industry is changing, and private practice must evolve as well to continue providing patients with the best possible care,” they wrote. “Shifting your approach to incorporate hearing implant technology can benefit both your patients and your practice.”
Pitfalls of Expansion
Racey and Riess also listed a number of common pitfalls audiologists may encounter as they broaden the scope of their practices. First and foremost is the very real danger that a patient may effectively be “lost” to the CI center. This could mean breaking an important connection and, potentially, limiting their treatment options.
“Open communication is the key,” the authors said, noting that the best way to avoid this is to open up discussions with CI surgeons in your area. Get a sense of how they handle audiologist referrals before you submit any. “Be prepared for cases where the implant center may say they need to follow the patient once they are implanted and consider that scenario.”
Another common pitfall involves reimbursement. Depending on the patient’s insurer, “durable medical goods” (including the external components of an implanted device) are sometimes reimbursed at a lower rate than their actual cost. The authors suggested audiologists bill insurers only for the cost of visits and allow patients or manufacturers to bill for parts and accessories.
Patients who do not have insurance or who will personally bear any part of the cost of their treatment may benefit from a financing option. Audiologists and hearing device retailers who partner with CareCredit are able to offer their patients financing for visits as well as purchases. This alleviates a common concern and minimizes delays in treatment. Essentially a health and wellness credit card, CareCredit is offered by more than 195,000 healthcare practitioners and retailers nationwide.
As Racey and Riess explained, audiologists who grow their practices by diversifying their offerings are doing a good thing for themselves, their businesses, and their patients, principally by creating more options for treatment and cementing an important relationship.
“Patients like what is familiar, and that familiarity, convenience, and existing relationship can bring a patient back to your practice—especially if they know that the choice is theirs.”