Bundle Up

“Unbundle” – its a huge buzzword in audiology right now. Check out any hearing-related blog or publication made by audiology professional associations and there’s no doubt you’ll find people talking about this topic.

For those who aren’t familiar with the concept, I’ll try and explain briefly. Currently many audiologists and other hearing professionals sell hearing aids as part of a package. The patient pays a set dollar amount which typically covers the hearing aids, hearing aid accessories, the cost of the hearing evaluation, the time spent on the initial consultation, the time and use of equipment for fitting the hearing aids, the time to adjust the hearing aids, the time spent counselling and teaching, device maintenance, cleaning, and minor repairs. However, often the patient does not see all of this, and views the price that they paid as the cost of the hearing aids only. As a result, there is a public perception that the cost of hearing aids is super-inflated, with consumers believing that hearing professionals are making enormous profits off of the sale of hearing aids.

In reaction to this, some hearing professionals have begun selling “unbundled” hearing aids – with many others calling on all hearing professionals to do the same. In this model, the patient pays for the hearing aids at a cost much less than the typical bundled price point, but must pay for any additional services separately. Many are in favour of unbundling as a way to make hearing aids more affordable for the masses. As well, its often seen as a fairer pricing model. If you need more time with a professional, you pay for it; if you don’t, you save money.

I can fully understand these arguments, but I have a major concern. Is it truly ethical to sell unbundled hearing aids? Hearing aids cannot be fit as simply as eyeglasses – they require an extensive fitting process, and multiple follow-up visits to make adjustments that will lead to the best possible hearing rehabilitation. They also require a great deal of counselling and training for the patient to experience the most positive results. Is it appropriate for a hearing professional to sell a product knowing full well that the patient may choose to not return for ongoing care in order to save money? Should we be okay with the fact that patients could experience discomfort, substandard levels of amplification, or ultimately stop using their hearing aids because they choose not return to the clinic to correct these issues? In a bundled model, we recognize that a higher level of money is spent by the patient in exchange for hearing aids that will meet their needs to a high level of satisfaction. In an unbundled model, we grant patients the option of paying less money, but with a greater chance that we are failing to meet their needs at all, or even cause negative effects.

No one is going to an orthodontist to purchase discount do-it-yourself braces. No one is going to a physiotherapist to buy a book of possible exercises they can perform post-injury. No one is purchasing medicine from a pharmacist and figuring out the best dosage, method of administration, and side-effects for themselves. So why is it in the best interests of patients in need of hearing care to be free to take the bulk of care into their own hands? Why should hearing professionals be compliant in this process?

I worry that what I’ve written thus far may make me sound a tad extremist in my beliefs. However, I do believe that change is necessary in audiology, and new pricing models have a role to play in that. Maybe unbundled hearing aids could be withheld as an option from children, seniors, and other vulnerable populations. Maybe there are different levels of bundled services that could be purchased – the bare minimal featuring just real-ear measurements and a single follow-up appointment, while more expensive packages could include comprehensive post-fitting speech-in-noise testing. Maybe a bundle should only include the first 18 months post-fitting, with additional care at a pay-per-use basis.

One thing I will fully acknowledge is the general for hearing professionals to be more transparent. If professionals are going to charge patients in a bundled model, the patient should be aware of what the bundle consists of. Instead of quoting the cost as only hearing aids, the professional should give the patient some idea what proportion of the total cost goes towards the devices themselves, the testing, and follow-up care. Call it a “transparent bundling” model if you like.

Other notes:

  • Can we stop using the term “sell” in relation to hearing aids? Rarely do people say that pharmacists “sell” medicine. They fill prescriptions, which doesn’t just include the exchange of a medicinal product for money. Pharmacists have to be aware of the medical impact that the drugs they provide have, know how they interact with other medications, counsel the patient on proper administration and many other things. Hearing aids and the accompanying services required for good hearing care are as vital a health service as prescription medication to many.  Therefore, let’s try and use “fit” or “provide” instead of the S-word – because hearing professionals do so much more than that. (Maybe manufacturers could stop employing “Salespeople” and employ “Product Representatives” instead – many other industries practice this.)
  • $8000 is often given as the cost of a pair of top-end hearing aids in a bundled pricing model. Hearing aids are usually expected to last around 5 years – making an estimated daily cost of $4.38 for hearing aid use, $4.74 if you include the cost of batteries, and $5.01 if you incorporate spending $500 on repairs over the lifetime of your hearing aids. While this is no small amount, its certainly more digestible than spending $8000 up front. I wonder if the potential exists for a hearing aid leasing or subscription service?

How do you feel about this topic? Agree? Disagree? Let me know!

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