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Hearing healthcare has a new opportunity to become a partner with primary care providers because, in the new reimbursement environment that places value of care over volume of patients seen, the hearing healthcare specialist can help primary care providers succeed—especially with the elderly or those with chronic illnesses. Let’s begin with an all too common situation, which until rather recently has been unreported in the literature: An individual in his early 70s with Type II diabetes and mild, sensorineural hearing loss delays medical care because he hesitates to call for an appointment with his primary care provider due to difficulty understanding the appointment clerk on the phone.
The focus of the change is that “value” payments are being added to the traditional “volume” based fee-for-service reimbursement system in primary care. Over the last decade or two, it has been recognized that this traditional system has a very significant unintended consequence. There are numerous quality metrics being applied to primary care practices today, though the specific value-based payment varies by insurer and location. Only a few years ago, most primary care practices had little or no opportunity to receive revenue on the basis of quality metric performance. The “new money” for primary care actually represents a transfer of money from hospitals and specialists.
The language being used to capture this idea is that primary care is doing population health.
Referrals to audiology and hearing care professionals from primary care in the past were generated for the most part by requests from the patient and their family. Today, if hearing loss is recognized as a factor leading to poor patient compliance with medical care, then the poor compliance will cost the physicians’ practice real money.
In the traditional reimbursement environment, primary care providers are not at financial risk if their patients do not take their medicine, do not have recommended vaccinations or screening tests, or do not follow up after they are seen by another doctor. The evidence is growing that hearing loss—even mild to moderate hearing loss (see Barbara Timmer’s article3 in the April 2014 Hearing Review)—interferes with communication and speech understanding at a very basic level. Hearing healthcare has a new opportunity to become a partner with primary care providers because the hearing healthcare specialist can help the primary care provider succeed.
In short, interventional audiology can help primary care practices add value in a way that boosts their bottom line as well as improve the quality of life for many of their Baby-boomer patients. Clearly, hearing care professionals must leverage the changing healthcare system by working closely with primary care physicians and administrators so that a greater number of patients suffering from conditions associated with hearing loss come forward at an earlier age for hearing screening. Foley et al4 recently demonstrated that self-reported hearing loss is independently associated with higher total medical expenditures.
Future hearing healthcare marketing strategies need to focus on how to integrate the “knowledge economy” to generate tangible and intangible values in the primary care market place.
This partnership can be entered into if audiologists and hearing care professionals change  their roles to that of “interventionist” and “knowledge marketers” who inform primary care about how our expertise and services can assist in primary care’s ability to practice “preventive care.” Ultimately this partnership improves the quality of care, the quality of lives, and the quality of the financial performance of the primary care, as well as the hearing care practice.
Even a partnership based on mutual respect between primary care medicine and the hearing care professions may not be enough to overcome the forces associated with the ambivalent patient who is often resistant to our interventions.
This inability to take swift action can be explained through the lens of help-seeking behavior. 5) Maintenance, when the individual makes a deliberate attempt to maintain their changed behaviors. Two self-report questionnaires have been used in “stages of change” research to ascertain the underlying decision making process of individuals with hearing loss.
Research using the Health Belief Model and Stages of Change model have attempted to better understand behaviors of individuals with hearing impairment who have failed hearing screening. More recently, Laplante-Levesque et al10 evaluated the stage of change of 224 adults who failed an online hearing screening. Taken as a whole these studies suggest that hearing screening alone is not enough to improve help-seeking rates. Carson based her Spiral of Decision Making model on the longitudinal study of a group of woman between the ages of 72 and 82 years of age.
Changes in the primary care delivery model and implementation of knowledge-based marketing tactics intended to foster a deeper relationship between audiologists and physicians do not alter the fact that onset of hearing loss in adults is a stigmatizing condition. The social model of disability identifies systemic barriers, negative attitudes, and exclusion by society for individuals suffering from a chronic condition, such as ARHL.
In an evolving healthcare system, the role of physicians, audiologists, hearing instrument specialists, and others is to ease, reduce, or eliminate environmental, attitudinal, and societal barriers of patients.
1) The way primary care medicine is practiced is changing and this change affords hearing care professionals an opportunity to get more directly involved in the care of patients at younger ages with milder hearing loss. 2) If hearing care professionals are to leverage these opportunities they must use evidence from peer reviewed studies, which shows a relationship between various medical conditions and ARHL as a key part of their marketing message. 3) Given the psychological nature of ARHL, long-term professional success is largely predicated on what happens once a patient decides to seek the services of a practitioner. The BCIG believes that if a patient meets the criteria for a cochlear implant as specified in the NICE Guidance, funding for that treatment must be provided by the appropriate healthcare commissioning body following a positive assessment by the specialist cochlear implant centre.
The British Cochlear Implant Group is a professional body representing all the cochlear implant centres and other specialist medical practitioners throughout the United Kingdom.
A cochlear implant is an electronic device which may be suitable for children and adults who receive no useful benefit from conventional hearing aids. Cochlear implants are not suitable for all profoundly deaf or deafened adults and children. Further to the BCIG and You survey which we undertook in 2015, the results are now available here. At the pre-employment stage it is critical to have a baseline audiogram before working in noisy work environments. Current noise legislation specifies that in cases where the daily exposure is greater than 85 DbA hearing surveillance including audiometry must be offered to employees.


Spirometry is used in health surveillance programs where the worker is exposed to dusts, fumes or chemicals and at risk of work related asthma. Spirogram testing on workers complaining of chest symptoms; as an aid to clinical diagnosis. Medwise will work with a new client to conduct a full review of all the sitea€™s occupational health services in place as well as a review of current statistics concerning duration of disabilities, injury trends, etc. Frank Wartinger is a pediatric audiologist at All Children’s Hospital in Tampa, Florida and a clinical instructor at the University of South Florida.
Musicians and audio engineers are at high risk for developing Music Induced Hearing Disorders (MIHD), and prove to be a sensitive clinical population as their hearing is uniquely critical to both their livelihood and their personal life.
This course will review tinnitus and clinical tinnitus assessment including use of questionnaires and audiologic assessment. As it becomes increasingly evident that better hearing leads to better patient compliance and better overall outcomes, hearing healthcare professionals stand to reap huge benefits and an increasingly important role in the overall healthcare system. In Part 1 (November 2013 Hearing Review),1 we pointed out that, rather than centering on the dispensing of a hearing aid or medical device, we should be practicing interventional audiology: a focus on the disease state of hearing loss and its relationship to the chronic medical consequences of hearing loss. There is a constellation of forces at work within the American healthcare system that may enable hearing care professionals to emerge as integral members of a patient’s health and wellness team.
Both private and public insurance programs, as well as large employers, are changing the way primary care providers are being reimbursed for their services.
Reimbursement in traditional primary care is a function of volume: the more patient visits a primary care practice sees in a year, the higher the annual revenue will be.
The focus is on seeing the maximum number of patients a day that can reasonably be accommodated with the minimum of overhead expenses.
If patients were not sufficiently motivated to take care of their health, they would often miss recommended screening tests or take medicines irregularly.
There are many ways being used today to pay primary care practices to improve the value of their services. These payments tend to focus on the quality of care for chronic diseases and also on the percent of patients who receive preventive treatments (eg, vaccinations) or screenings (cancer, cholesterol,  etc). Hospitals and specialists, naturally, are having trouble accepting the fact that this idea has gained traction with insurers, Medicare, and Medicaid. Treatment of hearing loss was considered elective, an issue that was almost entirely related to patient preference.
With value-based reimbursement systems growing rapidly, these same primary care practices are now at a clear financial risk.
This communication and understanding is critically important for patient compliance with medical care, especially for patients with chronic illnesses and the elderly.
Audiologists, in particular, should understand these new issues in primary care and be clear that the services which audiology offers are not simply services to the patient, but they represent a service that will help the primary care practice as well. Part of this strategy includes educating primary care medicine about the increased costs associated with caring for individuals with hearing loss. The key component of a “knowledge economy” is a greater reliance on intellectual capabilities.
A transition to marketing our knowledge of modifiable risk factors that contribute to the presence of co-morbidities, resulting in an increased risk and incidence of hearing loss is vital to the future of hearing healthcare. Over the past few years, several studies have enriched our knowledge of how adults with chronic medical conditions, such as ARHL, manage their condition and what cues to action may influence their behavior change.
The Health Belief Questionnaire (HBQ)7 is a 33-item assessment, developed by Saunders and colleagues that measures five constructs: severity, benefits, barriers, self-efficacy, and cues to action on a 10-point scale. Milstein and Weinstein9 evaluated the “stage of change” in 147 older adults participating in hearing screening.
In this study, 50% of the participants were in the preparation stage of change, while 38% were represented by the contemplation stage and another 9% by the precontemplation stage. Another line of research attempting to explain the underlying decision-making process of hearing-impaired individuals was proposed by Carson.11 The Spiral of Decision Making model (Figure 3) explains the “push-pull” between seeking and not seeking help that many patients with hearing loss of gradual onset experience.
In order to embrace the health belief models shown in Figures 1-3, hearing care professionals are encouraged to view the condition of ARHL through the lens of the social model of disability. While physical, sensory, intellectual, or psychological variations may cause individual functional limitation or impairments, these do not have to lead to disability unless society fails to take account of and include people regardless of their individual differences.
This change requires a significant shift away from price-driven , product-centric advertising to knowledge-based marketing strategies, which place the skills of the practitioner at the center.
The essence of the practitioners skills rests with their ability to unravel the so-called spiral of decision making. There are some other options detailed for your information such as Assistive devices and other communication options. This will screen for previous damage before commencing employment, and avoid liability for a€?inheriteda€™ hearing damage.
Hearing surveillance involves regular audiometric testing to monitor the workforce for signs of noise induced hearing loss and allow early medical intervention to conserve hearing.
Appropriate health surveillance programs can then be defined to ensure optimal employee health. Tinnitus is one of the most common hearing disorders associated with intense sound exposure and specific care should to be taken by the clinician when evaluating and treating the musician or audio engineer experiencing tinnitus.
Brian Fligor and other leading experts to explore the latest research in NIHL and its clinical application to audiology practice. The purpose of this presentation is to provide participants with information about the special issues that patients with tinnitus face and helps to start tinnitus care and management services in their own practices.


In Part 2 (July 2014 HR),2 we explored some of the specific research that directly encourages the medical-audiological relationship and how to leverage peer-reviewed health science to build a physician referral base. Thinking he has been told to alter his medication regimen, his diabetes is soon out of control and he ends up in the emergency room.
The graying of the American population, the notion that baby-boomers want more active participation in their healthcare, the emergence of direct-to-consumer amplification products, the unsustainably rising costs of healthcare—all of these factors have the potential to profoundly change the way audiology and hearing care are perceived by primary care physicians. The reason for these changes is the rising cost of healthcare and the realization that primary care is the key to reducing those costs.
The system is complex in that some patient visits receive higher reimbursement than do others, but the system has nevertheless been purely volume-based. The most successful practices in this traditional volume-based model were usually the busiest.
When they finally had their appointment, they needed more care than would have been the case if they had been seen sooner. As a result, they suffered from illnesses that could have been avoided, and caring for those illnesses was  yet another cost to the healthcare system.
One common method is to pay the primary care practice a periodic bonus if certain performance standards—usually called “Quality Metrics”—are met. The number and sophistication of these quality metrics is rapidly increasing, and as this occurs, the potential dollar value of the payments to the practice is also increasing.
It is not uncommon for practices to receive an additional 10% of their annual revenue from quality metric performance; and 20% and even 30% of traditional volume-based revenue are being seen from high performing practices. But it has gained traction because it works. The increase in income to primary care is only a small fraction of the decrease in income to hospitals and specialists, and the savings in healthcare costs for large employers, insurers, and government programs is why this is going to grow. And, of course, these are the very patients who have the highest incidence of hearing loss. Hearing loss was associated with greater odds of office-based, outpatient, and emergency department visits and not only costs that would be directly attributable to hearing loss treatment (eg, medical equipment expense). We should implement an “Educate to Obligate” marketing strategy aimed squarely at primary care physicians, utilizing clinical research, changing healthcare economics, patient education, and services-focused marketing that persuades them to think differently about how to enter into a patient care partnership with us.
Before the screening, 76% of the participants were in the precontemplative or contemplative stages.
Ultimately, it is the personal relationship between hearing care professional and primary care physician; hearing care professional and patient that drives the sustainability of the our profession.
Interventional Audiology: Partnering with physicians to deliver integrative and preventive hearing care. Application of the Health Belief Model: Development of the Health Belief Questionnaire (HBQ) and its association with hearing health behaviors.
Please note: There is an issue with course audio that is corrected at about the 14 minute mark. Topics included: strategies for prevention of noise and music-induced hearing loss, tinnitus assessment in musicians, nutrition and noise, and emerging research on otoprotective agents. This is the second in a series of 4 webinars in the 2014 Noise Induced Hearing Loss Seminar Series on AudiologyOnline. In Part 3, we link the changes in healthcare and our emerging knowledge of behavioral models of hearing loss with in-clinic success.
Acutely ill patients were seen promptly, but other patients waited patiently, sometimes for many days and even weeks for routine appointments. That cost is large, and it turns out that paying primary care to focus more attention on prevention and earlier treatment is far less expensive that paying the entire healthcare system for the cost of caring for patients who had missed opportunities to detect, prevent, or treat illnesses at an earlier stage.
A common quality metric in primary care today focuses on the care of diabetic patients: if lab and other tests done to measure the effectiveness of diabetic treatment meet certain standards, the primary care practice receives periodic cash payment from the insurer based on the number of diabetics in their practice and the quality measure performance. Future work should investigate the mechanistic basis of the observed association and whether public health strategies focused on hearing rehabilitative treatment could mitigate excess medical expenditures associated with hearing loss. Additionally, the University of Rhode Island Change Assessment (URICA)8 is a 24-item self-report assessing the first four stages of change outlined in Figure 1, using a 5-point scale. Viewing our value proposition through the lens of the social model of disability, rather than through the lens of the medical model of disability in which the dispensing of hearing aids is at the center, has the potential to transcend the marketplace. This payment is in addition to the usual volume based reimbursement which the practice receives for each visit. Although both tools have been validated, given their length, neither questionnaire is considered viable clinical tools in their current form.
The next installment of our interventional audiology series will examine the role of solution-based interviewing techniques and how they can be used to improve in-clinic success. If you had to do tinnitus pitch matching, the listener would probably select the highest pitch, but you can hear how it would be very difficult to find a pitch match on a sound containing with so many different elements.My tinnitus. Prevalence of leisure noise-induced tinnitus and the attitude toward noise in university students.
The tinnitus functional index: development of a new clinical measure for chronic, intrusive tinnitus. Tinnitus reaction questionnaire: psychometric properties of a measure of distress associated with tinnitus.



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