Hearing aid dispenser kentucky,constant clicking noise in my ear 05,tinnitus ear pain and hearing loss - Review

Author: admin, 03.04.2015. Category: Is There A Cure For Tinnitus

Prices of hearing instruments are either flat or declining, binaural fittings have continued to increase in popularity, and low-cost hearing aid options are starting to make their way into the armamentarium of devices that dispensing professionals offer, according to a new survey conducted by The Hearing Review during the concluding months of 2013. Overall, a picture emerges of an industry that is witnessing some major changes in response to new technology being offered by hearing aid manufacturers, the Internet and Big Box retailers, pricing pressure exerted from forces both within and outside the traditional hearing industry, and the demands of the aging Baby Boomer generation. An excellent article (“The Coming Crisis in Audiology”)3 by Barry Freeman, PhD, addresses this topic and warns that, in coming years, greater numbers of audiologists will be retiring from the field than entering it—while the senior population and the need for audiological services increase. In the present survey, about three-fifths (57%) of respondents identified themselves as dispensing audiologists, and about the same percentage said they had attained either a doctoral (37%) or masters (23%) degree.
Second, as with previous HR surveys, this year’s survey had several very large dispensing outlets—including 6 that reportedly dispensed more than 100 hearing aids per month, with 4 of these reporting very large unit volumes (per month).
However, when one looks only at those practices dispensing fewer than 100 hearing aid per month (ie, excluding the 6 largest dispensing offices in the survey), the average was 23 units, and the median was 20. Going back 20 years and comparing 2013 figures to those of 1994 and 2003 HR survey statistics,1,2 there are fewer hearing care offices today dispensing more than 20 hearing aids than in the past (Figure 3).
Another thing that comes out of a comparison of this HR survey is, in general, larger practices appear to be growing at faster rates than smaller ones.
This represents a much higher-than-expected percentage for the premium technology instruments—at the expense of percentages for the mid-level and economy instruments. A separate informal “straw-poll” in February by the editor of about a half-dozen hearing aid manufacturer executives on the same question brought a wide range of responses. Also included in Table 2 are the weighted average prices, which are based on the averages of the three price levels shown at the top of the table and, in the case of the total weighted averages (bottom line), the 2013 HIA statistics6 for private-sector unit volume (ie, non-VA dispensed hearing aids). The total average weighted price for all styles of hearing aids at all technology levels was $2,363—the highest yet for any Hearing Review survey. Figure 5 reflects this hearing aid technology and style pricing, and compares the prices with the same CPI-adjusted (2013) data from dispenser surveys taken in 201011 and 2005.10 When comparing 2013 to 2010 CPI-adjusted figures, premium technology hearing aids have decreased in price by 2% to 9%, mid-level technology prices have remained essentially the same, and economy level prices have actually increased by 12% to 17%.
However, comparing 2013 to those of 2005 (CPI-adjusted) some 8 years ago suggests that prices have decreased almost across the board.
For several years, industry analysts and hearing aid manufacturers have been reporting flat to declining hearing aid prices on a worldwide basis.
Figure 6 summarizes previously published survey data from Hearing Instruments, Hearing Review, Hearing Journal, and the Phonak Practice Management surveys since 1980. In this year’s survey, we also asked what was the very lowest priced hearing aid the practice offered (eg, the final hearing aid that might come out of a dispenser’s drawer when it’s apparent that price alone is the only factor stopping the patient from adopting amplification). A total of 16% indicated that they did not offer the full complement of audiological services with this lowest-priced aid, and 8% said they actually marketed this device as a personal sound amplification product (PSAP). And speaking of PSAPs… We also asked what percentage of new clients are believed to have tried a PSAP prior to purchasing a hearing aid.
In this survey, an average of 84% of fittings were reported to be binaural, with a median of 90%. Figure 7 shows historical data published in Hearing Instruments and Hearing Review surveys going back to 1979. The United States’ 84% binaural fitting rate is substantially higher than any other developed country.
Likewise, in this survey, cost was cited by 45% of respondents as the #1 reason for lack of purchase by first-time buyers, out-polling the #2 reason of “Not yet ready” (14%) by a 3 to 1 margin. The base price of a set of binaural hearing aids (an average of $3,300-$6,000 as shown in Table 2) can be a shock to first-time users and a financial burden, especially those on a fixed income. Average and median hearing aid unit volumes increased in 2013 over 2012 for dispensing practices in this survey—especially the larger ones. Although the 2013 survey reports a fairly substantial increase in the average weighted hearing aid price ($2,363), this was primarily due to the very large number of premium technology hearing aid sales reported by survey participants.
In 2013, the average price of an economy level hearing aid (weighted by HIA statistics relative to hearing aid styles) was $1,657, while mid- and premium-level technology aids averaged $2,196 and $2,898, respectively. Dispensers in this survey believe that 10% of their new patients tried a PSAP prior to their first visit (median 5%). An average of 84% of patients were fitted with binaural hearing aids by survey respondents (median 90%), up from 80% in 2005.
Although cost remains a major deterrent in buying hearing aids, only 17% (median 10%) of patients pay using a third-party financing company or via in-house payment options that the dispensing office establishes (8%, median 5%). The average dispensing office uses its #1 brand of hearing aid for over three-quarters (77%) of its fittings. About the author: Karl Strom is editor-in-chief and a founding editor of The Hearing Review. We arrange “Open House” Hearing Clinics to increase in-office sales with absolutely NO up-front money or advertising. I just spent a wonderful week with 2 old friends that have been in my office on separate occasions. I have had the pleasure of working with Ken Barber and Jim Kelly, from Hearing Partners, in both my offices.
They come in and call all the old users and get them back in for follow up and show new products.
While the commission rate was higher than I usually pay my consultants, I had no advertising expenses to pay. In November and again in December 2013, The Hearing Review emailed a survey via SurveyMonkey using The Hearing Review subscription database. Age of dispensing professionals reported in 3 different Hearing Review dispenser surveys taken roughly 10 years apart (1994, 2003, 2013).
More than one-third (37%) of the dispensers were over 60 years old, and 18% were 65 years or older—what most consider retirement age. Figure 1 compares survey respondent ages from two other Hearing Review surveys taken roughly 10 years apart.1-2 Over the 20-year period, there is a clear trend away from practice owners in their 40s, with the majority (63%) today being in their 50s and 60s, compared to 53% and 36% for 2003 and 1994. That article also notes that an American Academy of Audiology (AAA) survey of all its members (ie, not focused on private practice owners) found that 38% were over age 50, and only about 25% of all audiologists are practice owners. This is slightly more than the ASHA 2012 Audiology Survey,4 which reported a median of 17 years’ experience for audiologists (again, in a wide range of audiology positions, not just dispensing). Nearly two-thirds of respondents (62%) were either completely independent or affiliated with an independent network, co-op, or buying group, while another 16% were affiliated with but not owned by either a manufacturer or corporate chain.

If you were to ask most industry experts, they would probably comment that this year’s survey is weighted disproportionately to independent dispensing professionals (who, not coincidentally, are probably the most avid readers of The Hearing Review). Average hearing aids dispensed per month in three different HR dispenser surveys taken roughly 10 years apart (1994, 2003, and 2013). Due to this, these largest of firms have been left out when computing averages for some factors (eg, units dispensed, revenues, etc).
Smriga5 estimated in 2011 that manufacturer-branded and corporate-owned practices accounted for 32% and 8% of all dispensing offices, respectively, while affiliated providers made up another 37%. The median reported average number of net hearing aids dispensed per month in 2013 was 20 units, according to survey respondents. This represents about a 4% to 10% sales increase over 2012 when dispensers reported an average of 22 units and a median of 18 units per month. In particular, when looking at the 21-30 and 31-40 unit per month categories, the numbers of practices dispensing these higher volume levels have decreased from 25% to 18% and 14% to 5%, respectively, over 20 years. Top: Reported average and median percent utilization of economy, mid-level, and premium hearing aid lines. For example, in the 2006 dispenser survey,10 the percentages were 30%, 46%, and 24% for premium, mid, and economy level aids, respectively. In general, they felt the smallest percentage use was in the premium lines (eg, ranging from 20% to 30%), and they gave widely varying but generally higher responses for the mid and economy lines (30%-60%). The average weighted price of premium technology hearing aids decreased by 10% to 12% (decrease of $312-$384), and by 6% to 10% (decrease of $122-$235) for the mid-level aids.
It’s interesting to note that, in the 2008 MarkeTrak VIII survey,9 when ignoring VA, free, and discounted hearing aids, the median out-of-pocket cost was $2,000—or $2,164 in CPI-adjusted 2013 dollars (Sergei Kochkin, personal correspondence, March 2014).
Much of this can be attributed to global changes in state reimbursement programs (eg, VA and the UK’s NHS), Big Box retailers, and increased competition from both within and outside the traditional hearing aid market. Historical average hearing instrument prices taken from Hearing Instruments, Hearing Journal, and Hearing Review surveys from 1980 to 2013, as well as MarkeTrak (shown in both nominal prices and 2013 CPI-adjusted prices). What it suggests is that this survey’s results—particularly if you consider it is probably skewed by a higher usage for premium product lines—confirms flattening  to declining hearing aid prices during the past decade not just as an aggregate result of rapid volume growth in the VA, mass retailers like Costco,12 and discounting by chains and networks, but also as actual lower prices in independent, private-practice dispensing businesses in response to a more competitive, price-focused market. These analog hearing aids had a price range from $1,055 to $1,331 in 2013 dollars—about $400-$500 less expensive than the digital aids of their day and significantly below today’s average economy-level price of $1,657. This brings up several interesting questions that cannot be explored here due to space issues. It’s well accepted that bilateral amplification (fitting two ears with hearing aids) offers large and meaningful benefits, especially in understanding speech in competing noise (eg, cocktail party effect). This may be a point that approaches the theoretical maximum (possibly 85%-90%, although I could find no data concerning unilateral hearing loss for adults or speculation on a theoretical maximum for binaural fittings). Historical percentage of binaural vs monaural fittings since 1979, as reported by Hearing Instruments and Hearing Review magazine dispenser surveys. In most years during the past 3 decades, binaural hearing aid fittings have increased by 1 to 4 percentage points.
For better or worse, the bundling of products and services into a dispensing office’s prices continues to be common practice. Survey respondents indicated that half (50%, median 50%) of their patients pay for their hearing aids using a credit card, and another 37% (median 30%) pay with cash or check (Figure 8).
However, Figure 6 shows that hearing aid prices have more than doubled in the 20+ years since 1993 (an increase of 106%, or $1,218 in 2013 dollars). Just over 1 in 5 dispensing practices (21%) in the survey reported offering only one product line, while more than 3 in 5 dispensing practices (61%) offered 2 to 4 brands of hearing aids. Figure 9 compares the number of brands carried by dispensing offices in 2013 to the number of brands carried in 2005 and 2003, according to HR dispenser surveys.2,10 Ten years ago, only 6% of practices reported carrying only one brand of hearing aids compared to 21% today. Regardless of the number of brands offered in a typical dispensing office, the average percentage of hearing aids in that office coming from the #1 brand has remained essentially the same: 77% (median 80%) of all hearing aids in 2013 compared to 72% in 2003. The survey also asked respondents an open-ended question, inviting them to list their three most-used brands.
The median number of units per month dispensed in 2013 increased to 22 units from 20 units in 2012. When comparing 2013 to 2010 CPI-adjusted figures, premium technology hearing aids have decreased in price, mid-level technology prices have remained essentially unchanged, and economy level aids have increased in price by 12% to 17%. The average price of the very lowest priced hearing aid in a practice was $1,025 (median $995). As a group, the Big-6 hearing aid companies have increased their market dominance during the last decade, although their relative positions in the market remain fairly dynamic. Although CareCredit was involved in sponsoring the survey, at no time did the company see individual survey responses, and it did not participate in the analysis of the data (ie, the views presented here are solely those of the editor).
Ken Barber worked his magic all day Monday and Tuesday to make sure Steve had a full schedule of consulting with my patients.
A total of 179 US hearing care professionals responded to the survey hailing from 42 states (7 responses came from Canada and other countries and are not counted in this total).Although CareCredit was a sponsor of the survey, the individual survey responses were kept confidential with The Hearing Review’s editor and publisher, and these responses are not available to anyone outside our company (including CareCredit). It should be noted that the present survey had a smaller percentage of practice owners (ie, and more employees) than the previous surveys. This departs from previous HR surveys in which owners and co-owners were often much higher. The trend is most obvious when looking at the percentage of respondents in their 40s in Figure 1: a continual decrease from 32% in 1994 to 17% in 2013.
Only 12% were owned by a Big Box retailer, corporate chain, or hearing aid manufacturer, while 10% of respondents were not-for-profit businesses (*not included in the results of this report). Figure 2 shows that more than 3 in 5 respondents had either no affiliation with any group (42%) or belonged to an independent network, co-op, or buying group (20%). In general, larger percentages of dispensing practices are dispensing fewer hearing aids today than they were 10 and 20 years ago. First, it should be noted that this is the first Hearing Review dispenser survey administered by email (via SurveyMonkey).
Although the editor has some disagreements with the criteria used to categorize practices in that study (ie, the degree of “independence” for practices in various networks), this would leave only 23% of practices having no corporate affiliation, as compared to the 62% in this survey. Concomitantly, the percentages of practices dispensing between 1-10 and 11-20 units per month increased from 12% to 25% and 28% to 33%, respectively, over the same 20-year period.

Roughly speaking, if one compares the two pie charts in Figures 4a-b, it would appear plausible that the one-third (33%) of practices with revenues of less than $250,000 are probably the same one-third (34%) reporting net profits of less than $50,000. Bottom: Average (median in parentheses) prices of the five major styles of hearing aids in each of the three pricing categories.
Table 2 shows the results from survey respondents about their specification of economy, mid-level, and premium technology product lines (top of Table 2). And, even then, the editor thought the premium level was a higher-than-expected value—even when considering the fact that HR survey respondents are predominantly independent private-practice dispensers. For the industry as a whole, they indicated that more sales are migrating down—and not up—the value chain. Thus, there is a price difference of $1,241 between the highest and lowest technology levels, with the difference between the economy and mid-level lines being $539, and the difference between the mid-level and premium lines being $702. This data from a 6-year-old consumer survey is very close to the mid-level weighted average price ($2,196) in this survey—what some might view as roughly the  midpoint for the commercial market.
About 2 in 5 practices (44%) offered a “lowest priced” option for under $800, but only 6% offered one for less than $500. However, as defined by FDA regulations, PSAPs are not designed to address hearing impairment.
Binaurality also helps to localize sound sources and makes listening less tiring when trying to follow conversations.
In 2013, 84% of patients were fit with binaural hearing aids (median of 90%), according to this survey. A total of 83% of respondents said they used a bundled pricing system in the sale of hearing aids, while 17% itemized their product and service billings.
Those dispensing offices that do maintain contracts average just over one-quarter (27%,  median 20%) of their clients covered by the insurance, and those clients account for about one-fifth (22%, median 15%) of their gross revenues. Only one-quarter of patients pay for their hearing aids using a third-party financing company (eg, CareCredit, Wells Fargo, etc, 17%, median 10%) or via in-house payment options (8%, median 5%) that the dispensing office establishes. The increasing frequency of binaural fittings has also greatly added to the cost of hearing aids (it should be noted, however, that some dispensers offer discounts for binaural sales).
Hearing Review has published several articles by CareCredit and other industry experts about why providing financing options to patients can increase the number of first-time users, reduce returns, improve customer satisfaction and value, and decrease the business risks associated with having a high amount in accounts receivable.Additionally, an argument can be made that providing financing options represents another weapon in the battle against many of the price-centric delivery channels challenging the hearing industry.
A total of 13% of respondents said their practice(s) offered 5 to 6 brands, and only 5% offered 7 or more brands.
Perhaps more telling, nearly half (48%) of the offices in 2003 carried 5 or more brands compared to just 18% today. Although the most common number of brands to carry has always been between 2 and 4, the number of single-line dispensing offices has increased while it is increasingly uncommon to carry 5 or more brands. However, comparing 2013 to CPI-adjusted prices of 2005 shows that prices have decreased (in 2013 dollars) almost across the board. Thanks also to Holly Hosford-Dunn, PhD, who helped provide some of the historical pricing data (2006-2011) in Figure 6. EuroTrak + JapanTrak 2012: Societal and personal benefits of hearing rehabilitation with hearing aids. About 1 in 5 were affiliated with but not owned by either a hearing aid manufacturer (9%) or a corporate chain (7%), while smaller percentages said their office was owned by either a Big Box retailer (6%) or a corporate chain (4%). Past HR surveys were conducted using only the US mail, with the mailings directed to owners and weighted according to Hearing Industries Assn (HIA) state net unit sales statistics for the private-sector market. Likewise, the one-fifth (20%) of practices with revenues between $250,000 and $500,000 account for about the same percentage (18%) making $51,000-$100,000 in net profits, while the 30% with revenues between $501,000 and $1 million are the same practices (29%) with net profits between $101,000 and $250,000. Survey respondents reported that, on average, 37% of the hearing aids they dispensed came from premium product lines, 44% came from mid-level lines, and 19% came from economy-level hearing aid lines.
Several noted that the total market (eg, Big Box, VA, etc) is becoming increasingly differentiated from private practice dispensing, which may partially explain the figures. Traditional BTEs, which make up 21% of the market, tend to be the least expensive, ranging in average price from $1,580 to $2,769. Kochkin13 showed that cost considerations—specifically full or $1,000 of insurance coverage, a price of $500 or less, and costs of repair—figured into 4 of the top-10 factors that would persuade a reluctant potential user to purchase a hearing aid. Likewise, providing warranties and insurance coverage for hearing aids can make sense—and head off trouble—if there is a need for costly device replacement or repair. The result was that the Big-6 hearing aid manufacturers—Sonova, Starkey, William Demant Holding (WDH), Great Nordic (GN), Siemens, and Widex (in that order)—accounted for an estimated 93% of the hearing aid unit volume dispensed in the survey.
The average weighted price of premium technology hearing aids has decreased by $312-$384 (in 2013 dollars), and by $122-$235 for mid-level aids, depending on the style of hearing aid.
Finally, the 17% of practices with gross revenues of over $1 million may account for the 19% of practices reporting net profits of more than $250,000.
Additionally, some dispensing offices have evolved a “boutique” approach to personalized service and dispensing. The Hearing Review survey2 was one of the first to point out that, in the early 2000s, brand utilization resembled a “back to the future” scenario: a trend back to single-line dispensing offices, with far fewer offices offering 5 or more brands­—due to networks and buying groups, an increase in manufacturer-owned offices, and now the rise of Big Box retail. This compares to 74% of Big-6 hearing aids dispensed in the 2005, using a slightly different methodology.10 The rank order of the corporate groups in that older survey was Siemens, Starkey, GN, Sonova, WDH, and Widex. Another 10% reported being a nonprofit (eg, university clinics, VA) and these were not included in the results.
Thus, net profit margin appears to range from about 20%-33%, with larger businesses enjoying superior profits. Last year also saw more high-end product introductions than in the years following the Great Recession of 2008. So, although the Big-6 groups have increased their dominance, there are continual changes in their market positions relative to each other.
I trust them so much that if I had to in an emergency I would hand them the keys to my office.

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