A Personal Letter From Dr. Melissa Karp

Here is an interesting situation: A patient comes in and reports they can buy a hearing aid online or from one of the big box stores at a much lower price than in my office. The purpose of this blog post is not to shame anyone for their shopping practices, but to educate consumers about what it means when a hearing aid available for these low prices.

When we order directly from the manufacturers, we often get a discount off list price. The hearing aid in question has a list price of $2449 per ear.  If our office sold this device for $1899.99, we would make less than $500. That may seem ok, but keep in mind that to correctly fit this device, we need to:Complete a comprehensive hearing evaluation, including measures of functional communication. A speech in noise test (such as the QuickSIN, BKB-SIN, or HINT) and some measure of the patient report via questionnaire (such as the COSI, HHIE, or the COAT).

Complete a hearing aid selection process. This process involves getting to know each patient individually and identify their communication needs, personal preferences, discuss any assistive listening device needs (such as amplified phone, smoke detector for hearing impairment, amplified alarm clock), budget, any physical considerations (e.g., poor vision, lack of feeling in the fingertips, dexterity concerns, etc.).

Order the hearing aids and accessories (if selected). If custom instruments are ordered, ear impressions need to be completed.When the hearing aids arrive, electroacoustic analysis of the hearing aids to be sure they are meeting all the specifications.  

An in-house study at UNC-CH conducted in 2008-2009 showed 12% of new hearing aids failed this test and needed to be sent back, and 18% of repaired hearing aids failed to meet specification and needed to be sent back for additional repairs.

Contact the patient and schedule a fitting appointment.Fitting appointment: This appointment consists of setting the hearing aids to meet prescriptive targets and verifying these targets are met using probe microphone measures. The patient is taught all about care and use of the hearing aids. Communication strategies and aural rehabilitation options are gone over. If there are specific complaints like tinnitus, additional time setting a tinnitus program and going over a tinnitus protocol are required.

Follow up visits – usually at 2 and 4 weeks to make any fine-tuning changes, ensure the patient is comfortable with all care related aspects of the hearing aids, and follow up regarding difficult situations and improvement noted.

In our office, that comes to 5.5 hours of time at about $90 per hour. That does not even cover our overhead costs – to fit these hearing aids using best practice, we are already losing money if we price match. I’m also not including the follow-up visits that we include in our pricing, so we are actually making less than $90 per hour.

Contrast this to the online presence or big box retailer:

The online retailers do not offer on-site service. They don’t even look in your ears! If you have difficulty, you have to mail your devices back and wait for someone to make changes and return them to you. They do not verify your hearing aids are set properly and are providing the correct amount of gain in your ears. Even if they are set as a manufacturer “the first fit,” there is no guarantee they are providing the gain in the ear as seen on the computer screen. This is where individuality matters and why measuring these settings is necessary.

The big box retailers have other revenue streams and can lose money on hearing aid devices. They also get more significant discounts from the manufacturer because they order in bulk and their instruments may not have the full features of what you get in an audiologist’s office.

In addition, they are limited in the brands they offer. Many of their hearing aids that are private label have the software locked. This means that they can be adjusted only by that company. This becomes a problem if the store closes, such as when Sam’s Club closed 60+ locations in 2018. Those individuals had to drive long distances to the next Sam’s Club or purchase new hearing aids that were not a private label.

There are other things to think about:

A local business hires local people. My single audiologist practice employs a patient care coordinator, accountant, assistant, and a PRN employee. We refer to local speech-language pathologists, physicians, tutors, and other medical providers. When we have events, we buy food from local vendors and support their businesses.

We sponsor local sports teams and cultural events.We create a warm and welcome space for our patients. They are not rushed. Their questions are answered.We pay taxes that go back to our community.

We attend our children’s career days at school and talk about the importance of hearing protection.We attend conferences and continuing education events to be sure we are always providing the best possible care and educating ourselves on the newest technology, rehabilitation processes, and medical information relevant to our field.All of this information is not to say you shouldn’t buy a device online or at a big box store.

As an audiologist, I feel a personal responsibility to educate the public that hearing aids are only part of the treatment for hearing loss; by trying to save a few dollars, you could be missing out on the facets of care that make the difference between an excellent outcome and a poor outcome.

As we know, hearing loss impacts more than just communication. It affects cognition, fall risk, social engagement, and quality of life. Hearing loss impacts the person with hearing loss, and every person they encounter – treating hearing loss should be as complete and individual as the person being treated. You will not find that level of care in any big box or online store.