RP303 - Hearing Aid Adoption Rates in an Audiology Clinic: Unbundling for Improved Efficiency

Abstract:
The purpose of this study was to investigate a policy-related factor (price unbundling) and patient-related factors (demographics and audiometrics) that might affect hearing aid adoption. Hearing aid consultation appointments (n = 5186) were examined retrospectively, focusing on adults without hearing aid experience. In the unbundled model, a separate fee was charged for the consultation appointment. After unbundling, fewer non-candidates were seen by providers and a higher percentage of consultation appointments resulted in adoptions. Non-adoption reasons were related to lack of perceived hearing difficulty and were stable over time. By unbundling, consultations can be made more efficient without negatively impacting revenue.

Summary:

Purpose:
The majority of adults with permanent hearing loss who could benefit from hearing aids do not adopt them. Low adoption rates are problematic because patients who could benefit from devices continue to live without assistive technology. A potentially related issue is the use of costly clinical time and resources devoted to consulting patients who have no intention of adopting hearing aids. This reduces the efficiency of the clinical pathway from evaluation to fitting for patients who are ready to adopt amplification. Therefore, understanding the patient-related (e.g., age, audiometric findings, speech-in-noise performance) and policy-related factors (e.g., service delivery model, fee structure) that affect adoption is important. The purpose of this study was to investigate a policy-related factor and patient-related factors that might affect hearing aid adoption for adults, specifically price unbundling, and demographic and audiologic factors, respectively.

Design:
Retrospective data from more than 5000 records of hearing aid consultation appointments in an audiology clinic in a medical center were examined. Appointments were conducted between 2019 and 2023, capturing visits when services and devices were charged using a model that was bundled (2019-2022) and unbundled (2023). In the unbundled model, a separate fee was charged for the consultation appointment. Analyses were conducted to evaluate the effect of unbundling on adoption rates, number of visits, and number of devices dispensed per provider per month. In addition, analyses focused on potential demographic and audiometric predictors of hearing aid adoption rates.

Results:
After unbundling, a higher percentage of consultation appointments resulted in hearing aid adoptions (increased from 53% to 65%), despite a decline in the number of hearing aid consultation appointments. The absolute number of hearing aid adoptions per provider did not change over time (i.e., hearing aid device revenue was not negatively affected). Also stable were reasons for hearing aid non-adoption; they were primarily related to lack of perceived hearing difficulty. Audiometrically, patients with higher hearing thresholds, more difficulty understanding speech in noise, and more self-reported difficulty hearing in important listening situations were significantly more likely to adopt hearing aids than were people with better hearing thresholds, speech-in-noise performance, and self-reported hearing performance.

Conclusions:
Among adults who are potential first-time hearing aid users, differences between non-adopters and adopters were related to degree of hearing loss and self-perceived difficulty hearing, rather than perceived cost or value of devices. These results contribute to the growing set of findings that perceived need, rather than cost, are driving hearing aid adoption rates for many adults with hearing loss who seek in-person hearing services. In addition, unbundling was beneficial for reducing clinic visits of people who are not candidates in hearing aid consultation appointments and increasing adoption rates for people who are seen. This leads to more efficient use of hearing aid clinician’s time in clinic. Therefore, separate fees for consultation appointments can result in efficient appointment scheduling (reducing the number of appointments overall while increasing hearing aid adoption rates) without negatively impacting revenues.

Brief Summary of Clinical Takeaways:
The clinical takeaway for this session is that unbundling hearing aid consultation fees can improve clinical efficiency without negatively affecting revenue.