Institute of Medicine (IOM) Consensus Study on Accessible and Affordable Hearing Health Care for Adults

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1 Institute of Medicine (IOM) Consensus Study on Accessible and Affordable Hearing Health Care for Adults Hearing Loss Association of America Anna Gilmore Hall April 27, 2015

2 I got a hearing aid and it is useless! It is in my drawer at home. My mom doesn t understand that loss of hearing in one ear has changed my life. My boss wants to help me but neither of us know what to do to help me at my job. My doctor told me my hearing loss was just a part of growing old. I am so frustrated trying to get answers and good information My boss told me to get ear muffs to deal with the noisy class room. Why is being able to hear only for the rich? I struggle to hear in noisy places, so we don t go out much. Because I can t enjoy going out, my wife stays home too.

3 When someone in the family has a hearing loss, the whole family has a hearing loss

4 Hearing Loss is not isolated to just hearing and communication issues, but is tied to many kinds of health and illness issues

5 Hearing Loss impacts both the individual, family and society in terms of: Lost income Lost taxes Increased health care costs Increased unemployment Lost contributions Decreased volunteerism

6 Listen Hear! Employee Survey Which of the following describes your hearing? Response Employees Overall I believe my hearing is healthy 58% 53% 66% 57% I suspect I have a hearing problem, but I have not sought treatment I have a diagnosed hearing problem and I am getting treatment (wearing a hearing aid, etc.) 30% 30% 30% 31% 12% 17% 5% 12% Source: 2013 Listen Hear! Employee Survey

7 Hearing Well Contributes to Health

8 Top four questions HLAA gets every day What do I do if I have a hearing loss? What kind of support can I get to purchase hearing aids or other listening technology? Did you know that neither Medicare nor my insurance covers hearing aids! I just got a hearing aid, and I still can t hear. Now what do I do? I can t tell the difference between good hearing technology and bad? What s a PSAP?

9 Hearing Health Care System Confusing Conflicts Hard to access Often primary focus is on hearing aid

10 Primary Care The goal for hearing health care must be to eliminate barriers to effective, accessible, and affordable hearing health care. The Hearing Loss Association of America (HLAA) supports the inclusion of a standardized approach to screening for hearing loss in primary health care settings that includes both a subjective and objective component in all adults during routine physicals; the Welcome to Medicare assessment; and Medicare annual risk assessments, that are accomplished in primary care settings.

11 Primary Care People value advice from primary care providers: 2000 Study: 63 percent of people listed their primary care physician as the most important source of information about where to go for hearing health care services. Kochkin study found that individuals with hearing loss, reluctant as they are, will listen to their doctors. If the physician reports a positive experience with hearing instruments, a person with hearing loss will be more motivated to seek treatment for hearing loss. Study also reported that persons with hearing loss are eight times more likely to be positively inclined to purchase a hearing instrument if their physician has recommended one. Hase M: Is marketing to physicians worthwhile? Results of a survey. Hear Rev 2000;7(4):43 Kochkin S: MarkeTrac IV: Correlates of hearing aid purchase intent. Hear J 1998;51(1):30-41

12 Medicare Excluding seniors from access to affordable hearing health care and devices is penny wise and pound foolish. Seniors with hearing loss need greater access to hearing aids and aural rehabilitation services. Medicare must provide hearing health care screening and evaluation services, hearing aids and hearing rehabilitation services for all who are entitled to Medicare services. The Hearing Loss Association of America supports amending Title 18 of the Social Security Act to include coverage of hearing examinations for the purposes of prescribing, fitting or changing hearing aids, coverage of the hearing instruments themselves and aural rehabilitation.

13 Medicare Elimination of cost barrier Comprehensive coverage of services, from audiological testing to post-fitting adjustment, service and aural rehabilitation Cost Controls

14 Medicare Reduced health care costs associated with hearing loss People staying in workforce longer supplementing their income Medicare coverage will lead other insurance companies

15 The goal for hearing health care must be to eliminate barriers to effective, accessible, and affordable hearing health care and ensure access to a full range of personal hearing technology. There must be a wide range of solutions to fit the needs of the variety of individuals with hearing loss. The Hearing Loss Association of America supports a hearing health care system that provides consumers access to the full spectrum of safe and effective hearing technology to meet their individual needs. Wider Access to full spectrum of Hearing Technology

16 Wider Access to Full Spectrum of Hearing Technology Easy access to the full spectrum of hearing technology based on individual need and ability to pay including hearing aids and the full range of assistive listening devices including personal sound amplification products (PSAPs).

17 Wider Access to Full Spectrum of Hearing Technology To the greatest degree possible, hearing technology should be interoperable and useable by consumers without requiring the purchase of proprietary technology

18 Access to full spectrum of hearing technology Access to appropriate hearing technology through multiple points of entry, including through hearing health care specialists (audiologists, hearing instrument specialists, otolaryngologists), direct web access, pharmacies, and retail outlets

19 Wider Access to Full Spectrum of Hearing Technology Creation of functional performance standards for all hearing technology

20 Wider Access to full spectrum of hearing technology Utilization of multiple platforms, including websites, informational brochures, product labeling and in-store information, to provide the information and education needed to ensure informed consumer decision making, including, but not limited to: - Expected performance of the hearing technology - Means of comparison to other similar hearing technology - Limitations of the hearing technology

21 FDA Regulations Personal Sound Amplifying Products (PSAP) Controversy on labeling of products that amplify sounds: Hearing Aid (regulated) vs. PSAP Consumer Product (not regulated) A Hearing Aid is a wearable sound-amplifying device that is intended to compensate for impaired hearing A PSAP is a wearable electronic product that is not intended to compensate for impaired hearing, but rather is intended for non-hearing impaired consumers to amplify sounds in the environment for a number of reasons, such as for recreational activities While some of the technology and function of hearing aids and PSAPs may be similar, the intended use of each article determines whether it is a device or an electronic product FDA Guidance for Industry and FDA Staff, Document issued on: Feb 25, 2009

22 Personal Sound Amplification Products Critical distinction is whether it is labeled for hearing loss If labeled for hearing loss, it is a hearing aid Places it in the traditional HHC distribution model - licensed dispensers and physician/waiver required Distribution is controlled by audiologist/dispenser Not a consumer product available in commercial venues Product that may be of benefit to individuals with hearing loss may purposefully not be labeled as such so it can then be distributed outside of the HHC distribution channel Most PSAPs are substantially lower in cost than hearing aids Some of the technology and function is similar to hearing aids Increase of PSAPs on web/ pharmacies/ electronic stores Makes new and/or alternative distribution systems for new assistive listening technologies challenging

23 Personal Sound Amplification Products However, if a potentially useful device is not labeled for HL, consumers are left uncertain whether of benefit to them Makes access confusing - especially for the lower cost amplification devices available in commercial venues Differing perspectives among FDA, professional organizations, manufacturers (electronic and hearing aid), and consumers on what should/should not be available and how labeled and marketed Devices range from less complex to sophisticated Assistive Listening Devices (ALD) Personal Sound Amplifying Products (PSAP) Smartphone Applications

24 Assistive Listening Device - Pocket Talker

25 Traditional PSAP - Quiet Sound Amplifier

26 Smart PSAP

27 Apps for phones and other smart technology

Rapidly evolving technology in which line between hearing health care and consumer products becomes increasingly blurred Size of hearing loss population increasing New businesses entering market to

28 Rapidly evolving technology in which line between hearing health care and consumer products becomes increasingly blurred Size of hearing loss population increasing New businesses entering market to capture those patients/consumers through nontraditional channels More demanding and tech savvy consumers Expect improved audibility, speech understanding in noisy, reverberant environments, good cosmetics, affordable devices and convenient access

29 Market Force

30 Educated Consumer Educated consumer is the best customer transparency information standards comparison value added to products to increase market appreciation

31 Collaboration Stakeholders Consumers Hearing health care providers Hearing Aid Industry Consumer Electronics Industry Federal Regulators Insurance companies

32 Hearing Health Care Delivery Provider centered care Technology Patient centered care Changing consumer

33 Current delivery models Bundled Model Business model is dependent on selling a hearing aid One price - which some consumers want in order to have ongoing access to provider without extra expense Unbundling Model Values input from the professional Transparency of what you are paying for Looks at different options for managing hearing loss Aural rehab is important Many other technology options are considered Costs are variable depending upon services

34 Specific challenges for different populations Young adults leaving high school need to become self advocates without parental support and guidance Working adults often don t know what they need for listening technology in the workplace Employers 20% of workforce has hearing loss Older people afraid of technology Old old people dexterity, cognition, lack of support from others, lack of support in assistive living arrangements

35 Challenges & Opportunities

The Savvy Hearing Aid Consumer. Gloria Garner, Au.D. Doctor of Audiology University Hospital Speech & Hearing Center

The Savvy Hearing Aid Consumer Gloria Garner, Au.D. Doctor of Audiology University Hospital Speech & Hearing Center Agenda Prevalence, Symptoms and Causes of Hearing Loss Impact of Hearing Loss Ten Tips