Creating a disruption-resistant practice

By Kim Cavitt, Au.D., Audiology Resources, Inc.

COVID-19 created a great deal of uncertainty in hearing healthcare. It illustrated, in a glaring way, how entrenched in 20th century delivery and pricing models our practices had become and how limiting those models are in a contactless or contact-reduced clinical or retail situation. COVID-19 has provided us with a bit of a roadmap with where we need to be in delivering 21st century care.

Know the lay of the land

First, it is important to know the lay of the land. In other words, what limitations do existing state and federal hearing aid dispensing laws and managed care payer policies pose? Many state audiology and hearing aid dispensing laws have specific minimum test requirements for hearing aid dispensing that may limit the utility of in-situ, online and app-based audiometry in the assessment of new hearing aid purchasers.

Ironically, it may be the upcoming over-the-counter hearing aid regulations that force changes in the assessment requirements and limitations at the state level. It is important to note that some managed care entities have medical policies which govern hearing aid coverage.

For example, United Healthcare’s commercial insurance coverage policy indicates, “standard plans include coverage for wearable Hearing Aids that are purchased as a result of a written recommendation by a Physician”.1 This type of physician recommendation may be more challenging in a zero- or low-contact situation.

What innovative technologies exist

Okay, now that you know the rules and regulations you can operate within, determine what innovative technologies exist that make remote assessment possible. There are many options available from companies like eMoyo, Shoebox, Audidata and Otohub.

These entities offer remote tele-audiology and/or mobile test options, including bone conduction and speech audiometry. It is important that we begin to explore these types of equipment so we can better respond to the needs of our patients and of the situation in our community. Some patients may never be comfortable returning to your office, so remote or mobile care is key.

Explore alternative pricing models

We also need to explore alternative pricing models. COVID-19 plainly showed a limitation of a bundled delivery: Because patients had all pre-paid for care, there was no way to capture revenue for these tele-health or curbside follow-up visits as they had been included in the bundled delivery.

Unbundling would have produced patients who would have needed to pay privately for tele-health or curbside care (as they had opted to pay for service as it is needed), thus improving your cash flow or would have pre-paid for service plans, which may or may not have included tele-health, or which were priced to better reflect the true value of your time.

Consider expansion of practice offerings

Finally, we need to consider expansion of our practice offerings (as allowed by state-defined scope of practice) to include services which are medically necessary and improve patient outcomes, satisfaction and performance but which also can successfully be delivered via telehealth. Communication needs assessments, tinnitus evaluation and management, auditory rehabilitation, and patient counseling are fantastic options to consider since they can be easily incorporated into mobile, face-to-face or remote practice.

The worlds of retail and healthcare delivery are now forever changed. Over-the-counter hearing aid options are going to continue to push us to evolve our antiquated care, pricing and delivery models. It is time for us to respond to these forces by considering new and different opportunities and ways of meeting the needs of those we serve.


1. “Hearing Aids and Devices Including Wearable, Bone-anchored and Semi-implantable,” United Healthcare, December 1, 2019.