Disclaimer:  This is a field study being funded by Better Hearing, Inc., the parent company of Better Hearing Centers Of Florida.  The results are being compiled to study the practice of dispensing hearing aids and not the hearing aids themselves.  Data is being collected weekly and updated regularly and is contained herein.  This is a field study and not a clinical study or a research study and therefore does not conform to any FDA or any academic institution requirements or methodology.   The methodology was designed by Better Hearing, Inc.  Although the manufacturers are aware of the Study format they do not participate directly in the Study and merely offer discounts in purchasing to Better Hearing, Inc. based upon volume usage.  Better Hearing, Inc. is a for profit company.

Introduction

     The business model of how hearing aids have been dispensed since their inception consists of testing, taking ear impressions, concluding a sale with payment and the patient coming back in a week or two for delivery of the hearing aids.  The patient had to wear a product molded to the shape of their ear canal.  For patients who had never tried amplification before, they would have to trust the Audiologist or Hearing Aid Dispenser in their professional choice of size and circuit selection without knowledge of whether the product would be comfortable and work well in their environment and life style.  To tender an average of $4,000 to $6,000 dollars to someone who they just met without knowledge of whether the product would improve their life or not was a huge leap-of-faith on behalf of the patient.

     Come the day of delivery; about 10 business days laters, the patient would receive the hearing aids.  It would naturally feel strange in their ears.  Their voice would sound funny, tinny and hollow to them (especially with a high frequency loss only).  Everything would sound loud; including the things they didn’t want to hear louder… like noise.  The dispenser would say: “don’t worry…you will get use to it!”  And the patient would be sent away for a week or two until their first follow up.  Sometimes they would get use to it and many times they wouldn’t.  Hence the common problem of hearing aids ending up more in the draw than in the patient’s ears.   The patient would then be put through the stress and strain of returning the hearing to the dispenser who would usually not give up their sale without coaxing and cajoling the patient uncomfortably.  In the end, the dispenser would charge the patient the state-allowed return penalty of between $300 to $500 for their troubles if they did finally take the hearing aids back.  The patient was now $500 poorer and completely disgusted with the process and may never try hearing aids again.  Many times the patient was just not mentally ready at that time.  No one wins under this scenario.  Especially the patient who needed help.

     In 2003, GN Resound, one of the largest manufacturers of hearing aids in the world took a novel approach to how hearing aids would deliver sound.  Recognizing that the number one complaint that would cause hearing aids to be returned was a custom hearing aid that would make the patient feel like they are speaking as if their head was in a barrel.   Resound invented a new circuit called a DFS (Digital Feed Back System) which would allow the new hearing aid to open up the ear canal by using a small, surgical silicone tip without plugging up the ear completely and without hearing aid feedback or whistle.  In addition, the electronics of the hearing aid were now less susceptible to damage by moisture, wax, oil, skin and hair because the unit sits on top of the ear, instead of inside a hostile environment.  The “Air” as it was called, was an immediately success and allowed patients to be fit same day without ear molds.  These early over the counter instruments did have limitations and only addressed a small audience of  modest-loss, high frequency only, patients.  In addition, they were expensive.

     Since the inception of the Resound Air, there have been many advances in open fit instruments.  The price as dropped dramatically.  The complexity of the circuit adjusts for more listening environments.  The size of the instrument and the fitting range the hearing aid can service is very impressive.  Currently Better Hearing Centers of Florida dispenses approximately 87% OTE and BTE instruments over custom products for the following reasons:

• More comfortable in the ear
• More natural sounding
• No “barrel” effect of the patients voice
• Immediate delivery and gratification
• No wait, less anxiety and buyers remorse
• Ability to demonstrate results before purchase
• Easier to solve wearer problems
• Much less maintenance by both wearer and office
• Cosmetically appealing

     Better Hearing Centers of Florida, owned by Better Hearing, Inc., the corporation that funds the Lend Us Your Ears study, took a novel approach to helping people try amplification.  Let patients take hearing aids out for a “test drive” in their environment and don’t charge the patient a penalty if they decide that hearing aids are not for them or the time isn’t right.  Take out all the elements that contribute to creating stress for the patient and let the patient evaluate the hearing aids on their own terms.  This approach is now the Lend Us Your Ears Study in the form it is being conducted today.

Methodology

     The Lend Us Your Ears Study began August 28^th, 2007.   The methodology of testing and distribution has changed dramatically since its inception and morphed into the program that it is today. 

     In the beginning, the concept was a “mass distribution” method to keep the cost of dispensing the hearing aids down in price to meet the financial needs of the masses.  After being in the hearing aid business for over 22 years at the time, we understood very well that due to the fact that the overwhelming majority of hearing aids are paid by the patients themselves and not funded by insurance or Medicare, cost is a major consideration as to why our industry only fits approximately 10% of the population that clinically needs hearing aids.  Hearing aids can cost $1500 to $3000 each on average and most patients need two instruments.  So we studied the price point where most patients will at least consider amplification. This number begins at under $3000. 

     In order to offer a hearing aid at that price point we examined two to three models and settled on a product from Rexton; a division of Siemens Audiological Technical Group.  The Targa Pro is a third generation instrument that offers some advanced features such as multiple programs, directional microphones, great anti-feedback properties and a sizable fitting range.  Although not the smallest or most sophisticated instruments; this product was a very good value for the money; backed by a major manufacturer.

The Good, Better, Best Model Scenario

     Sear and Roebuck believed that the easiest way for a consumer to understand the value and price point of a product was to offer just three different products and their value level to the consumer.    Hearing aids have generally had as many as six different value levels within a size hearing aid,.  It was equally difficult for the Hearing Care Professional and patient to understand the  differences as to how the patients hearing will be affected by increase in models.  We implemented the Sears approach to help the patient understand differences easier.  The three points of purchase are as follows:

1. Open fit thin tube product with directional microphones, multiple programs and two to four channels.

2. Receiver-in-the-canal product (RIC) with directional microphones, either multiple programs or fully automatic and noise reduction.

3. Receiver-in-the-canal product (RIC) with directional microphones, either multiple programs or fully automatic and noise reduction, smaller size and multiple bands and channels.  Depending upon the manufacturer, an optional remote control and charger system can be added.

Manufacturers

We align ourselves with only top level manufacturers.  This gives the patient confidence they can receive service no matter where they go.  It also reduces the patients concern of whether they would be able to receive service if our company ever went out of business (a fear many people have in this day and age)  Although the manufacturers are not officially part of the study they understand what we try to accomplish and have given us bulk discounts.  With a program like this you need a large inventory of difference price point hearing aids in each office to accommodate the number of patients “demo-ing” the instruments.    The manufacturers that we have chosen to participate in this study include:

1. Rexton (A Siemens Audiological Technical Group member)
2. GN Resound
3. Unitron (a sister company to Phonak)

How The Study is Presented To The Patient

We never hide the fact that we are here to sell hearing aids.  In fact we tell the patient that this is a field study and we are here to sell them hearing aids.   We also don’t deny that we are not the only company that offers a demonstration program.     We focus on the main difference between our program compared to our competitors in that we give them an initial two week trial without asking for a deposit or even a credit card number.  We start the relationship based upon trust.  We trust the patient with our hearing aids costing $3000 to $4000 with nothing more than a handshake and a general released that says they will take responsibility for them if they are lost or stolen.   This sets the tone for the entire future relationship.  If we are willing to put forth our product, our time and our trust into helping the patient, they realize that we care about their hearing health and not just about selling them a product.

By the time the patient sits for testing, the study has been explained to them in great detail at least five times.  This included trial period, price points and payment or opt-out options.  The five times the study is explained to the patient is as such:

a.    In the advertisement in the newspaper or on our television commercial

b.    In a recorded “preample” when they call on the phone to book and appointment

c.    When the booking agent answers questions or explains the program when booking the appointment

d.    When the patient fills out paperwork they are given a sheet on how the study works

e.    And finally the Specialist will explain it again for the patient is asked if they want to proceed.

The patient may elect to receive a free hearing test and not be fit with instruments or choose to proceed with a fitting should they have a hearing loss.  There is no sales pressure applied.  In fact, one of the main reasons we consider the study successful is because we no longer have to sell the instruments; the instruments sell themselves because they are evaluated without sales pressure under the patients real work conditions.   We merely look for motivated individuals willing to try digital, open –fit amplification.

Do we accept every patient who walks through the door?; No!  In order to make this study statistically valid and truly represent a reasonable test group we make sure that the patient meets three criteria:  1) they have a hearing loss that would be well served by open fit technology.  2) they are personally motivated to help their hearing situations and not coerced by members of their family. And 3) The patient is financially able to acquire hearing aids via any method we have possible; including internal payment plans.  The third reason might sound self-serving, but you have to remember that the senior population is predominantly retired and they have lots of time on their hands to be part of any activity that might sound interesting to them.  In addition, there are malingerers and hypochondriacs who will prey on any medical trial that would garner attention to themselves.  Both of these reasons will skew the results of the methodology.  Remember, we are studying the way hearing aids are being dispensed to the public; therefore we need a test group that 1) has a hearing loss and 2) have the ways and means to acquire hearing aids.  

Benefits to the Hearing Industry

This program builds awareness of hearing loss and correction.  Most of the patients who have tried our hearing aids and either purchased them or returned them, always thank us for having a program like this available.   People in general are scared of what is unknown or foreign to them.  This program takes out the fear of hearing aids.  The primarily reason cited by our patients of why they came in to see us was the fact that they could take home a pair of hearing aids for up to forty-five days without risk of losing money.   Most patients would tell us that they came in with the idea that they would hear what we had to say but they were absolutely ready to walk out at any time. They then tell us that our low-pressure approach made them decide to move ahead with the program.  Based upon our current statistics, our purchase rate is approximately 30%.  That means that 70% of the patients who tried hearings decided to not purchase that time due to factors such as financial, they didn’t like them or they were just not ready to embrace the process.  Either way, that population has now tried hearing aids and may very well decide to purchase at a later date from other sources beside our practice.  In fact people will participate in our program, love the hearing aids and then shop around until they find a dispenser to beat our price; or go the Internet route or Big Box retailers.   Those participants are now hearing better due to their involvement in our program.  Our approach has exposed many more people to digital, open-fit amplification than would have occurred without a program like ours.  We are very proud of how many people we have helped directly and indirectly.

The following is the graphical results of the Study to date.  It is our intention to continue with the study as long as the population finds it rewarding.   Please refer back for updated results as they are compiled.

Written By William Breakstone, M.S.,BC-HAS
Results Compiled by Kelly Jenkinson