Private Practice in a Time of Big Health

By Bre Myers

This article is a part of the March/April 2018, Volume 30, Number 2, Audiology Today issue.

Previous articles have addressed growing concerns within the field regarding impact and changes in the practice of audiology now that big-box stores and their low-cost hearing aids are reality. There has also been much debate surrounding third-party payer plans that reimburse for hearing-aid services, but at a much lower rate than most independent audiology practices can afford to accept.

Another, perhaps more disturbing issue that the profession must address, or at least be cognizant of, is the growing trend of hospitals purchasing small primary care and specialist practices. These acquisitions continue to merge other previously independent health and medical care facilities under a much larger corporate umbrella, and may impact practice patterns. This article reviews the shift towards mergers in health care, and its potential effects on audiology as a profession and the independent audiology practice.

How Did We Get Here?

Goldstein (2001) eloquently summarizes the transition from audiology as primarily an academic pursuit aimed at rehabilitation to the adoption of hearing-instrument dispensing within the profession, in order to ensure that our patients were receiving appropriate devices, adequate services, and follow-up care. Unfortunately, with little business training and relatively few examples to go by, well-meaning audiologists adopted similar business models (i.e., bundling services with devices, not charging for hearing tests, etc.) as those we wished to protect our patients from.

While the technology of hearing aids has transformed dramatically over the past few decades, the model of traditional dispensing has not. Arguably, audiologists, particularly those that focus solely on adult hearing aid dispensing, are unfortunately viewed by the general population as not significantly different from hearing instrument dispensers (except for that expensive degree hanging on the wall). Yes, there are true centers of professional excellence that abide by the best practice guidelines for fitting and dispensing, but there are also many who do not. Yes, there are some that are adopting unbundled service models, but there are many who have not.

The point of this article is not to enter into a debate into the merit or feasibility of various dispensing practices. However, some historical context is important to determine the best direction ahead.