Controversial recommendations from a government advisory group studying hearing treatment call for hearing aids to be treated more like glasses. In order to understand why these recommendations were made, we’ll look at the problem of untreated hearing loss in a Cause Map, a visual diagram of cause-and-effect relationships that create a root cause analysis.
The first step in any problem solving method is to determine the problem. In this case, it’s untreated hearing loss. Using the Cause Mapping method, we’ll go a step further and document the impacts to the goals as a result of the problem. Untreated hearing loss impacts the public safety goal in several ways: it can lead to social isolation, depression, cognitive dysfunction, and dementia. The patient service goal is impacted because patients are unable to hear properly. The financial goal is also impacted because of the out-of-pocket expense of many hearing aids.
The next step is to analyze the issue by capturing the cause-and-effect relationships. We do this by beginning with one of the impacted goals. Cognitive dysfunction and dementia have been found to result from hearing loss because of the additional strain on the brain while it attempts to understand garbled sound in patients that are unable to hear properly. Additionally, reduced auditory input may cause parts of the brain to shrink. We can add in the other impacted goals as appropriate. Social isolation and depression result from the inability to fully participate in activities due to being unable to hear properly. This itself is an impact to the goals.
Patients are unable to hear properly when they suffer from hearing loss and they are not using hearing aids. About 30 million Americans suffer from hearing loss. In many cases, this is an effect of aging, but the causes of hearing loss were not discussed in detail by the advisory group. The group found that only a small number of those Americans suffering from hearing loss actually used hearing aids.
Some patients are unaware they are suffering from hearing loss. Hearing evaluations are not part of routine checkups, including annual Medicare wellness visits. For patients who know of their hearing loss, the out-of-pocket expense of hearing aids may be keeping them from treating it. The cost of hearing aids and fitting services average about $4,700. Insurance reimbursement is limited and while Medicare covers diagnostic hearing tests, it doesn’t pay for hearing aids. Patients’ abilities to shop around or switch providers can be limited. In many cases, patients don’t have access to their hearing tests and are unable to give their test results to a different provider from the one who performed the diagnostic testing. Hearing devices and services are often bundled, making it difficult to compare costs and some devices can only be programmed by certain providers, limiting access and increasing costs of servicing.
The advisory group has recommended that hearing aids be sold more like eyeglasses: the results of a hearing test given to a patient, who can then choose to get a prescription hearing aid from the provider of their choice or an over-the-counter wearable for mild hearing problems. (There are various products like this ranging in price from $50 to $500 but the FDA doesn’t consider them hearing treatments.) This would require action by both the FDA and hearing evaluation providers.
The group also recommends hearing aid providers itemize invoices and disclose if the aids can only be programmed by certain providers. Additional recommendations are for Medicare and other insurance providers to evaluate coverage of hearing aids and related care, and for the scientific/ medical community to perform more research into the physical health effects of hearing loss.
To view the impacted goals, Cause Map including cause-and-effect relationships, and solution recommendations related to untreated hearing loss, please click “Download PDF” above.