Download Penny-wise and pound foolish: Top considerations when

Penny-wise and pound foolish:
Top considerations when purchasing
hearing technology
Stephanie J. Sjoblad, Au.D.
Clinic Coordinator / Associate Professor
UNC Division of Speech and Hearing
Barbara L. Winslow Warren, Au.D.
Coordinator of Clinical Education / Assistant Professor
UNC Division of Speech and Hearing
Agenda
Overview of Trends
History of Hearing Healthcare
Terms & Definitions
American Academy of Audiology
Hearing Aid Billing Practices
Survey Results
A Model for Unbundling
Current Trends vs. Best Practice
Image: http://www.propwise.sg/are-you-being-pennywise-pound-foolish/
Audiologist
Consumer
Professor
Advocate
Mommy, Wife, Daughter, Sister, Friend
And one more…Bargain hunter!
Clinical Coordinator
Show of hands…who has ever….
GONE TO A YARD SALE
SHOPPED AT A THRIFT STORE
BOUGHT SOMETHING AT
A CONSIGNMENT SHOP
PERUSED CRAIGSLIST
EXPERIENCED THE THRILL OF WINNING
AN EBAY AUCTION
Have you thought about saving money
on hearing healthcare….
ONLINE HEARING TESTS
INTERNET HEARING AID
PURCHASES
BIG BOX/WAREHOUSE
HEARING AID
PURCHASES
30+ years of marketing the product!
“The price of your X hearing aid includes custom programming if you so
desire. Your hearing aid is already programmed for high frequency
hearing loss - the most common hearing loss curves in the hard-ofhearing population.”
The History of Our Profession
It was an ASHA Code of Ethics violation for
audiologists to dispense hearing aids.
The audiologist recommended the device(s) and the patient
purchased the device as a retail product from a distributor.
Audiologists were paid for their services, including:
diagnostic services, administering hearing aid evaluations,
and hearing aid adjustments and audiologic rehab.
The Supreme Court ruled that
“A society’s canon of ethics having the effect of limiting
compensation among the society’s members is illegal.”
Handbook of Clinical Audiology, 5th Edition
Katz, Burkard, Medvetsky, 2002
Understanding Economies of Scale
Hearing
Aids
Cell
phones
Only 2% of our population use hearing aids
10
Economics of volume purchases
Veteran’s
Administration
BIG BOX STORES
Sole
Provider
Hearing aids do not magically just work
Hearing Aids
5/29/2012
Professional
Services
Maximum
Communication
Improvement
12
Hearing well in a noisy world, Consumer Reports (2009)
•
•
•
•
•
•
Sound-proof booth for testing
Several types of hearing tests
Choice of brands, styles and features
Real Ear Measures to customize the fitting
Rehab classes and/or therapy
Flexible evaluation period with option to return
hearing aid(s)
• Convenient hours
• Walk-in repairs
Find a licensed and certified audiologist that offers the
above AND an unbundled pricing option.
Bundled Billing
Combining products & services into one lump sum.
PATIENT’S BILL
Hearing
Aid
Hearing
Aid
Pre-Fitting EAA
Fitting
2 Years
Pre-Fitting
D-Mic
Test
Fee
of
Service
Real-Ear Measures
$
Bundled Billing
Combining products & services into one lump sum.
PATIENT’S BILL
2 wk: Follow-up
4 wk: Follow-up
$
6 wk: Follow-up
6 mo: Tubing Change
12 mo: Annual Check
15 mo: Repair (wax)
17 mo: Tubing Change
20 mo: Repair (Moisture)
24 mo: Annual Check
Unbundled Billing
Breaking up prices completely.
PATIENT’S BILL
Hearing
Aid
Hearing
Aid
Pre-Fitting EAA
Pre-Fitting
D-Mic
2-Years
Test
Fitting
Service
Fee
Real-Ear Measures
$ $
$
$
Unbundled Billing
Breaking up prices completely.
PATIENT’S BILL
2 wk: Follow-up
Hearing 4 wk: Follow-up
Aid
6 wk: Follow-up
$ $
$
$
Hearing
Aid
6 mo: Tubing Change
12 mo: Annual Check
Pre-Fitting D-Mic Test 15 mo: Repair (wax)
17 mo: Tubing Change
Real Ear Measurements
20 mo: Repair (Moisture)
24 mo: Annual Check
Completely Unbundled Billing
Advantages:
Disadvantages:
• Transparency
• More options for patients
• Defers much of the cost until services are
rendered
• Patient pays only for what is used
• Could meet patient’s needs easily
• Patients may wish to eliminate necessary
procedures (EAA, REM, etc.)
• Patients may not reliably return for necessary
visits because they will need to pay
• May increase administrative time to manage
• Greater possibility of not collecting billables
AAA Hearing Aid Billing Practices Survey
Does your clinic bundle services
into the price of hearing aids?
2011
2012 No
20%
No 33% Yes 67% Yes
80%
A survey in 2006 reported that 87% of hearing aid dispensers are bundling.
(Hearing Journal, 2006)
2012 AAA Hearing Aid Billing Practices Survey
Does your clinic retain a non-refundable professional
fee if the hearing aid(s) are returned for credit?
State Laws require that all fees incurred with the provision of a hearing aid be returned 7% No 16% Yes 77% State Law
requires
that all
fees be
returned
to the
patient.
6%
2011
No
18%
Yes
76%
2012 AAA Hearing Aid Billing Practices Survey
Is the non-refundable fitting and professional fee…
72.6% 11.4% 6.5% 1.8% Contingent on the
services provided
6.1% 1.6% A flat rate regardless A flat rate based on A percentage of the Cannot charge a fee as
of hearing aid
the level of technology
total cost of the
this would violate
technology/style/price
hearing aid
state law(s)
Other
Professional Services are valuable
DENTISTS
OPTOMETRISTS
HAIR STYLISTS
PLUMBERS
ETC…
UNC- Hearing & Communication Center
11 years ago – an inspiring conversation
He wanted to
pay for
services after a
one hour visit
Dr. B, a retired dentist from the
UNC School of Dentistry
•His hearing aids
were
over 2 years old
•His warranty
had expired
At the
time, we
were
charging
NOTHING
We
arbitrarily
chose an
hourly rate
for services
Began charging
small amounts
for services
such as tubing
changes, inhouse repairs,
etc.
2005 A new beginning at UNC-HCC
Mission: To make hearing care more affordable!
• Lowered hearing aid prices, as 2 years of services were no
longer included up-front
» Included a 60-day “trial” period
• Term “Trial Period” became “Evaluation & Adjustment Period”
• Non-refundable professional fee increased proportionately to
reflect services rendered during E&A Period.
» Included:
• Pre-fitting Electroacoustic Analysis (EAA)
• Real-Ear Measurements (REM)
• Follow-up and Adjustments for 60 days
• Our model was inspired by Patricia Gans.
(J. Nemes, “To bundle or not to bundle? That is the question.”Hearing Journal, April 2004.)
Our [Partially] Unbundled Billing
up prices completely,
Breaking upBreaking
prices completely,
after the TRIAL period.
after the EVALUATION AND ADJUSTMENT period.
PATIENT’S BILL
Hearing
Aid
Hearing
Aid
$
$
Pre-Fitting D-Mic Test
2-Years
Pre-FittingProfessional
EAA Checks Fee +
Service
45 Days of Follow-Up
Real-Ear Measures
$
Our [Partially] Unbundled Billing
Breaking up prices completely,
after the initial evaluation and adjustment period.
PATIENT’S BILL
$
Hearing
Aid
$
$
Hearing
Aid
2 wk: Follow-up
4 wk: Follow-up
6 wk: Follow-up
6 mo: Tubing Change
12 mo: Annual Check
15 mo: Repair (wax)
$1000
Professional$3000
Fee +
17 mo: Tubing Change
Fitting
2-Years
45
Days of Follow-Up
Fee
Service 20 mo: Repair (moisture)
24 mo: Annual Check
Sample Impact on HA Prices:
2 Hearing Aids
(premium tier,
digital)
Non-refundable
professional fee
Service period
included,
following fitting
TOTAL
INVESTMENT
2004
BUNDLED
2005
UNBUNDLED
$5000
$X,XXX per
device
$200 total
$XXX per ear
Duration of
manufacturer
warranty
$5200
60 days
Lower
upfront cost
Enlightening patients
…who purchased their hearing aids on or after July 1, 2005 or had never seen the unbundled model before. Mr. Smith, we are recommending XYZ
hearing aids as a part of your treatment
plan. The hearing aid cost is $X,XXX per
device. We recommend 2 hearing aids,
therefore the hearing aids will cost $X,XXX.
The professional service fees to fit these
hearing aids and for 45 days of services will
be $XXX/ear. The professional service fees
are non-refundable. Your total investment
the day you go home with the hearing aids
will be $X,XXX. Services after the 45 day
evaluation and adjustment period will be
fee for service.
Image from:
http://thefamouslastword.blogspot.com/2012/01/googlethinks-im-old-man.html
Reassuring patients
…who purchased their hearing aids prior to July 1, 2005. (And heard that their friends bought hearing aids yesterday, for less $.) Mrs. Jones – All the services you need
during your 2 year manufacturer’s
warranty period were paid for up front.
You can come see us anytime you need
services for your hearing aids and you
have already paid for those visits. Our
current policy no longer provides these
unlimited services up front, and that is
why the fee is less.
Image from: http://interestingni.blogspot.com/2011/01/navyshocked-by-shipboard-profanity.html
5/29/2012
UNC-HCC Treatment Plan
We do not ‘sell’ hearing aids. We aim to rehabilitate our patient’s
hearing utilizing evidence-based clinical practice. As a part of our
customized process, we encourage each patient to:
• Participate in Better Hearing Workshops (Aural Rehabilitation)
• Complete Auditory Training program - Listening And
Communication Enhancement, also called “LACE”
• Assess benefit and satisfaction throughout the process
» Abbreviated Profile of Hearing Aid Benefit (APHAB)
» Client Oriented Scale of Improvement (COSI)
» Satisfaction with Amplification in Daily Life (SADL)
The product is worthless if the patient
cannot use it effectively.
36
Current Trends and
Recommended Procedures
What exactly is best practice in the
hearing aid world?
Current Trends:
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38
An Evidence-based Model
Hearing
Evaluation
5/29/2012
Functional
Communication
Assessment
Hearing
Aid Fitting
Hearing
Aid Followup
Individualized
and Group
Aural Rehab
39
Current Trend: Online Hearing Tests Hearing Evaluation
• Comprehensive
Evaluation (92557)
» Diagnosing the type and
degree of hearing loss:
• Extensive case history
• Visual inspection /
Otoscopy
• Speech testing
• Pure tone threshold
search
» Air conduction and
bone conduction
• Tympanometry (92567)
• Acoustic reflexes (92550)
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41
Current Trend: Online Hearing Aid (HA) Purchases 63 options
Hearing Aid Selection
Hearing Aid Evaluation (92590/1)
UNC HCC Functional
Communication Assessment
• Characteristics of Amplification Tool
(COAT)
•
•
•
•
Quick SIN (Speech in Noise)
Loudness Discomfort Measures (LDL)
Acceptable Noise Level (ANL) as needed
Cochlear dead region testing (TEN-HL) as
needed
• Lifestyle Assessment
• Client Oriented Scale of Improvement
• HA selection
• Earmold Impressions
44
5/29/2012
(R. Sweetow, “Instead of a hearing aid evaluation, let’s assess functional communication ability”. Hearing Journal, 2007.)
Hearing Aid Selection Process
Look for a clinic that offers an objective Hearing Aid Selection
Process (92590, 92591 or V5010)
“Functional Communication Assessment” (FCA)
• Lifestyle Assessment
• Self-Assessment Questionnaires (APHAB, COSI, COAT)
• Loudness Discomfort Levels (LDL) Test
• Quick Speech In Noise (QuickSIN) Test
• Acceptable Noise Level (ANL) Test
• Earmold Impressions
Sweetow, R. (2007) Instead of a hearing aid evaluation, let’s assess functional communication ability. Hearing Journal, 60(9), 26-31.
Current Trend: Wholesale/Online Hearing Aid Purchases Wholesale Store
Audiology Clinic
Ebay
Hearing Aid Fitting Procedures
• When the HAs are Received from the Manufacturer
» Quality Assurance (V5011)
• EAA, DM, HAC
• The day of the Fitting
» Conformity Evaluation (V5020)
• Probe Microphone Measures
» Hearing Aid Programming (V5014)
» Orientation (V5011)
• Care, maintenance, use
» Dispensing Fee binaural (V5160)
» Hearing Aid – digital BTE binaural (V5261)
• Hearing aid fitting follow-up
» Appointments included for 45 days
5/29/2012
• Recommend: 2 week and 4 week (six week as needed)
47
HA Quality Assurance Procedures
• Behind the scenes (before patient arrives):
»
»
»
»
Electroacoustic Analysis (EAA)
Directional Microphone (DM) test
Distortion test
Hearing aid check
• Visual inspection and listening check
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2008 – 2009: New Hearing Aids
12%
Passed inspection/EAA
Failed inspection/EAA
88%
New Orders Failing QA Inspection by Manufacturer
Manufacturer A
Manufacturer B
Manufacturer C
7.60%
20%
25%
(S. Sjoblad, B. Warren. 2009.)
2008 – 2009: Repaired Hearing Aids
18%
Passed inspection/EAA
Failed inspection/EAA
82%
Percentage of Repaired HAs Failing QA Measures
Manufacturer A
Manufacturer B
Manufacturer C
Manufacturer D
Manufacturer E
Manufacturer F
9.70%
18.90%
20.50%
41.20%
20%
0%
(S. Sjoblad, B. Warren. 2009.)
Hearing Aid Fitting
• Day of Fitting
» Conformity Evaluation (V5020)
• Probe Microphone Measures/Real Ear Measures
» Hearing Aid Programming (V5014)
» Orientation (V5011)
• Care, maintenance, use
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51
Real Ear Verification
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A Case for Real-Ear Measurements
Pt’s Loudness
Discomfort
Levels
Hearing Aid
MPO
65 dB Speech
55 dB Speech
Patient’s
Hearing
Thresholds
(dBSPL)
A Case for Real-Ear Measurements
Pt’s Loudness
Discomfort
Levels
Hearing Aid
MPO
65 dB Speech
55 dB Speech
Patient’s
Hearing
Thresholds
(dBSPL)
Hearing Aid Fitting Procedures
• When the HAs are Received from the Manufacturer
» Quality Assurance (V5011)
• EAA, DM, HAC
• The day of the Fitting
» Conformity Evaluation (V5020)
• Probe Microphone Measures
» Hearing Aid Programming (V5014)
» Orientation (V5011)
• Care, maintenance, use
» Dispensing Fee binaural (V5160)
» Hearing Aid – digital BTE binaural (V5261)
• Hearing aid fitting follow-up
» Appointments included for 45 days
5/29/2012
• Recommend: 2 week and 4 week (six week as needed)
55
Balancing the Investment
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56
Current Trend: Ignoring the importance of HA follow‐up Hearing Aid Check:
• Six Months:
HEARING AID PROCEDURES, EARMOLDS, AND ACCESSORIES (and related professional services)
√ CPT / HCPCS mod.
DESCRIPTION
FEE √ HCPCS mod.
DESCRIPTION
FEE √
√ V5257
V5299
Office Visit
Digital BTE, monaural
92592
HA Check, monaural (visual & listening inspections)
V5256
Digital ITE, monaural
92593
HA Check, binaural (visual & listening inspections)
V5255
Digital ITC, monaural
92594
Electroacoustic Analysis, monaural
V5254
Digital CIC, monaural
92595
Electroacoustic Analysis, binaural
V5262
Disposable Aid, monaural
V5014
HA Repair by Mfctr., 6 mo. Warranty
V5261
Digital BTE, binaural
V5014
HA Repair by Mfctr., 12 mo. Warranty
V5260
Digital ITE, binaural
V5014
HA Repair, in-house per ear small parts replaced
V5259
Digital ITC, binaural
V5014
HA Repair no charge
V5259
Digital CIC, binaural
V5267
HA Supplies/Accessories (see reverse)
V5263
Disposable Aid, binaural
92590
HA Evaluation, monaural (Func. Comm. Assess.)
V5241
Dispensing Fee, monaural
92591
HA Evaluation, binaural (Func. Comm. Assess.)
V5160
Dispensing Fee, binaural
V5275
Earmold Impression (each)
V5110
Dispensing Fee, bilateral
V5264
Earmold Custom (each)
V5090
Dispensing Fee, unspecified aid (FM)
V5265
Earmold, Disposable (each)
V5200
Dispensing Fee, CROS
V5011
Fitting and Orientation of Hearing Aid(s)
V5240
Dispensing Fee, BICROS
V5011
Fitting and Orientation of FM
V5298
Hearing Aid, miscellaneous
V5020
Conformity Evaluation (Real-Ear Measures)
V5298
Lyric Subscription
V5014
Hearing Aid Reprogramming
92630
Audiological Rehabilitation [pre-lingual]
V5267
Musician's Earplugs Filters (each)
92633
Audiological Rehabilitation [post-lingual]
» Office visit (V5299)
» HAC (92592/3)
• Visual and listening inspection
»
x2
Hearing aid repair, in house (V5014)
• per ear – small parts replacement
• Annual:
» Office visit (V5299)
» HAC (92592/3)
• Visual and listening inspection
» Hearing aid repair, in house (V5014)
HCPCS mod.
DESCRIPTION
FEE
98960
Education & Training, individual
98961
Education & Training, 2-4 persons
98962
Education & Training,5-8 persons
V7212
Encounter for hearing conservation & Tx
99002
Shipping and Handling
V5299
Loss and Damage Deductible, per device
V5299
HA Extended Warranty
69210
Cerumen Removal [IMPACTED]
92700
Cerumen Removal [not impacted]
98986
Telephone Assessment
98969
Online Assessment
V5266
Battery (6 batteries/pk)
V5266
Battery Club Membership (8pk of 6)
V5268
ALD, Telephone
V5269
ALD, Alerting
V5270
ALD,TV Amplifier
V5274
ALD, miscellaneous (ex. FM, wireless)
V5299
Hearing Service Miscellaneous (Home visit)
EAA at one year and
as needed
• per ear – small parts replacement
» EAA and Directional Microphone testing (92594/5)
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58
Current Trend: Fear of Being Billed for Services HEARING AID PROCEDURES, EARMOLDS, AND ACCESSORIES (and related professional services)
√ CPT / HCPCS mod.
DESCRIPTION
FEE √ HCPCS mod.
DESCRIPTION
FEE √
√ V5257
V5299
Office Visit
Digital BTE, monaural
92592
HA Check, monaural (visual & listening inspections)
V5256
Digital ITE, monaural
92593
HA Check, binaural (visual & listening inspections)
V5255
Digital ITC, monaural
92594
Electroacoustic Analysis, monaural
V5254
Digital CIC, monaural
92595
Electroacoustic Analysis, binaural
V5262
Disposable Aid, monaural
V5014
HA Repair by Mfctr., 6 mo. Warranty
V5261
Digital BTE, binaural
V5014
HA Repair by Mfctr., 12 mo. Warranty
V5260
Digital ITE, binaural
V5014
HA Repair, in-house per ear small parts replaced
V5259
Digital ITC, binaural
V5014
HA Repair no charge
V5259
Digital CIC, binaural
V5267
HA Supplies/Accessories (see reverse)
V5263
Disposable Aid, binaural
92590
HA Evaluation, monaural (Func. Comm. Assess.)
V5241
Dispensing Fee, monaural
92591
HA Evaluation, binaural (Func. Comm. Assess.)
V5160
Dispensing Fee, binaural
V5275
Earmold Impression (each)
V5110
Dispensing Fee, bilateral
V5264
Earmold Custom (each)
V5090
Dispensing Fee, unspecified aid (FM)
V5265
Earmold, Disposable (each)
V5200
Dispensing Fee, CROS
V5011
Fitting and Orientation of Hearing Aid(s)
V5240
Dispensing Fee, BICROS
V5011
Fitting and Orientation of FM
V5298
Hearing Aid, miscellaneous
V5020
Conformity Evaluation (Real-Ear Measures)
V5298
Lyric Subscription
V5014
Hearing Aid Reprogramming
92630
Audiological Rehabilitation [pre-lingual]
V5267
Musician's Earplugs Filters (each)
92633
Audiological Rehabilitation [post-lingual]
HCPCS mod.
DESCRIPTION
FEE
98960
Education & Training, individual
98961
Education & Training, 2-4 persons
98962
Education & Training,5-8 persons
V7212
Encounter for hearing conservation & Tx
99002
Shipping and Handling
V5299
Loss and Damage Deductible, per device
V5299
HA Extended Warranty
69210
Cerumen Removal [IMPACTED]
92700
Cerumen Removal [not impacted]
98986
Telephone Assessment
98969
Online Assessment
V5266
Battery (6 batteries/pk)
V5266
Battery Club Membership (8pk of 6)
V5268
ALD, Telephone
V5269
ALD, Alerting
V5270
ALD,TV Amplifier
V5274
ALD, miscellaneous (ex. FM, wireless)
V5299
Hearing Service Miscellaneous (Home visit)
Insert graphics and info on online HE… x2
2011 Hearing Aid Billing Practices Survey
How many visits does the average patient have
during the “manufacturer’s warranty” period?
Greater than 6 times annually
1.7%
5-6 times annually
4.4%
39.5%
3-4 times annually
54.3%
1-2 times annually
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
Why are there fees for repairs?
Out of
Warranty
repair
Patient pays the
manufacturer’s
repair invoice,
plus a fee for our
services.
In
Warranty
Repair
Patient still pays
a fee for our
services.
SERVICES may include:
• Hearing Aid Check -92592, 92593
• Attempt to repair the hearing aid in
house - V5014
• EAA – 92594/5
• Directional Mic Test – 92594/5
• Hearing Aid Programming – V5014
• Feedback Test, as needed – V5014
• Synchronization, as needed – V5014
• Shipping and Handling– 99002
Includes most
necessary
services,
standard
accessories,
semi-annual
checkups,
annual
evaluation, etc.
Premium Care
Patient pays for
services
following
trial/adjustment
period
Standard Care
Minimal Care
Service Plan Examples:
“Worry Free
Option”
includes
everything with
VIP treatment
for the life of the
device.
Coverstone, J. (2011) Fee for service models in audiology practices. Audiology Today, 24(5), 36-46.
What our patients are saying? PATIENT: R.P. “I am more than happy to come in for any appointment that will improve my ability to hear and I am happy to pay for it.” PATIENT: S.M. “When it came time to fit my hearing aids, I really think your use of this thing [patient points to real‐ear measurement system] made all the difference.” “Yeah, [your billing method] did surprise me a little bit. But I think the main thing was that I was seeing everything that you guys do here, versus what I had been getting before.” PATIENT: S.H. “You are not charging me enough for all that you do.” PATIENT: S.O. “My experience with your clinic and these hearing aids is like nothing I have ever experienced before, I am so sorry I did not find you sooner.” Summary of Objectives
Describe the considerations consumers should identify when
embarking in the search for a hearing healthcare provider
and new hearing technology.
Understand various billing models and fee structures one
may encounter during the hearing aid selection and
evaluation process.
Discuss the importance of evidence-based practice in
successful hearing aid fitting and audiologic rehabilitation
outcomes
5/29/2012
64
Finding the best hearing care checklist
Find a Board Certified Audiologist who
follows AAA Guidelines for Management of
Hearing Loss
Inquire if the practice offers
itemized/unbundled billing options before
you make an appointment
Review the practice website and verify the use
of objective hearing aid selection procedures
and Real Ear Probe Microphone Measures
Recognize that hearing aids will not cure
hearing loss. Enroll in Audiologic Rehab
classes and consider Auditory Training.
Beyond Monday Morning…
Be prepared that hearing loss treatment is
an on-going process.
Routinely attend your local HLAA Chapter
meetings for ongoing support from others
with hearing loss.
Continue to educate yourself!
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66
Don’t be fooled by the mad world of hearing aid advertising. Image from: http://www.thefiscaltimes.com/Media/Slideshow/2012/03/21/Mad‐Men‐Advertising‐That‐Would‐Change‐America.aspx Proceed as a wise consumer! References
• Bonta, R., (2004) Communicating true value. Advance for
Audiologists, 6(5), 30-33
• Cavitt, K., (2010) Personal email communication.
• Foltner, K., (2009) What’s my time worth? Part 3:
Breakeven analysis. Advance for Audiologists, 11(3), 44.
• Gitles, T., (1999), Re-inventing the profession: A new
model of hearing care delivery (First of two parts). Hearing
Journal, 52(9), 32-34.
• Gitles, T., (1999) Re-inventing the profession: A new
model of hearing care delivery (Second of two parts).
Hearing Journal, 52(10), 53-55.
5/29/2012
68
References (con’t)
• Nemes, J., (2004) To bundle or not to bundle? That is the
question. Hearing Journal, 57(4), 19-24.
• Stone, C., (2005) Real talk on unbundling. Advance for
Audiologists, 7(6), 59-60, 76.
• Sjoblad, S., Warren, B., (2009) Get real: Can QA checks
and REM improve the bottom-line? Presented at
AudiologyNow 2009, Dallas, Texas
• Sweetow, R. (2007) Instead of a hearing aid evaluation,
let’s assess functional communication ability. Hearing
Journal, 60(9), 26-31.
• Sweetow, R. (2009) Hearing aid delivery models: Part 1 of
2. Audiology Today, 21(5), 49 -57.
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69
References (con’t)
• Sweetow, R. (2009) Hearing aid delivery models: Part 2 of
2. Audiology Today, 21(6), 33-37.
• Van Vliet, D. (2003) In praise of unbundling. Hearing
Journal, 56(4), 36.
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CONTACT INFORMATION:
Stephanie Sjoblad:
[email protected]
Barbara Winslow Warren:
[email protected]
5/29/2012
SPECIAL THANKS TO:
AAA
Debbie Abel, Au.D.
Annette Burton, Au.D.
Kim Cavitt, Au.D.
Katherine Cresante
Melissa Uhlman, Au.D
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