Final Word | March 2016 Hearing Review

When charging fees for services, is it best to bundle, unbundle, or take an eclectic approach? We have debated the issue of separating out fees for hearing aids and services—or “unbundling” them—for decades. The arguments for bundling include the simplicity of the process, elimination of a penalty for returning for service, and the ability to be transparent in stating a bottom-line price for the combination of services and products. In this model, there may be an incentive to provide fewer services to optimize reimbursement for time spent. Further, fees may be collected for services not provided. Arguments for unbundling speak to the professionalism of assigning value to the services, and the fact that fees are charged only for services actually delivered.

There are mixed opinions on the merits of bundling, and unbundling, but my observation is that a large majority of us offer a bundled package of services and products for hearing aids. This is at odds with typical medical billing where individual services and products are unbundled, itemized, and submitted for reimbursement. With the itemization process, there is a financial incentive to perform and bill for more services. Neither system is free from incentives that may not be in the best interest of the consumer.

Medicare, in an effort to provide an incentive for better coordination of care, and to stem the increasing cost of care, has started to implement bundled payments for certain procedures.  For instance, joint replacement for hips or knees requires hospital charges, and fees for surgeons, anesthesiology, physical therapy, pharmacy, and others involved in the care of the patient. If things go badly, there may be a readmission to the hospital with additional fees. Under the bundled care plan, the providers agree to accept one flat payment for all services and supplies, no matter how much or how little care is provided.

Isn’t it an interesting turn of events that Medicare is now following a model that we inherited from mid-20th Century hearing aid salespeople? Hospital managers are preaching that bundled payment plans are “the wave of the future.” Time will tell us how the change works out for medical care.

That leaves us with the question of what we should be doing about our delivery model in our practices today, and in the near future. We are facing increasing challenges with respect to the public perception of affordability and accessibility of hearing care. The best practices for assessment, selection, and fitting of hearing aids include the participation of an audiologist or other hearing care professional. Those of us who regularly deal with patients who have hearing difficulty know that the individuals we care for typically are dependent upon us for assuring that they receive continuing benefit from their hearing devices. Our participation in the delivery of best practices clearly is a part of the cost of their hearing care. Some say that cost is a significant barrier to the acquisition of hearing aids. Alternatives to best practices that are promoted often do not include the participation of hearing professionals and, as a result, may be less expensive.

As consumer electronics continue to evolve technologically outside the realm of hearing aids, but in a way that may provide benefit for individuals with hearing difficulty, the reality of consumer behavior is such that consumers with hearing difficulty may be experimenting with these products—and asking us for advice. We will likely be in the position of providing guidance to consumers about the use of these consumer products. In my opinion, these consultations should be offered as a fee for service.

The Final Word? As a provider, I firmly believe in the best practice model as it exists for those who need our services to support them. I also believe that I should do my homework so I can be well-informed on newly evolving products and available to advise consumers on the use of these emerging technologies.

Bundle or unbundle my fees for services? I’m going to continue to be eclectic in my approach. There are times that the simplicity of a bundled fee makes the most sense with certain consumers. Even with the bundled approach, calling out and “itemizing” the services included provides full disclosure of what the consumer is paying for.

Dennis Van Vliet, AuD

Dennis Van Vliet, AuD

Dennis Van Vliet, AuD, has been a prominent clinician, columnist, educator, and leader in the hearing healthcare field for nearly 40 years, and his professional experience includes working as an educational audiologist, a private-practice owner, and VP of audiology for a large dispensing network. He currently serves as the senior director of professional relations for Starkey Hearing Technologies, Eden Prairie, Minn.

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Original citation for this article: Van Vliet D. The Final Word: To Bundle or Unbundle? Hearing Review. 2016;23(3):50.?