Eyecare practices find incorporating audiology improves patient care loyalty.

by Bob Kronemyer

A growing number of optometrists are finding that offering hearing services at their location is convenient and appreciated by their existing patient base and also provides a secondary steady financial stream.

“Patients love our service,” Mike G. Wallace, OD, a private practitioner from Flushing, Mich., told Primary Care Optometry News in an interview. Dr. Wallace has been providing hearing services at his office for about the past 5 years. “If you identify a hearing impairment for the first time, patients don’t know where to go to. They are much more comfortable with a professional referral than with a commercial establishment or people who advertise. They also like the fact that their optometrist has vetted the different hearing providers.”

 Dr. Wallace’s staff conducts the initial 45-second hearing screening. 

Additionally, patients — even those without a hearing impairment — will often refer parents or friends, he said.

An audiologist rented space from Dr. Wallace until about a year ago, when he decided to partner with Vision Hearing Alliance (Naperville, Ill.).

Dr. Wallace explained that the optometrist purchases any necessary equipment and instrumentation from Vision Hearing Alliance. Then, a separate entity, Hearing Professionals of America, which is affiliated with Vision Hearing Alliance, rents the equipment and instrumentation from the optometrist and creates the processes to implement hearing services in the office.

“Hearing Professionals of America provides the personnel, the care for the patients and the marketing,” said Dr. Wallace, who has considerable experience helping other ODs implement hearing services in their offices.

There is also a commitment to inform the community as a whole about the service, he said.

Implementation into the practice

Patients are not charged for the initial 45-second screening conducted by Dr. Wallace’s staff.

“An earphone audiometer is placed over the patient’s ear, and the patient indicates with a hand-clicking device when he or she hears different tones. We might be able to identify someone missing high level tones or low level tones,” Dr. Wallace said.

A follow-up comprehensive evaluation with the audiologist is also provided at no charge.

Dr. Wallace’s office refers six to eight patients a week to hearing services, which represents nearly a full day for the audiologist who is onsite 1 day a week.

“I have a small 8-foot by 8-foot room for the audiologist that is available anytime of the week,” Dr. Wallace said.

The conversion rate from a hearing consultation to the purchase of a hearing aid is 20%, he added, and the optometrist profits from the hearing aid sale.

“In many cases, if your vision is poor, so is your hearing,” Brian Conrey, cofounder and vice president of Vision Hearing Alliance, told PCON.

The company, which was founded in 2009, integrates hearing health care services inside independent eye care practices. Of the current 62 locations nationwide, about 90% are OD-based and 10% MD-based, he said. The turnkey operation handles every aspect of the business, including managing, marketing and securing the audiologist.

From an ophthalmic prospective, “we are a tenant in the building,” Mr. Conrey said. “The doctor screens the patients. If the patient needs a hearing evaluation, the doctor simply offers the option of referring that patient to the hearing center on-site.”

Eye care professionals need to provide either a separate room to accommodate the audiologist 1 day a week or have their exam lane available on a day of the week when vision care is not provided, he said.

Raising awareness, patient care

“The goal of the model is to raise the level of patient care that the optometrist or ophthalmologist provides in a town,” Mr. Conrey said. “Most patients have not had a hearing screening usually since kindergarten or the fourth or fifth grade. Our model makes sense to the patient, yet does not disrupt the flow of an average optometric practice.”

Practices refer up to 20 patients a month for hearing services, with the average being between 12 and 15 patients, according to Mr. Conrey. The audiologist is on-site 1 day a week. Monthly marketing for all the offices consists primarily of print mail or newspaper.

“We are also a heavy search-engine marketing company,” he said.

Mr. Conrey cautions optometrists about using the phrase “hearing aid.”

“Most patients, unfortunately, have a bad taste in their mouth with hearing aids from previous experiences,” Mr. Conrey said. “By the optometrist not talking about hearing aids at all, but simply just talking about hearing care, this will make the patient feel at ease.”

Mr. Conrey stated that 22% of patients fail the hearing screening, regardless of age, so the optometrist will have an appropriate patient base, “whether he or she thinks so or not.”

Optometry, audiology at Salus

Salus University in Elkins Park, Pa., houses both the Pennsylvania College of Optometry and the Osborne College of Audiology. In fact, Salus University is the only educational institution in the country where colleges of optometry and audiology are on the same campus, according to Linda Casser, OD, FAAO, dean of the college  of optometry and a member of the PCON Editorial Board.

“There is cross-pollination on the student level by virtue of a major shared course on evidence-based medicine,” she said. “Both programs are biomedicine-based.”

In addition, a shared student governance and faculty among the two disciplines also exist.

Dr. Casser believes that the collaboration of optometry and audiology into offices that comanage the same patients “is a natural outcome of this educational process.”

Victor Bray, PhD, dean of the college of audiology, pointed out that hearing loss is the third most prevalent chronic and untreated condition in the elderly. Hence, in the patient population seen by optometrists, “there is high comorbidity between vision loss and hearing loss,” Dr. Bray said. Furthermore, identifying and treating hearing loss “will improve the care the optometrist can provide on the vision side as well as the hearing side.”

Patient response is also positive, Dr. Casser said, because of the convenience of visiting one office to receive two services.

“In many cases, the vision and hearing care overlap due to some common disease source or syndrome, for comanagement by the two doctors,” Dr. Bray said.

“Comorbidity of hearing and vision loss also extends from the geriatric population to the pediatric population,” he said.

With the common rental-of-space model, “the audiologist may agree to come in 1 day a week to see patients, just like an optometrist might do with an ophthalmologist,” Dr. Casser said.

The model of tomorrow may involve a full-time optometrist and a full-time audiologist working side-by-side in the same location, she said.

“The two doctors may share a patient base, an administrative area, a waiting area and a check-in area, for mutual support,” Dr. Casser said. “The goal is for the two professions to coexist, each practicing at its highest level.”

Strengthening the patient bond

John A. Hovanesian, MD, FACS, a clinical assistant professor of ophthalmology at Jules Stein Eye Institute, University of California, Los Angeles, and PCON Editorial Board member, has been offering audiology services in his private practice the past 2 years.

“Hearing is a valuable service that many patients are not getting anywhere,” Dr. Hovanesian said in an interview. “It was a service we could add without a substantial change in our basic practice.”

Initially, Dr. Hovanesian feared that patients would be suspicious or slightly resentful about the added service.

“I was afraid they would think we were motivated by the opportunity to sell them something,” he said. “However, what I found instead was acceptance and appreciation. Many patients do not know where to go for a hearing problem they may have had for a long time. When we tell them we offer hearing services, they are relieved to know they can come to us. They surmise that a place they can trust for their eyes is a place they can trust for their ears.”

Offering dual services is also one more way eye care practitioners can create a greater bond with their patients, according to Dr. Hovanesian, whose practice contracts with EyeCanHear (in partnership with Beltone) to provide an audiologist and hearing services.

“That portion of the practice has become reasonably busy and certainly self-sustaining,” he said.

Still, he cautions that eye care practitioners should research regulations pertaining to their particular state to ensure they are permitted to operate side-by-side with audiologists.

Dr. Hovanesian also said the dual services are best suited for a high-volume practice with mostly older patients (older than 50) “who are much more likely to have hearing problems.” 

https://www.healio.com/news/optometry/20120709/eye-care-practices-find-incorporating-audiology-improves-patient-care-loyalty

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