Audiology, Daily Updates, Future Ear Radio, Hearables, Hearing Aids, Hearing Healthcare, Longevity Economy

074 – Geoff Cooling & Kim Cavitt, AuD – How Hearing Professionals Can Thrive in an Expanding Market

This week on The Future Ear Radio podcast, Geoff Cooling and Kim Cavitt join me to help break down the flurry of announcements that have occurred in the hearing health space recently and attempt to make sense of how the hearing professional fits into the burgeoning mild-moderate end of the market. We’ve seen a slew of announcements including Bose launching a hearing aid, Jabra launching a hearing aid (into Costco initially), Sonova purchasing Sennheiser’s consumer audio division, the fruits of the Jacoti + Qualcomm partnership with the introduction of “OTC Ready” licensing, and Apple’s new AirPods Pro feature, Conversation Boost. All of these announcements in a matter of weeks… the market catering to mild-moderate hearing losses is truly en fuego.

Ok, we get it, there’s a lot of change and innovation taking place but what exactly does all of this mean for hearing professionals and clinics? That’s what we talk through in this episode, as the three of us agree that in order for hearing professionals to participate in this milder end of the market, they will need to justify why patients should seek out their services, rather than simply purchasing something like a self-fit device online or at a big box retailer.

The key to success for this portion of the market may be for professionals to decouple from device sales and instead position themselves as the “navigator” in the patient’s hearing loss journey and rely on service-based compensation. In a world that’s becoming abundant with options for patients to choose from at the beginning stages of the journey, the opportunity might be to cater to the increasing amount of complexity and help patients to fully understand their options to meet their specific needs and guide them through the years.

Which then brings us to the question of why exactly these types of patients, who have by-and-large never sought out professionals in the past, would be motivated to access these kind of services. As we discuss, this is where remote consultations and evaluations will likely need to be emphasized, as the ease of accessing the provider and their services is paramount. We speak to how this might be facilitated with new technology and the ways to incorporate remote services effectively into a hearing clinic.

I really enjoyed Kim and Geoff’s perspectives shared in this episode and thought they tied nicely to the conversations had on episodes 72 (audiologists Abram Bailey & Steve Taddei) and 69 (Kat Penno, AuD and Andy Bellavia). I’m sure this won’t be the last time I have a discussion like this on the podcast as there appears to be no shortage of innovation and change on the horizon in the hearing health market.

-Thanks for Reading-
Dave

EPISODE TRANSCRIPT

Dave Kemp:

Hi, I’m your host, Dave Kemp. And this is Future Ear Radio. Each episode, we’re breaking down one new thing, one cool new finding that’s happening in the world of hearables, the world of voice technology. How are these worlds starting to intersect? How are these worlds starting to collide? What cool things are going to come from this intersection of technology? Without further ado, let’s get on with the show.

Dave Kemp:

Okay, so we are joined here today by two reoccurring guests, two awesome guests, Dr. Kim Cavitt and Mr. Geoff Cooling Welcome back to the podcast. Why don’t we go one by one, introducing ourselves. Tell the audience a little bit about who you are and what you do. We’ll start with you, Kim, ladies first.

Kim Cavitt:

Oh, thank you. I’m Kim Cavitt. I am an audiologist and I do consulting work in the hearing healthcare space from my office here in Chicago. I’ve been an audiologist for about 30 years. I’ve been in consulting about 20, do a lot of work with the Academy of Doctors of Audiology. Still teach in an AUD program at Northwestern, and I’m involved a little bit in the regulatory space because I am the Chairman of the Licensure Board for the State of Illinois.

Dave Kemp:

Lovely. Well, great to have you back on. Geoff, tell us a little bit about yourself.

Geoff Cooling:

I’m the irritating one.

Kim Cavitt:

The fun one. I like fun instead.

Dave Kemp:

My favorite Irishman.

Kim Cavitt:

I know.

Geoff Cooling:

So, qualified in 2006, 2007, was in private practice for years and then went to work for a manufacturer. Went out on my own in 2014, doing consultant and stuff like that and some locuming. Probably most famous for having a very big mouth And I am the co-editor of Hearing Aid Now, which is a consumer-focused site. And I’ve written I suppose some articles and strategy documents on a site called Just Audiology Stuff, which is more profession-focused. So, that’s me.

Dave Kemp:

Awesome. Well, I’m so glad that you two joined me today because I’ve had some conversations on the podcast lately that I wanted to build upon today with you two going back with the conversation I had with [Abram Bailey 00:02:36] and Steve [Tatty 00:02:37], Andy Bellavia, and [Cat Peno 00:02:39], really talking about okay, there’s a lot of change that’s occurring in this hearing healthcare market. Some of it is long overdue with the delay in the OTC legislation. And now we’re seeing companies just basically saying screw it and bringing their products to market even in this limbo period. But I think that there’s just this question mark of as this continues to change, where does the hearing professional fit in to this evolving market?

Dave Kemp:

And I think that a lot of what we’re seeing is probably going to be with the more moderate to severe end, what I think of as the medical side will probably stay somewhat similar. I’m not sure that there’s this what a lot of the change that’s occurring right now is going to impact so much. What I really think is happening is we’re finally seeing this mild to moderate portion of the market, which we know to probably be pretty sizable is really starting to appear to open up in terms of the different offerings and the access to those offerings becoming available. We’re seeing all kinds of new, like I talked about in the previous episode, Sennheiser buying, or I’m sorry, Sonova buying Sennheiser. And that followed on the heels of not long ago, Oticon buying Phillips.

Dave Kemp:

And so you see, okay, so there’s some jockeying happening here and so I think if we look at this new portion of the market that’s opening up, and we we operate off of the basis that okay, historically the hearing aid penetration rates and hearing aids being the quintessential solution for hearing loss, it’s been hovering around 25% historically. These numbers vary based on the source, but if you average it out, it’s probably somewhere in that ballpark. So about a fourth of people that should be treating their hearing loss are, and there’s probably a portion of those that even own hearing aids, how often they’re even wearing them. So, we’ve historically been plagued with this status of there aren’t enough people really treating and combating their hearing loss at scale.

Dave Kemp:

And so, I think that what we’re seeing with all of these moves that are taking place with the sheer proliferation of AirPods and all of these new augmentation features that are being embedded. I just saw yesterday Qualcomm and Jacoti, now that partnership that was announced about six months ago, it’s starting to come into fruition. There’s a new, basically with Qualcomm’s QC5100 chip, which powers a lot of hearable devices is going to have the ability for those OEMs to basically flip a switch to turn on Jacoti’s hearing augmentation. So you’re going to have this basic level hearing augmentation. And so all of these things, if you put all these pieces together, what we’re looking at, it appears to be that we’re about to see a lot of adoption in this mild to moderate market.

Dave Kemp:

And that’s where I want to kick things off with you two is to figure out where does the audiologist, where does the hearing professional fit into this market? And what are the ways that we as an industry can start to wrap our heads around how we should be preparing and positioning ourselves and what are the things that we shouldn’t necessarily be thinking about? What are maybe the red herrings that we shouldn’t be gravitating towards? So, Kim, why don’t I just kick things over to you and get your thoughts on what’s going on and your overall take of where things are headed.

Kim Cavitt:

I think you did a really good job of really outline what’s going on from the hardware and device standpoint and where things are headed. From the provider standpoint, the solution is simple. Practice ideology. I mean, that’s really all you need to do. Your opportunities are in front of you. You just need to practice audiology and decouple your identity and your whole financial structure from the product and focus on what the service is. There’s just so many opportunities out there. If you would just stop caring where the hearing aid came from and start focusing on providing the care that none of these entities will be able to provide at the level that you can provide it. But again, you’ve got to rethink who you are and what’s important to you. And just, again, I tell people constantly that key to the future of audiology is audiology. So, it’s really that simple.

Dave Kemp:

Okay. We’re going to definitely come back to this whole idea of double down on audiology because we’ve talked about this a little bit on the podcast before, but I’m really excited because you just recently wrote a piece that we’re going to go into, that details I think in specifics, what the opportunity looks like. So before I do that, Geoff, I want to kick that same question that I asked Kim over to you. Just broadly speaking, where’s your head at, in terms of where this market is at and you wrote some really good pieces recently on what’s the future of retail audiology? What’s the future of the hearing care professional?

Geoff Cooling:

I think that you’re dead right. There’s an explosion of augmented audio. Okay? I think that that will lead to earlier adoption by people because they are familiar with the idea of augmented audio from their headphones or from their TV or from whatever. I think the future for us lies in a more holistic approach to hearing care. By that I mean offering solutions to consumers that they want, as opposed to that we want them to have. So I think we need to be really cognizant of these new innovations, these new technologies, we need to include them in our offerings. And that will be in different ways than perhaps we’ve ever done before, but we need to include them. And we need to offer this more holistic approach. I think we will be, or we could be, what we are supposed to be, and that is guides in the journey to hearing better.

Geoff Cooling:

And up to now, have we really been guides in the journey to hearing better when our focus is on selling hearing aids? So, I think, to be honest with you, I think it’s a good thing. I think it will change how we practice, what we offer and will move us towards being just that. Guides to hearing better.

Dave Kemp:

Yeah.

Kim Cavitt:

Geoff, I use the term, I don’t want to be the captain of someone’s hearing journey because I think the patient needs to be the captain. I want to be the navigator.

Geoff Cooling:

Yeah, and you know what Kim? That is excellent analogy and that’s exactly the way I’m taking it. The future will be is that we’ll help them navigate the journey, but they will demand and want control of that journey. To now, really what retail audiology has done is told them the journey sucker up.

Kim Cavitt:

Yeah, do it our way or no way. Our way or no way. And I mean, Dave, I don’t want to take over, do you have a question for Geoff? I mean, I would be very comfortable that I would have an… And I don’t need think I need to have clinic time for a DTC solution, but I could have an e-commerce store that I vetted all the products, that I could give you great description as a why and who they’re good for. If I had a patient that was in my office that needed that solution, I would just direct them to my DTC store. And I would keep that very arms length from my clinic operations.

Geoff Cooling:

Yeah, no, agreed whole-heartedly. I think that is exactly what we need to do. We need to adopt these technologies, we need to offer them. And for some people it will make perfect sense. And as you said, and just as I was saying, as a guide and a navigator to better hearing, who better to offer those products and to guide them through those different product offerings. I think that if we don’t, and this is the cake, I think that if we don’t do exactly as Kim has just stated, that we’ll no longer be relevant to consumers in their journey. And the future of technology and innovation that’s happening right now, eventually may preclude us from hearing aid sales. The AI, the artificial intelligence, the leaps forward in artificial intelligence right now is outstanding. Even the machine learning that’s been undertaken by Widex and now by Signia through Widex-

Kim Cavitt:

Whisper?

Geoff Cooling:

Yeah, this and Whisper, it’s endless and it’s really, really, really good stuff. And it’s only going to get better. So if we’re not relevant to a consumer when they’re considering a product or they’ve started on their journey with the problems, with the idea of augmented audio, how are we going to make ourselves relevant later on? It just won’t happen.

Kim Cavitt:

And how are we going to not look self-serving?

Dave Kemp:

Mm-hmm (affirmative).

Geoff Cooling:

Well, I mean, up to now, we’ve looked pretty self-serving.

Kim Cavitt:

Yeah, right.

Dave Kemp:

So, you make a really interesting point here, Kim. Okay, so let’s use this example of these D to C items. Okay so let’s just say you have this $500, call it a Bose device. And that device can be bought at Best Buy, that device can be bought at Bose.com, and that device can be bought on your hearing shop, your little e-commerce attachment to your store. So then that begs the question, why would they go to you over these other things? And this is, I think, actually at the heart of where the opportunity really lies is that you’re the reason that people, whether it be a hearing aid, a DTC product, it’s about you, right? It’s about that navigator aspect of this, where it’s not you come in and you know this is going to be the device for you.

Dave Kemp:

It’s more of let’s really understand your hearing needs. And that might mean you have to really start to convert your services into being much, much more conducive to meeting the consumers where they are rather than just assuming you’ve got to come into my clinic and see me and perform all these tests. You’re just pushing people more toward Best Buy where they don’t have to do that and they’ve done their own research and they’ve determined this is the device for me. Or they even buy it direct from the manufacturer. So again, this is where, in my opinion, you have to figure out how do you really justify why people need to come and see you initially and what does that look like? What does that experience look like?

Dave Kemp:

Because I think, again, it goes back to this notion of yes, the hardware and the solutions are changing, but the delivery model needs to change along with that too. The access to the care and all of the evaluation and your expertise, I think needs to be made more accessible too.

Kim Cavitt:

Great. Yes. So I, again, I’ll just speak. I’ll be the American voice here for two seconds. And we do have some insurance involvement that is getting much, much more prolific than it used to be. That there’s more and more coverage for this. So in the world, you have to be everything that DTC can’t be. So I would have an e-commerce site. I would have a self-assessment on my own website. You can test your hearing and then it could direct you to an e-commerce solution. If your hearing falls below. I like the adage of I would do an online hearing test, a hearing handicap inventory, and something called CEDRA which is a… What does CEDRA stand for? But it is a 10 question assessment of odologic, potentially odologic problems that would require medical intervention.

Kim Cavitt:

If I had a patient that got greater than a moderate hearing handicap on all my self-tools that they could do at home, are greater and/or greater than moderate hearing loss, or failed CEDRA, they need to come in. These are people and I would have my website drive them to the reasons why they need to come in. If they pass all those things, then I would direct them to the links of the products that would be good for them. They don’t have to come in, but if they want to come in, they can. And if they came in, we would do a communication and functional needs assessment that would be beyond the traditional audio metrics that would be speech and noise, and more detailed case histories and inventories. It would maybe include cognitive screening. It might include a native really, or if they had a funky ear and I needed to know how to couple it, it might include a dexterity test to see what they can handle. It might include an auditory processing screening. It’s going to include a lot of patient inventory and a lot of patient interview.

Kim Cavitt:

And then at the end, you create a care plan that may or may not include a traditional hearing aid. It might still include an OTC or DTC solution. It might include implantable devices. It might just include accessories where they just really need TV ears, or they really need some auditory rehabilitation. But that’s what we need to be offering is really evaluating these folks as to what their comprehensive needs are. And I will take this opportunity that if, and any of my students or former students who listen to this now, if you do not have in your care plan some discussion of hearing protection, you are immediately going down 10 points on anything. We have got to do a better job of prevention and protection, and that should be part of every care plan.

Dave Kemp:

I mean, talk about opportunity too. Hearing conservation.

Kim Cavitt:

Talk about opportunity. Hearing conservation. Yes.

Dave Kemp:

I mean, seriously, it seems obvious to me that there’s so many different professions out there that operate heavy machinery, loud machinery, people that are just exposed to high levels of noise for extended periods of time. It doesn’t take long to really think through, okay, where are all the local businesses around me? Is that an opportunity? Should I go and start pitching myself to them and helping them to understand. Musicians are a great example. I would bet that a lot of musicians don’t really even understand that what a musician’s ear plug is, is it’s actually a filter rather than it’s just occluding your hearing and it’s not going to really make the sound of the music any less. It’s just going to turn the volume down. There’s so many things like that it seems like.

Kim Cavitt:

Absolutely.

Dave Kemp:

And so, I guess when I’m thinking through this, because I agree with you, I think, okay, so you have this thing on your website. I tag you two on Twitter with the duet swim pool. Had that chart where he showed here’s the advantage of having an online hearing screener that works when you’re not in your office. And I think that’s another really fascinating aspect to this is these kinds of tools, they enable you to operate in a sense, whether it be just the lead gen, like you said, Kim, where maybe you don’t even fail that and you get directed on something on your website here, you can buy that. So, there’s a little bit of a business opportunity, but for those people that maybe do fail it and that warrants the next step, which is you need to now meet with me. What does this next step look like?

Dave Kemp:

Because I’ve been wondering this. Okay, so we know now a little bit more about this patient. And again, this is a lot of people that are being captured online so I know that there might be licensure laws, because if they’re out of state or whatever that might be, so again, this is a little American-centric here, Geoff, but I’m curious the way in which… In the absence, I guess, of because it’s obvious if they need to just come and see me in clinic, but again, let’s think a little bit outside of the box here and think of what about those people that maybe aren’t in the capacity to come and see you? Is there a way that you can facilitate, again, in this something that highly differentiates you in an online setting of, again, that next step?

Geoff Cooling:

I mean, yeah. I mean Hearx [inaudible 00:20:35, basically to have a clinic in a box, right? You send around to them, it’s on a tablet, it’s a clinically-graded test. There’s a video odoscope in the box, they shove it in their ear, so you can see the ears, et cetera, et cetera, et cetera. I mean, they don’t have to come in to you anymore. And I mean, so a lot of the argument, and there is some substance in the art, a lot of the argument is, well simple AC air conduction, pure tone audiometry doesn’t really tell us enough for medical purposes or for the filling of the hearing aids. Because if there’s a conductive element there and you just put in AC results, you’re not getting the right output.

Geoff Cooling:

But the thing is, is that the people who wander through your door have just simple sensory neural hearing loss. And we started to move forward with things to address the possibility where there’s medical issues, like as Kim said, the CEDRA, [inaudible 00:21:56], as I said, a very easy to use deal. They show it in their own ear, and it clearly shows if there’s wax or if there’s a problem on the eardrum or if there’s perhaps fluid in the middle ear and et cetera, et cetera. I think though, although it may well come in the future where boy, you can either do an online test or some sort of remote set of tests like that, that will actually give full clinically-validated results that are safe or that we feel really comfortable with in relation to medical referrals and stuff. I think they’re coming.

Geoff Cooling:

There’s a difference in the growth of loudness between people who have conductive elements and people who don’t. Surely there’s smarter people out there than me considering how they can use that to offer an online test that will flag up some sort of conductive issue.

Kim Cavitt:

Geoff, you’ve been an audiologist a long time. You know good and well that if you see an audiogram that has poor hearing in the lows, or is some flat moderate, that it’s probably conductive or has some semblance of a conductive component.

Geoff Cooling:

Conductive elements. Yeah, yeah, yeah.

Kim Cavitt:

I mean, you don’t need bone, you don’t need… I mean, looking in the ear is the one thing that’s the hardest thing for me to let go of, but I’ve let go of it. We know that it’s either wax or it’s some semblance of some degree of a conductive component. So, to get all caught up in, not you, but for our colleagues who just get all caught up in, “Oh, this is so bad and so dangerous,” I’m just sorry. I think it’s more dangerous to not treat hearing loss.

Dave Kemp:

I mean, seriously, especially with all of the research that’s coming out with, and again, I always have to preface this, I know that causation does not equal correlation, but I’m just saying there seems to be a lot of links to a lot of very detrimental health risks around your brain if you live with hearing loss for an extended period of time. Especially knowing that it tends to be progressive hearing loss. It gets worse.

Kim Cavitt:

And I want to add in about Duett and the folks at hearX. This is science researched-based products and software and tests. These are not fly-by-night people. These are academics who have created a product based upon their research.

Geoff Cooling:

Yeah, their stuff is outstanding. I’ve always-

Kim Cavitt:

Outstanding. Yes.

Geoff Cooling:

I’ve always thought their stuff was outstanding. From the first time I got a hold of their original [VO 00:24:47] and then started to play a little bit with their online testing process and stuff like that. Like I say, the stuff is outstanding. And it’s not, as you said, some fly-by-night rubbish. And, as I said, 90% of people have just simple sensory neural hearing loss, full stop. So, the argument that oh well, online tasks can miss some of the medical problems. Yeah, it can. But to be honest, 90% of the time, that won’t fucking matter because there won’t be any medical problems. So where do you go from that? And I think that’s really what I’ve seen consistently in all the years I’ve been involved with this business, this obstinate refusal to adopt or move forward.

Kim Cavitt:

We’re doctors, Geoff. We’re doctors.

Geoff Cooling:

I mean, the only reason we can even talk about remote care is because of the fucking zombie epidemic. If the zombie epidemic hadn’t happened, nobody would be adopting remote care. It could still be 20% of clinics adopting remote care. And consumers want that. Consumers are busy, they don’t take loosely. They don’t want to be driving to your practice, waiting in your waiting room, coming into your clinic. Okay, some of them do, some of them actually enjoy it and that’s part of the reason why we are in the care and service industry. But many of them don’t and they would rather you use the tills that are available for you to do remote stuff with them.

Dave Kemp:

Yeah. You touched on something there that I wanted to mention. So, Kim, I heard you on a podcast. It’s Life Aloud, it’s Jason Wiggins’ podcast. This is an awesome podcast, by the way. So shout out, check this podcast out. But, I was doing a little research. I was like, okay, searching for, I do this, I look at my guests to see are you on any recent podcasts so I can just gather some more information. And you said something fascinating on that podcast. You said, “That it takes, start to finish, seven and a half hours to get a hearing aid on average.” In terms of you start by setting that first appointment and it takes that much time to walk out with something. And again, these are the opportunities, in my opinion. Is can you cut that down? Can you make that more efficient?

Kim Cavitt:

You could cut that down a lot if you would do a lot more remote evaluation or remote follow-up, especially. That’s the low-hanging fruit. But think about it. Most of us are going to make sure that we get there between zero to 15 minutes before our appointment. So in order to do that, in almost any place in the United States, no matter where it is, unless it’s next door to you, you’re going to need to leave 30 minutes beforehand in order to get there. So you’re going to have to drive or walk to get to where, or take the train or whatever it is to get to where you’re going. You get there early. So we’re now 45 minutes that we’ve sucked up and we haven’t seen anybody. And then we see someone, takes 30 minutes to an hour, and then you got to go back the other direction. That’s still attached to that visit. The time to go home or go back to work because it’s time that you can’t do anything else. You can’t.

Kim Cavitt:

You’re going to have to take time off work. Think about if you’re an hourly employee. You’re literally missing getting paid, or you have PTO. You’re taking away from vacation time. And you’ve got to do that typically three to four times before acceptance. You might be able to be fit if they have stock, you might be able to be fit that day of that evaluation. But typically, especially if insurance is involved because you’re going to have to have an invoice with the patient’s name on it, you’re going to have to come back and again, you’re going to have another hour to two hours in that visit as well. And then follow ups. Almost everyone that I talked to wants two followups or is requiring two followups in that evaluation and adjustment period.

Kim Cavitt:

I did the math and it got to like seven and a half hours. Who wants to do that? I don’t want to do that. I would never do that.

Dave Kemp:

And let me ask you. So, with those followups, what exactly is going on? Is there any reason you need to be in clinic for that? Are you doing any types of tests or anything like that? This is my own naivety. I’m just curious.

Kim Cavitt:

Can I be honest? If it was me, it depends on the situation and Geoff, please just step in. Sometimes you are literally doing nothing because the patient’s completely happy. I could have found that out, have myself or my staff person either do a telehealth visit, text them, email them, or call them and find out if they needed to come back. I didn’t necessarily have to schedule them to come back. But people, if you tell them they need to come for follow up, they’re going to come for follow up. And do some people need to come back? Yes. Does everyone need to come back? No. But we make everyone come back. It’s one size fits all.

Dave Kemp:

Yeah.

Kim Cavitt:

And it’s our protocol. It’s our standard of care. We see them all the time so this is why we’re better. That’s just bullshit. You see them all the time because you feel like, I’ve had more than one person tell me this, that if they’re not with you, they’re unhappy or they’re with someone else. Who cares? Are they happy? Why don’t I just send them a hearing handicap inventory or an [AFAB 00:30:59], or a COSI that they did before and see if things are better? Why don’t I ask them in a survey? Why don’t I give them three questions, a smiley face and a tax? There’s all sorts of ways that I can ask them if things are okay and not have to see them. And if things are okay, they don’t need to come in.

Geoff Cooling:

You know, appointments for fucking no reason are appoints for fucking no reason.

Kim Cavitt:

For no reason.

Geoff Cooling:

And as Kim said, well, yeah, you have to treat every patient differently because every patient is different. They all have different wants, they all have different needs, they all have different acoustical needs and you have to treat them like that. So it’s arbitrary, but what’s happened is that nobody has unbundled. So everybody feels they have to justify the price that they are charged. And how they justify the price that they are charging is based on face time. That’s what it’s based on. In person face time. And some people, you know what? Some people need that in person face time. They really badly need it. But for a lot of people like say Steve Claridge, my business partner and the other editor and author of Hearing Aid Now. Steve Claridge has been wearing hearing aids since he was 13 years of age. He knows more about fucking hearing aids than some audiologists I know.

Geoff Cooling:

He doesn’t need five follow up visits. Steve needs you to fit his hearing aids well, get them to target, gave him an app where he has complete control over the acoustic output, and he’ll be ecstatic, and he’ll turn up every now and again when the receiver fails. So if I’m dealing with Steve, what’s my justification for charging the same price for Steve’s hearing aids that I’m charging Doris, who’s in with me every three or four weeks because she forgets how to change the wax cards or she wants to chat. Do you know what I mean? That’s one of the things that I think this industry has struggled with for so long. And the answer has always been bundled prices, bundled prices.

Geoff Cooling:

I think that the future is not going to be gentle to that business model. Up to now, the technology and innovation that’s happened within hearing aids has actually conspired to keep the business model as-is to protect it. And I said that in my article, I don’t mean that there’s been a great conspiracy, there hasn’t. What’s happened is the direction of innovation and technology has just really ensured that hearing aids stay within the current model. Listen, that’s changing. That is really changing. The innovation and the technology outside of the hearing aid world. What’s happening there and combined with some of the innovation and technology changes that are happening within the hearing aid world are shaking up and loosening the protection of the existing business model.

Geoff Cooling:

If I can have a set of hearing aids fitted to me and then use the AI on my hearing aid app, to fine tune them moving forward, in the moment, why do we need to go and see you? Why do we need to go and see you? And I think that that’s… I said that to somebody and they’re like, “I had somebody in and I had to do her fitness and I just had to fit them. No supercomputer is going to do that.” And I was like, “Yeah, right.” And I had nothing else to do.

Kim Cavitt:

And so Geoff, this is that exact story about Steve is why I became passionate about unbundling in the 1990s. And why I’ve been on this unbundling bandwagon in the United States now, it’s almost been 15 years. But, again, people just, “It’s going to cost me. I’m going to lose money.” It’s not about the pay. It’s always, “I’m going to lose money,” or, “It’s not good for the patient.” Always my answer is, I put my academic hat on, “Can you please show me the evidence of that? Do you have evidence to support that statement?” Because the bottom line is we don’t have evidence to support a lot of stuff that comes out of people’s mouth. That we’re better. Show me. Show me where our outcomes are better. Show me. And I’ll support you if you can show me, but you can’t.

Kim Cavitt:

And I’ll be the elephant in the room. There is a force that is, in this industry that is socialized and conditioned almost like a cult leaders do to believe that unbundling is bad and change is bad and all these new entrants are junk and you are better. You’re so special. Patients have to have you and blah, blah, blah, blah, blah. And they believe it. Everybody believes it. And they believe that over data, they believe that over the writing on the wall in terms of what the consumer electronics industry, and then they ignore the stuff that the industry is doing internally. They ignore what they’re doing because they’re protecting us. That’s just bullshit.

Geoff Cooling:

You’re dead right. This idea that change isn’t going to happen or we’re too special for change to affect us, it’s just rubbish. I was talking about Lexie hearing. And, now listen, Lexie hearing, they’re into con-aids. I mean, there’s nothing special though. There isn’t. They’re okay, basic, decent hearing aids. I tell you what’s special about Lexie hearing. Lexie hearing is just a platform. The consumer journey, the onboarding, and the customer service that they offer is fucking outstanding. Now, Lexie are really, really intelligent for what they’ve done. They’re doing this and that’s what they focused on. And the hearing aid product is just a hearing aid product. Lexie could decide tomorrow to sell Phonak hearing aids or reselling hearing aids or [crosstalk 00:38:40].

Dave Kemp:

Right. The hardware isn’t really what makes it important.

Geoff Cooling:

Exactly. And actually, what they focused on, the consumer journey, the benefit to the consumer, the onboarding, are the things that are the biggest threat to us in retail audiology.

Dave Kemp:

Well, let me actually play a little bit of devil’s advocate here because I actually think that so the gamification element of Lexie is one of the most interesting innovations I think to have transpired here recently. This idea that you actually get rewarded for wearing your hearing aids. And it’s a little shop and you get little things and little perks, but I think that it actually is onto something much, much bigger, which is, and this is what I wanted to ask you two, is like okay, so hearing aids are these in-the-ear devices, all of them. They’re so interesting from a telehealth standpoint because they’re little computers, so they can get a lot of data. And so when we talk about this vision of what the future might look like, where you’re more of this navigator, you’re more of consulting them and guiding them through their hearing loss journey.

Dave Kemp:

What’s fascinating to me about something like Lexie, and I know Starkey has a little bit of this too, with their Livio platform, but this idea that as the provider, you would actually have insight into their usage data that you can then use, like Kim, you’ve been talking about the inventories, the questionnaires, the surveys, you can augment that even further I think to really get an understanding of like okay here’s where I struggle. And you can see the log of the data to see, “Okay, at 3 PM when he said that he was in this restaurant, this is what it looked like.” And so it’s arming you, I think, with a whole lot more information. That, again, it positions you as, “I can make sense of this for you.”

Dave Kemp:

The consumer is largely not going to probably be the one that’s going to be making sense of it. It’s either going to be the system itself, but more likely, I think that it’s this idea of almost being a data coach where you’re really using that to understand here’s actually what I’m seeing from a performance standpoint. And that might be the big opportunity is, again, in this model, if it’s very much online and another thing that we didn’t really even mention with how many time savings there can be for the patient, there’s a lot of time savings for the clinician too so you can see so many more people.

Dave Kemp:

So what is this all building toward? Well, maybe this model in the future looks a lot more like I sell this device to you at cost. Maybe there’s a little bit of a markup, but I’m going to sell you the device and then where I get compensated is for the navigation piece. This idea of two weeks from now, we’ll meet and we’ll discuss what that first two weeks has been like. And I know that this is already sort of what a lot of people do, but I’m saying apply it in this more online-oriented world that allows for so many efficiencies from a time standpoint.

Kim Cavitt:

So Dave, I have a client in the U.S. that actually does dispense their hearing aids at cost. And the patient actually walks away with the invoice.

Dave Kemp:

Interesting.

Kim Cavitt:

For everything, for repairs, for ear molds, and then it is 100% service-driven pricing.

Dave Kemp:

Full transparency.

Kim Cavitt:

Full transparency. It was very, very important to them that when we created their pricing, that we created a pricing model that was fully transparent. This was something that they very, very… It was philosophical. Something that was very important to them. And so imagine a world where you, I’m a big fan of the patient interview and really asking them a lot of questions and listening. I ask questions and I listen back. And then imagine if you can-

Geoff Cooling:

You mean you listen?

Kim Cavitt:

Yes, if you can add data to that. Like, you’re telling me in your average day, you’re struggling in this meeting and now you have data that goes with it. Oh, maybe we need a table mic. Maybe we need a Roger. Maybe I need to come to your meeting and experience it myself. I used to do that all the time in my implant world when I saw patients. I would go with my implant patients and they paid me for my time for situations that were difficult, so that I could just sit and take notes and go, “Okay, this is how you need to approach this moving forward.” And create an auditory rehabilitation plan for these folks that’s not about the widget. It’s about what do you need to support your brain and your peripheral hearing and your widget in order to maximize your communication. And there’s a lot around that that’s not about the hearing aid. Again, I work at Northwestern. Audiology was founded at Northwestern post-World War 2, as an auditory rehabilitation of hearing loss.

Kim Cavitt:

It was rehabilitation of hearing loss. That’s what audiology is about really. And we’ve lost sight of that. We’ve completely lost sight of this is who we really are, are rehabilitationists and not salespeople.

Geoff Cooling:

What you were just talking about there, and Dave, sorry, going back to what you were saying like, “Oh, sell the device and actually two weeks later come back.” Unitron built a whole ecosystem around that concept.

Kim Cavitt:

Flex, right?

Geoff Cooling:

Yeah. Using the flex trial, using the app with the instant feedback, using all of those things, and nobody used them. In fairness, a lot of the time it pushed people towards top-of-the-range hearing aids. No surprise, right?

Kim Cavitt:

I love his laugh so much.

Dave Kemp:

I know. His laugh is amazing.

Geoff Cooling:

It delivered really good data, and it delivered data that you could, as a clinician, begin to make some decisions upon and begin to make some outlines on. I mean, that’s what we’re supposed to do. When we were talking earlier before the podcast started, I had a patient just yesterday and I did a quick [inaudible 00:45:11] and the scars were dreadful. And that framed how I was going to talk about a solution for this person and with the problem earlier is that we had discussed in depth what I advised was a Roger Select iN and a set of [inaudible 00:45:29] hearing aids because that’s what she really needed. Her speech discrim was pretty bad. Her speech discrim in quiet was pretty bad let alone in noise. And I had to tell this lady it doesn’t matter how much you spend on hearing aids, they aren’t really going to do the job. They will help, but they aren’t going to deliver anywhere what you would like.

Geoff Cooling:

However, if you couple a Roger Select with them in those particular areas, family areas that you were really concerned about, it will help. It will help. And that’s a hard conversation to have. But if we don’t have the data, if I didn’t have the data to have that conversation, if I didn’t understand her needs, if I didn’t understand her abilities, well then, you’re not having the right conversation. You’re not giving them the right recommendation, and that’s what we’re fucking supposed to do.

Kim Cavitt:

Yes. Amen. That’s what makes audiologists audiologists. It’s not, “Can I shove a widget on your ear?”

Geoff Cooling:

Yeah. I mean, people are so protective about audiologists and some are rightly because they offer a service and they offer a really, really good service. They deal with those in-depth tests that give them an understanding. They listen to the patient and then they talk about solutions. But the solution just doesn’t include the hearing aid. And sometimes, a solution won’t include a hearing aid. And I think that’s what we need to get our heads around. And I think the reason why most people are afraid of that and they’re afraid of offering this holistic hearing approach is because how am I going to make it pay?

Dave Kemp:

Right. That’s the crux of it all.

Geoff Cooling:

Yeah and I find that really irritating. “I am a successful doctor and how am I going to make it pay?” Work it fucking out. It’s just your fucking job. Work it fucking out. Do you know what I mean? You say, “You’re supposed to be a businessman or woman.” Work it out. I don’t know and that’s where I take my hat off to Kim. Kim has laid it out. Recent article laid it out. This is how you can make money. And thank you Kim for that. But why should she have to? People should be smart enough to work it out themselves. So, that’s my rant for today.

Dave Kemp:

I love your rants. No, I think that what it boils down to is that you can’t… I think this is one of the biggest struggles that this industry sort of grapples with is you don’t want to be perceived as a salesman. However, your entire business model is dependent on the sale of hearing aids. For by and large. I mean, some hearing professionals are in certain settings where it’s not as much of a success factor, I guess. But by and large, I think that it’s always been this way where it’s like, “This is how you generate revenue.” And this is always what existed. And this is what people know.

Kim Cavitt:

But David, it always hasn’t been this way. I mean, prior to 1978, audiologists in the U.S. made their money off of care. That’s how it worked. And there are many successful audiology practices in this country that do not, do not, provide hearing aids. I mean, I always go to Dr. Ferry, Jan Ferry here in Chicago. Jan specializes in auditory processing. She doesn’t even see adults. She doesn’t take any insurance. And she probably has a waiting list of seven weeks, and doesn’t dispense hearing aids. I have a client in California, vestibular clinic, they do not dispense hearing aids. Tinnitus clinics do, but that’s not… I know many tinnitus clinics that dispense hearing aids, but only to their tinnitus patients.

Dave Kemp:

Yeah, no, I agree with you. I think that there’s… If we can figure this out by and large as an industry, that’s awesome. If we really do have it be something that’s much more tied to your expertise and your service, like most medical professionals, then I think that this industry is going to be in a great position, because, again, it goes back to the beginning of the conversation.

Kim Cavitt:

So much opportunity.

Dave Kemp:

If you operate off the assumption that this is a big time growing pie, and so you don’t need to necessarily fixate on this idea that like, “Well now suddenly my existing patients are going to go and they’re going to buy these OTC self-assessment things.” Some might, but the fact of the matter is that there’s going to be a whole lot more people that are at least the barriers of entry are getting reduced to rubble in many regards. And so I think that if you operate off this mindset of this is a growing pie, growing industry, lots more people potentially that want to access my services. Again, this goes back to the beginning of how do you make these services A, more accessible and then how do you pivot to a way in which you’re compensating for the depreciating revenue from the hearing aid sales to this new, more service-oriented model?

Dave Kemp:

And it does, it goes back to probably having to unbundle, having to really start to itemize, like here’s what my billable hour is, and here’s how much these things cost, and being able to justify it through, again, I’m not here to sell you a device, I’m here to help navigate you through this traumatic period of your life and to give you a semblance of everything that you’re losing from your debilitating hearing loss for some, and helping them to navigate this as best as they possibly can. That seems to be the obvious answer and there’s facets of it.

Kim Cavitt:

So Dave, I have a business plan that I still may execute when I decide that I-

Dave Kemp:

Do it.

Kim Cavitt:

And the business plan is that I wouldn’t dispense any hearing aids. And so I would do communication needs assessments, and I would have an e-commerce store. And if I got to the point I wouldn’t have immittance either if I got to the point that I needed immittance, I need a referral. I wouldn’t do medical, I would just do communication needs assessments of children and adults. And then I would have an e-commerce store for the folks that wanted to get amplification direct to themselves. I would have the hearing test online, I would have CEDRA, I would have an inventory. I would build a back-end to that e-commerce store. I’d have it fulfilled by someone other than me. And I would just do communication needs assessments when I felt like it so that I can partially retire and I can work when I feel like it.

Kim Cavitt:

If you cashflow it, let’s say I did four of them a day, five days a week. And I would do them any time of day. I would be more of a concierge, open business. And what that means is if you want me to see you at eight o’clock at night, I’ll see you at eight o’clock at night. I don’t care. But let’s say I do four a day, five days a week. And it wouldn’t have to be Monday through Friday, it could be Saturday or Sunday, whatever. Let’s say, that’s how many I do. Four a day, 20 a week at $250. That’s $5,000 a week. And I didn’t sell anything. Didn’t sell anything. And let’s say I did that 40 weeks a year. That’s $200,000, and my overhead was probably minimal.

Dave Kemp:

Yeah. Right. It’s so feasible it seems like. I mean, and again, it goes back to this notion of if you’re really willing to take it upon yourself to do these things, whether it be I need to redesign my website, I need to include a hearing screen or embed that on there, I need to add an e-commerce store like you said, I need to make it so that I can facilitate these… It’s not as if your patients are unaccustomed to Zoom calls. As Geoff mentioned, the pandemic ushered in a lot of new norms. And so your patient is probably going to be very comfortable with an online consultation like this. Even if it’s a step one, it just seems like, again, that seven and a half hour time to get a hearing aid is okay, if you can cut that in half, there are so many implications of that.

Kim Cavitt:

And I can make money while I’m sleeping.

Dave Kemp:

Exactly.

Geoff Cooling:

The way I would pitch it to the profession is so a good established scientifically-based online screener is a triage. It actually saves them time and money because it makes sure that chair time is protected. And by that I mean, every time somebody sits in your chair, as a business, you really need to be making revenue. That type of triage system makes sense. Do you know what I mean? It makes sense for everybody. It makes sense for the consumer, it makes sense financially for the business.

Dave Kemp:

Yeah, no, I totally agree with you, Geoff. Kim, Geoff, I think that this has just been a wonderful conversation. Lots to unpack, lots to think about. But I think that the moral of this conversation is that there are a lot of opportunities. And I think that there’s a really optimistic way to look at things. Again, off this idea that this is a growing pie. So I’m sure this won’t be the last time we chat, but until next time, thanks for everybody who tuned in here to the end, and we will chat with you next time. Cheers.

Dave Kemp:

Thanks for tuning in today. I hope you enjoyed this episode of Future Ear Radio. For more content like this, just head over to FutureEar.co, where you can read all the articles that I’ve been writing these past few years on the worlds of voice technology and hearables and how the two are beginning to intersect. Thanks for tuning in, and I’ll chat with you next time.

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