Do patients value rehabilitative care beyond the hearing aid?
Dr. Brian Taylor talks with Anna Jilla, AuD, PhD, about what new research reveals about willingness to pay and the value patients place on professional hearing care.
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Why do so many adults with hearing loss postpone or avoid seeking help? Why do some clinicians continue to express a reluctance to charge for professional services? How much should I charge for services? These are age-old questions in our profession as clinicians look for effective ways to price and communicate the value of their expertise.
To explore the health economics behind this, I sat down with Dr. Anna Jilla, a clinician-researcher at the University of Louisiana-Lafayette. We discuss her recent AJA study, the first US-based benefit-cost analysis of hearing aids in two decades, and what it reveals about the important distinction between affordability and “willingness to pay.” Dr. Jilla also explains what the findings may mean for clinicians pricing standalone aural rehabilitation and other professional services.
This conversation is essential for any clinician navigating the complexities of modern, unbundled audiology practice. You might even be surprised to learn what the typical patient is willing to pay for standalone aural rehab services.
BT: Tell us about your background and research interests.
AJ: Thanks for the invitation, Brian. I am a clinician-researcher at the University of Louisiana-Lafayette, whose research interests sit at the intersection of auditory rehabilitation and public health. My passion for rehabilitation started very early in my career, with lofty goals of trying to address the billion-dollar question of ‘why do most adults with hearing loss either postpone or avoid engaging with rehabilitation or hearing aids?’
My line of research has tried to address this from various health economic perspectives. We know that affordability and willingness to pay are two distinct concepts as they relate to the uptake of rehabilitative services and hearing aids. For instance, many people may have financial resources to afford care but choose not to engage with hearing healthcare. Why? Willingness to pay. Just because someone has the money doesn’t automatically mean they are willing to pull out their wallets. Our most recent research has tried to address this question: ‘What is the perceived value of care?’
BT: Let's focus on that question of willingness to pay. I know your 2024 AJA article on the benefit-cost analysis of hearing aids and related services addressed the topic. What were the main questions you were trying to better understand?
AJ: Funny enough, our study was the first US-based benefit-cost analysis of hearing aids in over 20 years. Our recent AJA article sought to first determine the willingness to pay for prescription hearing aids, over-the-counter devices, and rehabilitative services, and then conduct health economic analyses to assess benefits in relation to costs. Most research has not assessed benefits for devices and associated services separately. We felt this distinction in measurement was important because, as a clinician, I always feared that patients would balk at paying for services separate from devices.
We then utilized the willingness-to-pay values as the ‘benefit’ input in our second aim of determining how benefits compared to direct costs of care. Briefly, benefit-cost analyses pit clinical benefits, measured in dollar amounts, against costs in dollars. This is why we chose benefit-cost analyses as part of our methodology: all outcomes are expressed in dollars. This is more easily discussed with decision makers who are not familiar with hearing healthcare. But, everyone understands the value of a dollar.
BT: Take us through some of the details. How did you conduct the study?
AJ: We conducted the study at two private clinics in California and Oklahoma among a sample of eligible adults who had purchased hearing aids within six weeks to five years. We provided an open-ended willingness-to-pay question where participants responded to the following prompt: “I would be willing to pay $____ for one new advanced digital hearing aid, but I would not be willing to pay more than this amount.” The rationale for assessing willingness to pay for one hearing aid instead of two is due to the economic rules of these analyses, which require that assessment be made for the smallest meaningful unit of the item or service, which, for us, is one hearing aid.
We also included a survey tool with three questions that solicited willingness to pay in a multiple-choice format. Each willingness-to-pay question was accompanied by a brief description of the intervention in question, including advanced digital technology prescription hearing aids, over-the-counter devices, and associated rehabilitative services. We then gleaned direct costs for prescription hearing aids from retrospective chart review. This gave us the ‘benefit’ input via willingness to pay and the ‘cost’ input for the prescription hearing aids.
For over-the-counter devices and rehabilitative services, we utilized a range of values to perform sensitivity analyses in determining what level of costs would exceed the expressed benefit. You can think of this as a ‘favorable’ cost, where that cost would still be below the benefit. The cost and benefit inputs were used to establish benefit-cost ratios, which are helpful to determine if benefits exceed costs on average at the individual level.
BT: What did you find?
AJ: The median willingness-to-pay values solicited from our sample were $2,000 for one hearing aid, $250 for associated services, and $0 for one over-the-counter device. The benefit-cost ratio of one hearing aid was 2.37 when utilizing actual cost values and assigning a $1 cost to those who had no out-of-pocket expense. We had to reassign this $1 cost because the ratio calculation with $0 in the denominator causes the outcome to be undefined.
BT: What does a 2.37 benefit-cost ratio mean in practical terms?
AJ: A benefit-cost ratio of 2.37 is very favorable and stands far above the decision rule of >1.0, where interventions are considered ‘worthwhile,’ indicating that benefits significantly exceed costs. Because the over-the-counter devices and rehabilitative services utilized exploratory cost inputs, we identified a range of costs that would still produce favorable benefit-cost ratios. For over-the-counter devices, we found that a cost of ≤ $50 per over-the-counter device would result in a favorable benefit-to-cost outcome. For rehabilitative services, we found that a cost of $100 would result in average individual benefit-cost ratios of >1.0.
For over-the-counter devices, low ratings of willingness to pay were consistent with the market uncertainty at the time, and among our group of current hearing aid users, many did not value the over-the-counter option. Yet, this has proven to be consistent with the most recent MarkeTrak survey, where Lindsey Jorgensen and I found that current prescription hearing aid users rarely intend to move to over-the-counter devices after having prescription ones. Additionally, we were pleased to find that consumers expressed such a clear perceived value of rehabilitative services.
BT: Regarding the value of standalone rehab services, what are the main takeaways for clinicians from this study?
AJ: This was perhaps the most exciting and relevant finding of the study. We have debated for many years whether patients would be willing to pay for services separate from devices in either itemized or unbundled billing models.
Our findings indicated that associated rehabilitative services have an inherent value to consumers, and they would be willing to pay a median of $250 for them. While that value is below what would be financially sustainable for clinics1, it accounts for best practices in hearing-aid-related services (e.g., needs assessment, selection, verification, orientation, communication training, and maintenance). It did not account for auditory training or other more intensive informational or personal adjustment counseling.
As a clinician, it is thrilling to see that our patients perceive the value in our professional services. Further, we now know that patients and consumers are willing to pay for those services separately from a device.
BT: Since this study was published, can you share any other insights you may have learned on this topic that clinicians might find helpful?
AJ: Since this study was published in December 2024, a modernized hearing aid services code set has been released for billing and coding purposes. (You can find details about these new codes by visiting your preferred professional organization’s website.)
For clinicians or administrators considering unbundling their billing, our research can inform those practices. Additionally, the most recent MarkeTrak survey found that many current over-the-counter hearing aid users expressed intent to obtain prescription hearing aids for their next set of devices. This is consistent with our findings and further demonstrates the value of prescription devices and the professional service components that accompany them.
BT: Anna, thanks for taking the time to sit down with me.
AJ: My pleasure.
1Editor’s note: Before Lace, revenue from aural rehabilitation in-person was not sustainable. Today, because Lace is patient-led and takes minimal time in the clinic, it is a revenue-generator above and beyond hearing aids.