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

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

Agenda

Image: http://www.propwise.sg/are-you-being-penny-wise-pound-foolish/

Mommy, Wife, Daughter, Sister, Friend

Consumer

Audiologist Professor Clinical Coordinator

Advocate

And one more…Bargain hunter!

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-of-

hearing population.”

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 History of Our Profession

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

10 Only 2% of our population use hearing aids

Economics of volume purchases

Veteran’s Administration

BIG BOX STORES

Sole Provider

Hearing aids do not magically just work

5/29/2012 12

Hearing Aids Professional Services

Maximum Communication

Improvement

• 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

Hearing well in a noisy world, Consumer Reports (2009)

Find a licensed and certified audiologist that offers the above AND an unbundled pricing option.

Hearing Aid

Fitting Fee

2 Years of

Service

Combining products & services into one lump sum.

Hearing Aid

$

PATIENT’S BILL

Bundled Billing

Real-Ear Measures

Pre-Fitting D-Mic Test

Pre-Fitting EAA

$

PATIENT’S BILL

24 mo: Annual Check

20 mo: Repair (Moisture)

17 mo: Tubing Change

15 mo: Repair (wax)

12 mo: Annual Check

6 mo: Tubing Change

6 wk: Follow-up

4 wk: Follow-up

2 wk: Follow-up

Combining products & services into one lump sum.

Bundled Billing

Breaking up prices completely.

Hearing Aid

Fitting Fee

2-Years Service

Hearing Aid

Unbundled Billing

Pre-Fitting D-Mic Test

Pre-Fitting EAA

Real-Ear Measures

$

PATIENT’S BILL

$

$ $

Real Ear Measurements

Pre-Fitting D-Mic Test

Hearing Aid

Hearing Aid

Breaking up prices completely.

Unbundled Billing

PATIENT’S BILL

24 mo: Annual Check

20 mo: Repair (Moisture)

17 mo: Tubing Change

15 mo: Repair (wax)

12 mo: Annual Check

6 mo: Tubing Change

6 wk: Follow-up

4 wk: Follow-up

2 wk: Follow-up

$ $

$ $

Completely Unbundled Billing

•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

Advantages:

•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

Disadvantages:

A survey in 2006 reported that 87% of hearing aid dispensers are bundling.

(Hearing Journal, 2006)

Does your clinic bundle services into the price of hearing aids?

AAA Hearing Aid Billing Practices Survey

Yes

80%

No 20%

2011

No 33% 

Yes 67% 

2012 

Yes 77% 

No 16% 

State Laws require that all fees 

incurred with the provision of a hearing aid be 

returned  7% 

Does your clinic retain a non-refundable professional fee if the hearing aid(s) are returned for credit?

2012 AAA Hearing Aid Billing Practices Survey

Yes 76%

No 18%

State Law requires that all fees be

returned to the

patient. 6%

2011

Is the non-refundable fitting and professional fee…

1.8% 

72.6% 

1.6% 

11.4% 6.5%  6.1% 

Contingent on theservices provided

A flat rate regardlessof hearing aid

technology/style/price

A flat rate based onthe level of technology

A percentage of thetotal cost of thehearing aid

Cannot charge a fee asthis  would violate

state law(s)

Other

2012 AAA Hearing Aid Billing Practices Survey

DENTISTS OPTOMETRISTS

HAIR STYLISTS

PLUMBERS ETC…

Professional Services are valuable

UNC- Hearing & Communication Center

Dr. B, a retired dentist from the UNC School of Dentistry

He wanted to pay for services after a one hour visit •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, in-house repairs,

etc.

11 years ago – an inspiring conversation

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.)

2005 A new beginning at UNC-HCC

2-Years Service

Professional Fee + 45 Days of Follow-Up

Breaking up prices completely, after the TRIAL period.

Hearing Aid

Hearing Aid

PATIENT’S BILL

Our [Partially] Unbundled Billing

Pre-Fitting EAA Checks

Pre-Fitting D-Mic Test

Real-Ear Measures

$ $

$

Breaking up prices completely, after the EVALUATION AND ADJUSTMENT period.

$1000 Fitting

Fee

$3000 2-Years Service

Professional Fee + 45 Days of Follow-Up

Hearing Aid

Hearing Aid

PATIENT’S BILL

24 mo: Annual Check

20 mo: Repair (moisture)

17 mo: Tubing Change

15 mo: Repair (wax)

12 mo: Annual Check

6 mo: Tubing Change

6 wk: Follow-up

4 wk: Follow-up

2 wk: Follow-up

Breaking up prices completely, after the initial evaluation and adjustment period.

Our [Partially] Unbundled Billing

$ $

$

Sample Impact on HA Prices: 2004

BUNDLED 2005

UNBUNDLED 2 Hearing Aids (premium tier,

digital)

$5000 $X,XXX per device

Non-refundable professional fee

$200 total $XXX per ear

Service period included,

following fitting

Duration of manufacturer

warranty

60 days

TOTAL INVESTMENT

$5200 Lower upfront cost

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.

Enlightening patients …who purchased their hearing aids on or after July 1, 2005 or had 

never seen the unbundled model before. 

Image from: http://thefamouslastword.blogspot.com/2012/01/google-thinks-im-old-man.html

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.

Reassuring patients …who purchased their hearing aids prior to July 1, 2005. 

(And heard that their friends bought hearing aids yesterday, for less $.) 

Image from: http://interestingni.blogspot.com/2011/01/navy-shocked-by-shipboard-profanity.html

5/29/2012

36

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.

UNC-HCC Treatment Plan

Current Trends and Recommended Procedures

What exactly is best practice in the hearing aid world?

Current Trends:

5/29/2012 38

An Evidence-based Model

Hearing Evaluation

Functional Communication

Assessment Hearing

Aid Fitting Hearing

Aid Follow-up

Individualized and Group

Aural Rehab

5/29/2012 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)

5/29/2012 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

5/29/2012 44 (R. Sweetow, “Instead of a hearing aid evaluation, let’s assess functional communication ability”. Hearing Journal, 2007.)

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

Hearing Aid Selection Process

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 

     

Audiology Clinic

Ebay

Wholesale Store

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

• Recommend: 2 week and 4 week (six week as needed)

5/29/2012 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

5/29/2012 48

88%

12% Passed inspection/EAA

Failed inspection/EAA

Manufacturer A

Manufacturer B

Manufacturer C

7.60%

20%

25%

New Orders Failing QA Inspection by Manufacturer

2008 – 2009: New Hearing Aids

(S. Sjoblad, B. Warren. 2009.)

82%

18%

Passed inspection/EAA

Failed inspection/EAA

Manufacturer AManufacturer BManufacturer CManufacturer DManufacturer EManufacturer F

18.90% 9.70%

20.50% 41.20%

20% 0%

Percentage of Repaired HAs Failing QA Measures

2008 – 2009: Repaired Hearing Aids

(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

5/29/2012 51

Real Ear Verification

5/29/2012 52

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

• Recommend: 2 week and 4 week (six week as needed)

5/29/2012 55

Balancing the Investment

5/29/2012 56

Current Trend: Ignoring the importance  

of HA follow‐up 

Hearing Aid Check: • Six Months:

» Office visit (V5299) » HAC (92592/3)

• Visual and listening inspection » 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)

• per ear – small parts replacement » EAA and Directional Microphone testing (92594/5)

5/29/2012 58

HEARING AID PROCEDURES, EARMOLDS, AND ACCESSORIES (and related professional services)√ CPT / HCPCS mod. DESCRIPTION FEE √ HCPCS mod. DESCRIPTION FEE √ HCPCS mod. DESCRIPTION FEE

V5299 Office Visit √ V5257 Digital BTE, monaural 98960 Education & Training, individual92592 HA Check, monaural (visual & listening inspections) V5256 Digital ITE, monaural 98961 Education & Training, 2-4 persons92593 HA Check, binaural (visual & listening inspections) V5255 Digital ITC, monaural 98962 Education & Training,5-8 persons92594 Electroacoustic Analysis, monaural V5254 Digital CIC, monaural V7212 Encounter for hearing conservation & Tx92595 Electroacoustic Analysis, binaural V5262 Disposable Aid, monaural 99002 Shipping and HandlingV5014 HA Repair by Mfctr., 6 mo. Warranty V5261 Digital BTE, binaural V5299 Loss and Damage Deductible, per deviceV5014 HA Repair by Mfctr., 12 mo. Warranty V5260 Digital ITE, binaural V5299 HA Extended WarrantyV5014 HA Repair, in-house per ear small parts replaced V5259 Digital ITC, binaural 69210 Cerumen Removal [IMPACTED]V5014 HA Repair no charge V5259 Digital CIC, binaural 92700 Cerumen Removal [not impacted]V5267 HA Supplies/Accessories (see reverse) V5263 Disposable Aid, binaural 98986 Telephone Assessment92590 HA Evaluation, monaural (Func. Comm. Assess.) V5241 Dispensing Fee, monaural 98969 Online Assessment92591 HA Evaluation, binaural (Func. Comm. Assess.) V5160 Dispensing Fee, binaural V5266 Battery (6 batteries/pk)V5275 Earmold Impression (each) V5110 Dispensing Fee, bilateral V5266 Battery Club Membership (8pk of 6)V5264 Earmold Custom (each) V5090 Dispensing Fee, unspecified aid (FM) V5268 ALD, TelephoneV5265 Earmold, Disposable (each) V5200 Dispensing Fee, CROS V5269 ALD, AlertingV5011 Fitting and Orientation of Hearing Aid(s) V5240 Dispensing Fee, BICROS V5270 ALD,TV AmplifierV5011 Fitting and Orientation of FM V5298 Hearing Aid, miscellaneous V5274 ALD, miscellaneous (ex. FM, wireless)V5020 Conformity Evaluation (Real-Ear Measures) V5298 Lyric Subscription V5299 Hearing Service Miscellaneous (Home visit)V5014 Hearing Aid Reprogramming 92630 Audiological Rehabilitation [pre-lingual]V5267 Musician's Earplugs Filters (each) 92633 Audiological Rehabilitation [post-lingual]

x2

EAA at one year and as needed

Current Trend:  Fear of Being Billed for Services 

Insert graphics and info on online HE… 

HEARING AID PROCEDURES, EARMOLDS, AND ACCESSORIES (and related professional services)√ CPT / HCPCS mod. DESCRIPTION FEE √ HCPCS mod. DESCRIPTION FEE √ HCPCS mod. DESCRIPTION FEE

V5299 Office Visit √ V5257 Digital BTE, monaural 98960 Education & Training, individual92592 HA Check, monaural (visual & listening inspections) V5256 Digital ITE, monaural 98961 Education & Training, 2-4 persons92593 HA Check, binaural (visual & listening inspections) V5255 Digital ITC, monaural 98962 Education & Training,5-8 persons92594 Electroacoustic Analysis, monaural V5254 Digital CIC, monaural V7212 Encounter for hearing conservation & Tx92595 Electroacoustic Analysis, binaural V5262 Disposable Aid, monaural 99002 Shipping and HandlingV5014 HA Repair by Mfctr., 6 mo. Warranty V5261 Digital BTE, binaural V5299 Loss and Damage Deductible, per deviceV5014 HA Repair by Mfctr., 12 mo. Warranty V5260 Digital ITE, binaural V5299 HA Extended WarrantyV5014 HA Repair, in-house per ear small parts replaced V5259 Digital ITC, binaural 69210 Cerumen Removal [IMPACTED]V5014 HA Repair no charge V5259 Digital CIC, binaural 92700 Cerumen Removal [not impacted]V5267 HA Supplies/Accessories (see reverse) V5263 Disposable Aid, binaural 98986 Telephone Assessment92590 HA Evaluation, monaural (Func. Comm. Assess.) V5241 Dispensing Fee, monaural 98969 Online Assessment92591 HA Evaluation, binaural (Func. Comm. Assess.) V5160 Dispensing Fee, binaural V5266 Battery (6 batteries/pk)V5275 Earmold Impression (each) V5110 Dispensing Fee, bilateral V5266 Battery Club Membership (8pk of 6)V5264 Earmold Custom (each) V5090 Dispensing Fee, unspecified aid (FM) V5268 ALD, TelephoneV5265 Earmold, Disposable (each) V5200 Dispensing Fee, CROS V5269 ALD, AlertingV5011 Fitting and Orientation of Hearing Aid(s) V5240 Dispensing Fee, BICROS V5270 ALD,TV AmplifierV5011 Fitting and Orientation of FM V5298 Hearing Aid, miscellaneous V5274 ALD, miscellaneous (ex. FM, wireless)V5020 Conformity Evaluation (Real-Ear Measures) V5298 Lyric Subscription V5299 Hearing Service Miscellaneous (Home visit)V5014 Hearing Aid Reprogramming 92630 Audiological Rehabilitation [pre-lingual]V5267 Musician's Earplugs Filters (each) 92633 Audiological Rehabilitation [post-lingual]

x2

How many visits does the average patient have during the “manufacturer’s warranty” period?

2011 Hearing Aid Billing Practices Survey

54.3%

39.5%

4.4%

1.7%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0%

1-2 times annually

3-4 times annually

5-6 times annually

Greater than 6 times annually

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

Why are there fees for repairs?

Service Plan Examples: M

inim

al C

are Patient pays for

services following trial/adjustment period

Stan

dard

Car

e Includes most necessary services, standard accessories, semi-annual checkups, annual evaluation, etc.

Prem

ium

Car

e “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.

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.” 

What our patients are saying? 

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

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.

Finding the best hearing care checklist

5/29/2012 66

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!

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.

5/29/2012 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.

5/29/2012 70

5/29/2012 71

CONTACT INFORMATION:

Stephanie Sjoblad: ssjoblad@med.unc.edu

Barbara Winslow Warren: barbara_winslow@med.unc.edu

SPECIAL THANKS TO: AAA

Debbie Abel, Au.D. Annette Burton, Au.D.

Kim Cavitt, Au.D. Katherine Cresante

Melissa Uhlman, Au.D