Good afternoon. I am Thomas Powers the doctor and not the Thomas Powers that is associated with this organization. That is why I look
different. I would like to thank the Institute for inviting me here. I would like to thank
the steering committee and the organizing committee as well. I am not usually a presenter
so I am a little out of my comfort zone, but we are excited to share what we are doing
with you. My apologies to Katherine Bouton for the medical
profession not adequately addressing her hearing issues. I compliment you for sharing your
hearing loss live with us and being an advocate for it. Because you guys are all researchers
and academics and I am a hands-on practical type person, the Institute wanted these talks
to be based on some numbers. What am I going to do for numbers? We went out and did a survey of the patients
that we have been working with, with their hearing loss. This screen just gives you an
overview. We screened 767 patients over a six month period. Of those 767, we tested
107 and of those 107 we fitted with a hearing aid. Seventy-nine percent of those patients
were new to hearing aids. Eight-six percent reported that they would not have purchased
or would have delayed getting those hearing aids due to the cost of hearing aids. That
has been discussed today. Certainly the cost is a big issue for these patients.
I have come from Lake Havasu City, Arizona. It is a very small town in Western Arizona,
on the shores of the Colorado River. It has a population of about 52,000. This time of
the year it does swell to 70,000 with the snowbirds. I have a very small practice. It
is just me. I am solo. I have my wife who helps me. She does the office management.
I have two receptionists and one medical assistant. Our claim to fame is either that we are America�s
home for the London Bridge or our extreme summer temperatures. You can see that we get
up to 110, and that is an average. If you know numbers, to have that average, you have
to have temperatures even higher. So we do get in the 120s at times. I have a practice
of about 7600 patients that are active patients. Forty-seven percent of those are between the
age of 45 and 64 and 47 percent are above the age of 65. I have notice that as I age,
the age of my patients get older, and I don�t have as many pediatric patients anymore. That
is fine. My tolerance for those snotty runny noses has decreased. Anyway, that is basically
where we come from. We are basically in the center of a triangle
between Los Angeles, Las Vegas and Phoenix. We are three to four hours from each one of
those metropolitan areas. So we are really out in the middle of nowhere with no other
surrounding communities. We incorporated hearing testing into our practice because it made sense. It allowed for more comprehensive care of the patient.
I was trained in residency. We had exposure to an audiometer. It was bulky, complicated
and needed a sound-proof booth and all of that stuff, and there was no way that I was
going to incorporate that into a private practice. It just wasn�t practical space-wise. It
wasn�t practical cost-wise. Hearing testing basically was neglected for the last 25 years
in my practice. Sure, we did the whisper test for commercial driver�s license, but how
accurate is a whisper test? It really is something that has been neglected. It was mentioned
earlier. If we can�t test for it, we can�t treat it. Why deal with it? Unfortunately,
that is what has happened across the board with most of my colleagues.
However, because of the system that we came across, it made sense to do it, and it adds
more comprehensive care to our patients. The patients aren�t getting the help as we talked
about earlier today. It is expensive for them. They are afraid of the cost. There is denial.
They certainly don�t come to you and say I have a hearing loss can you check me. They
are not satisfied with the solutions. I had a patient that went to a big store for
a hearing aid. They did their research on it. They found out that they could negotiate
the price a little bit. They negotiated the price, but when she got home, she realized
it wasn�t the same model that the original price was for. So she was very bitter about
that situation. So she lost all trust in their ability.
The program that we started was just in this past April. If you told me in March that I
would be testing and dispensing hearing aids and speaking in Washington, D.C. about it,
I would have said you were nuts, but here I am. It has been very, very interesting.
What we are doing is we are screening every patient over the age of 40 that comes in the
office. I have the MA with a simple hearing screening.
It has four frequencies, 40 decibels, and she tests every patient that comes in when
she does the vital signs. There is a form that she fills out with the results. There
is a subjective part to it from a scale of one to 10 of how bad their hearing is. That
form is given to me. When I am with patient, I go over that form. If they have missed two
frequencies and they have eight or less on the subjective part then I usually recommend
testing for them. We are able to do the testing in the office.
We have an automated Pure Tone Audiometer machine. It is software that is set up into
a laptop. It has a high quality headphone. We do it in a quiet room. We have a little
pre-question before, about seven or ten questions that help us rule out other pathological reasons
for hearing other than age-related. We are only interested in the age-related hearing
loss. If it is something more involved than age-related then we want to refer that out
to either the ENT or we also use the House Hearing Clinic in Los Angeles.
We are designed with this program to treat about 80 percent and 20 percent are probably
going to get referred out. Once the audiogram is printed up, I go over it with the patient.
If it shows that there is significant loss, the computer program will suggest hearing
aid. We have a hearing aid with one model. There are four versions to it. Each one is
pre-programmed with four programs. It is a behind the ear, free ear model, and we are
able to set the patient up with a demo right then and there. I will measure their ear.
We will determine the tube length, the dome size. My wife and my assistant will set the
hearing aid up and then I will fit it in to the ear.
Once it is in the ear, we assess how the comfort is. We assess what their perception of their
hearing is. We give them time with it. We invite them to go out to the lobby to see
what the TV sounds like. We invite them to go outside to hear what the traffic sounds
like, the air, the wind. If they are having an appointment with us, they will keep an
eye on them during that appointment and they can get used that that hearing aid.
If they decide to purchase it then my wife will help them to learn the maintenance and
care for it. She will go over the financial part of it and they are out the door within
an hour and a half. Their hearing is fixed. It is a very innovative system. It is very
simplified. Like I said, we are not going to treat everybody. We are at least getting
a lot of hearing loss taken care of. We do refer some out as noted.
These hearing screenings by far and large were not expected by the patient. We are certainly
not going to ask them can we test your hearing because there are patients who would say no.
They don�t want to know if they have a hearing loss. They are denying it, whatever. So we
just do it as part of the vital exams. Eight-nine percent did not expect to have their hearing
checked while in their primary care physician office of the ones what we surveyed. That
is a huge number. Twenty percent had had their hearing checked within the last two years.
You talked about this Preventative Taskforce that couldn�t come up with a decision on
whether hearing screening should be done. For us guys who are in the trenches doing
the day to day work we look at that and say are you nuts? Why would you not test for hearing?
It is simple. It only takes a second. What is the big deal? Those kinds of studies to
us are kind of disturbing. It is like the one that came out a few months ago about vitamins.
They couldn�t come up with any clear concise statement on vitamins.
Have you ever seen anybody with low vitamin C? It is a disease called scurvy. It is terrible.
What about low vitamin B12, pernicious anemia? I had a guy that walked in the office once.
I thought he had a stroke. We did CAT scans on him. He had no bleeds and no stroke. The
labs came back and he had a B12 level of less than 10. We loaded him up with B12. Three
days later, he was walking clinically perfect. Some of these studies we get pretty frustrated
with. Do it. There is no argument, just do it. That is what we are trying to do. These hearing screenings were appreciated by the patients as seen by these numbers.
Prior to screening, this lower part here is kind of interesting. This shows that 94 percent
of the people perceived that they had a hearing problem. Of those 94 percent, 80 percent needed
hearing aids. If they perceive it, there is a good change they have got a hearing problem.
So we have to go after it. This slide shows that 138 had failed those
hearing screens. We tested the 107 and 104 would benefit from the hearing aids. We weren�t
able to fit all of those for various reasons. Hearing aids we are showing can be dispended
by the primary care physician. We had 44 percent purchased. The other big number that is there
is at 24 percent that couldn�t afford it or the 16 percent that aren�t ready for
it. If we can get those people fitted with hearing aids we are just doing twice as good.
There is a lot of denial, especially with the older men without a spouse that is there
during the exam. It is called GOMD. It is called grumpy old man disease. It doesn�t
matter how bad their loss is. They could have a 90 decibel loss across all frequencies and
they are adamant their hearing is fine. It is huge denial. If the spouse is there, she
talks him into it. Boy, if that spouse isn�t there it is just a GOMD and there is nothing
that you can do to get that guy to get the hearing aid. It really helps to have that
spouse there. You can see that we are somewhat successful in providing hearing aids.
We applied the APHAB, the
abbreviated profile on hearing aid benefits. It is apparently an industry-wide standard.
You can see that 79 percent of our patients were new to hearing aids and 21 percent have
had previous hearing aids. When I was evaluating the system, I didn�t know if these hearing
aids were any good or not or whether they were just like the 15.00 Walmart model or
something. I really didn�t have any great way of knowing that these were decent hearing
aids. I have asked some of my patients that had
the hearing aids to come in and try these. They said that they were as good as the ones
that they had and when they were in the market for a new one they would come by and probably
purchase these hearing aids. Seventy-two percent of our patients were wearing them from eight
to 16 hours. I think that is pretty successful that they are wearing them and they are not
throwing them in the sock drawer like a lot of these ended up in. We are making sure that
they are comfortable and we are making sure that they are working.
My wife helps with any calls that come in. We are even able to do home visits if they
are older and can�t come to the office. So we will go out to the house and we will
help refresh them on how to take care of things or if a battery door broke off or whatever.
They are very satisfied and they are using them.
Here is the other part of the APHAB. You can see how we are transforming their lives. We
are making conversations with family easier for them. They are going to movie theatres
and understanding speech. They are going to the grocery stores and hearing much better.
So we are really making an improvement in their lifestyle. It is dramatic. It doesn�t
take long for us to do that. The impact on a practice: It doesn�t really
affect my receptionist other than they take the appointments. The MA is not really involved
with it. They get involved just because they are trying to guess who is going to buy and
who is not going to buy or who should buy. It is kind of a game for them. My wife is
really my assistant with it. Between the two of us, we end up doing most of it. It does
interrupt my schedule a little bit because I am seeing these hearing aid patients on
top of my regular 15 minute a day per patient schedule. It does back me up once in a while,
but we are still kind of working on that scheduling and it has had a little bit of impact, but
not much. The patients are very surprised. They are
very grateful and very happy. You can see some of the comments that they have said.
I think it is one of the best things that could have happened here in Havasu. There
are many people that can�t afford them. I think you are better off at your physicians.
I think he is more interested in fixing the problem than selling the hearing aid. Patients
really trust me. I have been taking care of a lot of them for 25 years so there is a lot
of trust there. It has been successful for that reason.
It is very rewarding and gratifying. It is life-changing to the patients. You put a hearing
aid in them and they just wake up. It is like Christmas morning. They can hear their cell
phones ring. We had one lady walking out hearing this flopping sound, and it was her flip-flops.
It is amazing what happens to them. It is a great service to provide. The technology
is great. We have been able to simplify it. It is cost-effective for the doctor, and you
can bring it in the office and do it right away. These hearing aids are only 1500.00
a pair, so they are substantially less. Most of them are going for 5000.00 to 7000.00 at
the big stores, so we are opening the door. Some patients still have a hard time affording
the cost, but we have the Care Credit Program for them if they qualify for that. It is still
frustrating that there are some that still can�t afford the 1500.00. It is very hard
to see those people walk out because you know that they would benefit from the use of it.
From a personal standpoint it is very gratifying. I get a lot of pleasure seeing people with
that happiness. If I treat somebody with high blood pressure and put them on a medication
that is going to cost them 100.00 a month and I tell them to eat certain foods they
don�t like. I tell them to lose weight; do you think they are going to thank me for
that? They understand the importance of it, but I sure don�t get a thanks. If you improve
someone�s hearing, and it is transforming for them and for me. So it is very gratifying.
We need to keep pushing this. You guys are doing great research and things will advance.
We will get the cognition assessment and things like that and this has no place to go but
up in improvement. We need to get this into family practice residencies. We need to get
it into primary care. I hope that I am just a stepping block for that. Thank you for your