Hearing aids linked to fewer hospital and ER visits by older adultsApril 26, 2018
They cost thousands of dollars, and insurance almost never covers them. But hearing aids may hold the potential to cut older adults' visits to the hospital or emergency room, according to a new study.
That could mean lower costs in the long run, though more research is needed to see if this is true. The study arrives at a time when discussion about adding Medicare coverage for hearing aids is rising.
In the new paper in JAMA Otolaryngology - Head & Neck Surgery, a team from the University of Michigan reports what they found after examining data from 1,336 adults ages 65 to 85 who reported they had severe hearing loss.
Strikingly, the researchers found that only 45 percent of those in the study actually use a hearing aid - despite having serious difficulty hearing. The rate is lower still among those with low incomes or less education, those who are African American or Hispanic, and those who live in Southern U.S.
After the researchers factored out those differences, they found that older adults who had a hearing aid were less likely to have gone to the hospital or emergency room in the last year. The difference was about two percentage points - not a major difference but large enough to be significant.
In addition, those who had been hospitalized and had a hearing aid had shorter stays than those who didn't have a hearing aid - averaging a half of a day less in the hospital.
On the other hand, those with hearing aids had a higher probability (by four percentage points) of having an office-based visit to a physician in the past year. They also had more such visits than those without hearing aids. Office-based visits are much less costly than emergency visits and hospital stays.
Impact despite lack of coverage
The association of hearing aid use with lower use of costly types of care is especially striking given the lack of insurance coverage for the devices, the authors say. Hearing loss is one of the most common conditions among those over age 65.
"Traditional Medicare doesn't cover hearing aids at all, Medicare Advantage plans may cover them but often ask members to share the cost at a high level, and only about half of states offer some Medicaid coverage for the lowest-income patients," says Elham Mahmoudi, Ph.D., M.B.A., lead author of the new study and a health economist in the Department of Family Medicine at the U-M Medical School. "As the debate over expanding coverage continues, we hope this research and our future work will help inform the discussion."
The findings, based on self-reported accounts of a single year of health care use, don't show a cost savings overall for those who have invested in a hearing aid. That is unlikely to be visible in a cross-section of data such as this, Mahmoudi notes.
In fact, those with hearing aids reported spending about $325 more out of their own pockets than those without, and said their health care costs were about $1,125 more overall, compared with those who had hearing loss but no hearing aids. The total Medicare spending reported by both groups was about the same.
"Hearing aids cost an average of $2,000 to $7,000, so the fact that overall annual health care costs for those with hearing aids were not that much higher is an important point on its own," says Mahmoudi, who is a member of the U-M Institute for Healthcare Policy and Innovation.
The new study is based on self-reported health care use and costs, gathered through the Medicare Expenditure Panel Survey conducted by the federal Agency for Healthcare Research and Quality.
The data also included self-reported health conditions. The fact that people who had hearing aids were also less likely to have chronic illnesses such as diabetes and high blood pressure may have had something to do with these chances of using costlier services, according to an editorial commenting on the new paper. Or, this difference may indicate that hearing aids are allowing individuals to lead more active and healthy lives. But the data used in the study don't allow the researchers to tell that for sure.
To get a different and long-term look at the same issue, Mahmoudi and her colleagues are already studying five years' worth of private insurance data provided by IHPI, and anonymous data from patients treated at Michigan Medicine, U-M's academic medical center.
By looking at documented costs and health care use over multiple years, they hope to look at whether hearing aids might be cost-effective - in other words, whether the initial spending on a device actually pays off in lower costs from other forms of health care for the same patient.
Mahmoudi's own experience with her father's hearing loss, and the experience of two of her co-authors informed the study. Michael M. McKee, M.D., M.P.H. and Family Medicine chair Philip Zazove, M.D., also worked on the study; both have hearing loss and use cochlear implants.
Mahmoudi's father, who is in his 80s, didn't use a hearing aid to offset his hearing loss until Mahmoudi helped him navigate the process of getting a hearing exam, and getting the hearing aid fitted and adjusted. The expense, and the need for several office visits to adjust the device's settings, make getting a hearing aid a complex undertaking.
But, she notes, other studies have found hearing loss can cause adults to feel isolated, make them less likely to communicate effectively with family and health providers both in and out of the hospital, and is associated with worse overall health.
A 2016 National Academies of Science, Engineering and Medicine report looked at hearing-related technologies for adults of all ages, and concluded that changes to the coverage and regulation of hearing aids should be made.
The panel's recommendations helped lead to a 2017 law instructing the U.S. Food and Drug Administration to develop guidelines that will allow hearing aids to be sold over the counter. The FDA hearing aid website provides current information, but the agency now has less than three years to develop and launch guidelines. No matter what, over-the-counter hearing aids are likely to be best for those with mild to moderate hearing loss.
In the meantime, the U-M team will continue to study the impact of hearing aids on patients' live and health.
"This is the first study to show an association between hearing aid use and how older people use the health care system," says Mahmoudi. "If we look over a longer period, it may be that the cost of the hearing aid may be covered by the difference in use of health care. That remains to be seen. But hearing loss is something that a lot of people experience, and it can be overcome in most cases. So cost effectiveness may be only one way to measure whether insurance coverage for hearing aids is the right thing to do."
Michigan Medicine - University of Michigan
Related Health Care Articles:
Pesearchers at Partners HealthCare published a study showing that Partners Pioneer ACO not only reduces spending growth, but does this by reducing avoidable hospitalizations for patients with elevated but modifiable risks.
According to a newly released NEJM Catalyst Insights Report, health care executives and industry insiders expect patients -- more than any other stakeholder -- to be the big losers of any comprehensive health care plan from the Trump administration.
Marking six years since the start of the Syrian conflict (15 March), a study in The Lancet provides new estimates for the number of medical personnel killed: 814 from March 2011 to February 2017.
The January issue of Health Affairs includes a study that explores a much-discussed issue in global health: the role of governance in improving health, which is widely recognized as necessary but is difficult to tie to actual outcomes.
Global lung cancer researchers and patient advocates today emphasized that new models of delivering care and communicating about cancer care play an important role in the fight against lung cancer.
Texas has experienced a roughly 6 percentage-point increase in health insurance coverage from the Affordable Care Act, according to new research by experts at Rice University and the Episcopal Health Foundation.
Training informal health-care providers in India improved the quality of health care they offered to patients in rural regions, a new study reports.
The Affordable Care Act has substantially decreased the number of uninsured Americans and improved access to health care, though insurance affordability and disparities by geography, race/ethnicity, and income persist.
Among adults enrolled in an integrated health care system, receipt of primary care at integrated team-based care practices compared with traditional practice management practices was associated with higher rates of some measures of quality of care, lower rates for some measures of acute care utilization, and lower actual payments received by the delivery system, according to a study appearing in the Aug.
The quality of health care provided to US military veterans in Veterans Affairs (VA) facilities compares favorably with the treatment and services delivered outside the VA.
Related Health Care Reading:
Jonas and Kovner's Health Care Delivery in the United States, 11th Edition
by James R. Knickman PhD (Editor), Anthony R. Kovner PhD (Editor)
This fully updated and revised 11th edition of a highly esteemed survey and analysis of health care delivery in the United States keeps pace with the rapid changes that are reshaping our system. Fundamentally, this new edition presents the realities that impact our nation’s achievement of the so-called Triple Aim: better health and better care at a lower cost. It addresses challenges and responses to the Affordable Care Act (ACA), the implementation of Obamacare, and many new models of care designed to replace outmoded systems. Leading scholars, practitioners, and educators within... View Details
Essentials of the U.S. Health Care System
by Leiyu Shi (Author), Douglas A. Singh (Author)
Essentials of the U.S. Health Care System, Fourth Edition is a clear and concise distillation of the major topics covered in the best-selling Delivering Health Care in America by the same authors. Designed for undergraduate and graduate students in programs across the health disciplines, Essentials of the U.S. Health Care System is a reader-friendly, well organized resource that covers the major characteristics, foundations, and future of the U.S. health care system. The text clarifies the complexities of health care organization and finance and presents a solid overview of how the various... View Details
Health Care Finance: Basic Tools for Nonfinancial Managers
by Judith J. Baker (Author), R.W. Baker (Author), Neil R. Dworkin (Author)
Health Care Finance: Basic Tools for Nonfinancial Managers, Fifth Edition is the most practical and applied text for those who need a basic and better understanding of health care financial management.
Using actual examples from hospitals, long-term care facilities, and home health agencies, this user-friendly text includes practical information for the nonfinancial manager charged with budgeting.
This exhaustive revision offers updated data throughout as well as six new chapters covering various cutting edge topics from the changing landscape in healthcare finance to... View Details
The American Health Care Paradox: Why Spending More is Getting Us Less
by Elizabeth H. Bradley (Author), Lauren A. Taylor (Author), Harvey V. Fineberg (Foreword)
Foreword by Harvey V. Fineberg, President of the Institute of Medicine
For decades, experts have puzzled over why the US spends more on health care but suffers poorer outcomes than other industrialized nations. Now Elizabeth H. Bradley and Lauren A. Taylor marshal extensive research, including a comparative study of health care data from thirty countries, and get to the root of this paradox: We've left out of our tally the most impactful expenditures countries make to improve the health of their populationsinvestments in social services.
In The American Health Care... View Details
Policy & Politics in Nursing and Health Care, 7e (Policy and Politics in Nursing and Health)
by Diana J. Mason RN PhD FAAN (Author), Deborah B Gardner RN PhD FAAN FNAP (Author), Freida Hopkins Outlaw PhD RN FAAN (Author), Eileen T. O'Grady PhD RN ANP (Author)
Featuring analysis of cutting-edge healthcare issues and first-person stories, Policy & Politics in Nursing and Health Care, 7th Edition is the leader in helping students develop skills in influencing policy in today’s changing health care environment. Approximately 150 expert contributors present a wide range of topics in this classic text, providing a more complete background than can be found in any other policy textbook on the market. Discussions include the latest updates on conflict management, health economics, lobbying, the use of media, and working with communities for... View Details
Basics of the U.S. Health Care System
by Nancy J. Niles (Author)
Basics of the U.S. Health Care System, Third Edition provides a broad, fundamental introduction to the workings of the healthcare industry. Engaging and activities-oriented, the text offers an accessible overview of the major concepts of healthcare operations, the role of government, public and private financing, as well as ethical and legal issues.
Each chapter features review exercises and internet resources that make studying this complex industry both enjoyable and stimulating. Students of various disciplines--including healthcare administration, business, nursing, public health,... View Details
An American Sickness: How Healthcare Became Big Business and How You Can Take It Back
by Elisabeth Rosenthal (Author)
A New York Times bestseller/Washington Post Notable Book of 2017/NPR Best Books of 2017/Wall Street Journal Best Books of 2017
"This book will serve as the definitive guide to the past and future of health care in America.”—Siddhartha Mukherjee, Pulitzer Prize-winning author of The Emperor of All Maladies and The Gene
At a moment of drastic political upheaval, An American Sickness is a shocking investigation into our dysfunctional healthcare system - and offers practical solutions to its myriad... View Details
The Health Care Handbook: A Clear and Concise Guide to the United States Health Care System, 2nd Edition
by Elisabeth Askin (Author), Nathan Moore (Author), Vikram Shankar (Author)
"An astonishingly clear 'user's manual' that explains our health care system and the policies that will change it." Pauline Chen, MD - The New York Times
The 2nd edition of the best-selling practical, neutral, and readable overview of the US health care system is now available. This updated edition of the Health Care Handbook covers:
• New sections on health IT, team-based care and health care quality
• A clear summary of health policy and the Affordable Care Act
• Inpatient & outpatient health care and delivery systems
• Health insurance and the... View Details
Public Health Nursing: Population-Centered Health Care in the Community, 9e
by Marcia Stanhope RN DSN FAAN (Author), Jeanette Lancaster RN PhD FAAN (Author)
Prepare for a successful career as a community/public health nurse! Public Health Nursing: Population-Centered Health Care in the Community, 9th Edition provides up-to-date information on issues that impact public health nursing, such as infectious diseases, natural and man-made disasters, and health care policies affecting individuals, families, and communities. Real-life scenarios show examples of health promotion and public health interventions. New to this edition is an emphasis on QSEN skills and an explanation of the influence of the Affordable Care Act on public... View Details
The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care
by T. R. Reid (Author)
A New York Times Bestseller, with an updated explanation of the 2010 Health Reform Bill
Bringing to bear his talent for explaining complex issues in a clear, engaging way, New York Times bestselling author T. R. Reid visits industrialized democracies around the world--France, Britain, Germany, Japan, and beyond--to provide a revelatory tour of successful, affordable universal health care systems. Now updated with new statistics and a plain-English explanation of the 2010 health care reform bill, The Healing of America is required reading for all those... View Details