22March2017

Hearing aid sales practices under

microscope
Australian Competition and Consumer Commission to give
evidence to parliamentary inquiry on commissions, incentives
and other mechanisms designed to drive sales and create a
conflict with clinical independence, professional integrity and
the primary obligation to consumers.

Invisible barrier to Closing the Gap

We know that school attendance rates for Indigenous children
with hearing loss are below those for other students. We
know they experience more difficulty with learning when they
do attend school. We know they display more behavioural
problems when at school.

Report shines light on economic impact

of hearing loss
Hearing loss is a significant issue facing the New Zealand
population with almost 20 percent of people now living with
some type of hearing loss, costing the economy $957.3 million
and the health sector $131.8 million each year.

Chair of consumer watchdog speaks out

"I feel it's my job to express concerns with certain proposed
approaches to privatising human services. This extends to the
potential challenges policy makers will face in delivering on the
enormous benefits of the National Disability Insurance
Scheme.

We acknowledge the traditional custodians of the land, community, sea, and waters where we live and work. We pay our respects to
elderspast,presentandfutureandvaluethecontributionsIndigenousAustraliansmakeinoursociety.Weacknowledgethechallengefor
IndigenousleadersandfamiliestoovercometheunacceptablyhighlevelsofearhealthissuesamongfirstAustralians.
Hearing aid sales practices under examination
The Australian Competition and Consumer Commission (ACCC) will appear tomorrow (Thurs 23
March) before the Parliaments Committee on Health, Aged Care and Sport as part of its Inquiry
into the Hearing Health and Wellbeing of Australia.

The ACCC recently raised concerns about the sales practices used in some hearing aid clinics in its
report Issues around the Sale of Hearing Aids: Consumer and Clinician Perspectives. The ACCC
stated that commissions, incentives and other mechanisms designed to drive sales can create a
conflict with clinical independence, professional integrity and the primary obligation to consumers.

Committee Chair, Mr Trent Zimmerman MP, stated that in view of the ACCCs recent report on the
sale of hearing aids the Committee is eager to discuss what can be done to ensure that hearing
clinics are primarily focussed on providing hearing impaired Australians with the highest possible
health outcomes.

Further information about the Committees inquiry, including the public hearing program is
available at http://www.aph.gov.au/Parliamentary_Business/Committees/House/
Health_Aged_Care_and_Sport/HearingHealth/Public_Hearings

Public hearing details: 12:45pm to 1:30pm, Thursday 23 March, Parliament House, Canberra.

Live Remote Captioning is available for this hearing at

http://www.aph.gov.au/Parliamentary_Business/Committees/House/Health_Aged_Care_and_Sport
/HearingHealth/Public_Hearings

Key points in ACCC report

Australian Competition and Consumer Commission (ACCC) recommended that hearing clinics
review their incentive programs and performance measures to ensure that they do not create a
conflict between healthcare advice and sales.

ACCC said some hearing clinics encourage clinicians to sell more expensive hearing aids by
setting sales targets, paying commissions to clinicians, having arrangements that favour
certain brands or are owned by companies that manufacture hearing aids.

Commission-based selling can provide incentives to clinicians to supply hearing aids that are
unnecessary or more expensive than a consumer needs.

This has the potential to lead to consumer harm where trusted advice is being given to
patients, many of whom may be vulnerable or disadvantaged.
An ABC Radio National Background Briefing investigation in 2014 found that even
audiologists who dont directly work for manufacturers often receive commissions and other
incentives to sell hearing aids to their patients. One company offered a trip to Las Vegas for the
audiologist that sold the largest number of high-end devices. None of this is disclosed to patients.

When it's not disclosed, it just doesn't stack up against what the community expects, says
audiologist Chris Whitfeld, who worked for a clinic owned by a hearing aid company until he left
two years ago.

Those kinds of pressures should either be removed, preferably, or at least disclosed.

The pressure on clinicians to sell is sometimes very direct.

In 2009, audiologist Dahlia Sartika worked for a clinic with a hearing aid manufacturer as its
parent company. That year, she was required to participate in a sales training session.

The trainer started the training by saying that he never had extensive training but like all of us
but he was very successful in hearing aids. He has his own practice ... then he suddenly took out
a copy of my certificates.

The trainer presented her certificates to the group before tearing them up.

He ripped my certificate in front of everybody, saying, This is all meaningless if you do not sell.

Deafness Forum of Australia regards the practice of upselling, commissions and bundling the cost
of a device with followup rehabilitation service as an area of risk for consumers who may have no
objective way of knowing whether the device recommended by an audiologist is best suited for
their individual needs.

"The arrangement where a hearing care professional receives a financial payment for promoting a
particular product brings in a level of uncertainty to a relationship that needs to be built on trust,
Deafness Forum chairperson David Brady said.

Consumers do not want the advice they receive to be any way influenced, or compromised by the
payment of a financial incentive to the clinician, he said.

Better Hearing Australia (BHA) said that some people are not receiving good audiological care and
encourages consumers to not be pressured into purchasing anything on the day of an initial
hearing assessment.

BHA National President, Michele Barry said Many people tell us stories of high pressure sales
techniques and a lack of follow up care. This is not in line with the principles of patient centred
care.
Audiology Australia encourages members of the public with concerns about the clinical services
provided by an audiologist to contact its office.

If the clinician is a member of Audiology Australia, anybody with concerns regarding the
clinicians conduct can lodge a formal complaint regarding a potential breach of our Code of
Conduct. If the clinician is not a member of Audiology Australia, we can help them to find another
organisation or body that can help them, CEO Tony Coles said.

Hearing Business Alliance (HBA) believes that in an industry driven by a small number of large
hearing chains, it is clear to all parties that self-regulation has failed the general public.

Seven hearing chains, which includes the government owned Australian Hearing, are responsible
for approximately 85% of the hearing aid fittings in our market. It is the position of HBA that the
professional bodies, which have worked hard to establish a Code of Conduct and a Code of Ethics
for clinicians to adhere to, are nonetheless powerless to enforce these ethical standards onto
business owners.

Independent Audiologists Australia believes that profiteering from the sale of hearing aids is
interwoven with healthcare in the audiology field. It says that regulation of audiology and
audiometry needs to be registered under the Australian Health Practitioner Regulation Authority
in order to force the culture of hearing services to change from sales to clinical service delivery.

Usher syndrome
Usher syndrome is a genetic condition characterised by hearing loss or deafness, the progressive
loss of vision and in some cases, vestibular dysfunction. The loss of vision is caused by an eye
disease called Retinitis Pigmentosa, which affects the light sensitive area of tissue on the back of
the eye (the retina).

Meet the boys living with Usher syndrome and defying darkness
This story on Usher Syndrome featured on the SBS current affairs program The Feed. Watch the
full segment at http://www.sbs.com.au/news/thefeed/article/2017/03/13/it-changed-all-my-preconceptions-
meet-boys-living-usher-syndrome-and-defying
Closing the Gap and hearing loss: invisible barrier
obstructs progress
By Damien Howard and Jody Barney

Hearing loss among Indigenous Australians is a largely unseen barrier to Closing the Gap
programs, according to Dr Damien Howard and Jody Barney, who explain how to be hearing loss
responsive in service delivery and communications.

Communication difficulties caused by the widespread unidentified hearing loss among Indigenous
people in Australia continue to undermine the effectiveness of Closing the Gap programs.

An Aboriginal worker with mild hearing loss once commented: You see that look, the look that
tells you they are thinking you are some stupid blackfella and you dont want to say you dont
understand; Can you tell me it again?

You just want to get away and never want to work with them again if you can help it.

Many people act on these kinds of feelings. They seek to avoid people, situations and service
providers because of these reactions. The everyday communication difficulties caused by their
hearing loss contribute to anxiety and disengagement. They will often seek to avoid education,
health and employment support services designed to help them. For instance, people may not go
to health clinics, or do not comply with provided treatment. Avoidance of specialist medical
appointments is one feature of this. In some specialist medical visits to remote communities,
50% of patients do not attend booked appointments. This can have dire health implications for
individuals. It is also an immense waste of resources.
When hearing loss begins early in life, it has greater impact than the late onset hearing loss that is
experienced by non-Indigenous Australians who are hard of hearing. Their hearing loss is
generally caused by occupational noise exposure and ageing.

Indigenous hearing loss is usually caused by endemic

childhood middle ear disease. Children with current
ear disease often have a temporary hearing loss.
Repeated infections can cause lasting damage and
some level of permanent mild to moderate hearing
loss. Up to 70% of Indigenous people are affected
fewer in urban communities, more in remote
communities.

We know that school attendance rates for Indigenous children with hearing loss are below those
for other students. We know they experience more difficulty with learning when they do attend
school. We know they display more behavioural problems when at school. We know Indigenous
workers with hearing loss have difficulty securing and holding jobs, have greater performance
difficulties and frequently avoid participation in workplace training.

There is also increasing concern about hearing loss as a factor in the over-representation of
Indigenous people in the criminal justice system; 94% of prison inmates in the Northern Territory
have been found to have a significant degree of hearing loss.

Those familiar with Indigenous disadvantage may wonder why they have not heard about the
incidence and impact of hearing loss among adults. One reason is that early onset conductive
hearing loss is mostly invisible.

First, most Indigenous people who are hard of hearing are not aware that their hearing is not
normal. The early origin of their hearing loss means it is something they have experienced for
most of their life. For them, what they how they hear is normal. If asked, they would deny
having a hearing loss.

Second, service providers (teachers, nurses, doctors, trainers, health professionals, social workers
and police among them) are unlikely to recognise poor hearing as an issue for people they work
with. Communication difficulties arising from hearing loss are generally attributed only to
language and cultural differences, or to limited intelligence or poor motivation. The latter two
perceptions, when noticed by clients astute in reading body language, can further
compound disengagement.

It is easy to imagine that hearing aids are all that is needed to resolve issues. They can help
some, but will not resolve all communication difficulties.
The communication issues experienced by an adult with early onset hearing loss are the result of
both current hearing loss and the legacy effects of unidentified hearing loss since childhood.
These may include a preference for visual communication strategies, anxiety related to an intense
fear of being shamed and a limited store of contextual knowledge that helps with understanding
what is said.

A store of contextual knowledge is what people normally acquire through fully hearing what is said
to them, and around them. Without a store of relevant contextual knowledge the big picture
what is said in any situation is harder to understand. So people with early onset hearing loss not
only have trouble hearing what is said, but they also frequently have difficulty understanding what
they hear.

Avoidance is a way of coping with anxiety about being shamed. Repeated avoidance results in
limited engagement and poor outcomes for programs designed to Close the Gap.

The use of hearing loss responsive communication strategies can help to deal with this barrier.
These strategies can be as important as culturally appropriate processes in programs. Indeed,
there is an overlap between the two. For those with hearing loss, what is said in culturally familiar
language within a culturally familiar process is easier to understand.

Other key components of hearing loss responsive service provision include the following:
using highly visual communication strategies
minimising background noise during conversations
using the language clients know best
using pre-learning providing information in advance to help explain the context, so
people can better understand what will be discussed
services having amplification devices to use as part of service delivery
training staff in the use of more effective communication strategies this includes training
workers to recognise hearing loss, develop necessary skills and avoid responses that
prompt shame, anxiety and disengagement

Closing the Gap programs will continue to fall short of targeted outcomes until they are designed
to be responsive to the needs of those with hearing loss.

From The Mandarin,

http://www.themandarin.com.au/76567-closing-the-gap-and-hearing-loss-an-invisible-barrier-
obstructs-progress/
Catherine Birman wins NSW Premiers Award for
Woman of the Year
Renowned surgeon, Associate Professor Catherine
Birman, has won the 2017 New South Wales Premiers
Award for Woman of the Year.

A/Prof Birman is one of the most experienced cochlear

implant surgeons in the world having performed over
1,000 cochlear implant procedures for children and adults
from three months to 94 years.

A pioneer in the field of cochlear implants for children

with complex medical conditions, A/Prof Birman is the
Medical Director of the SCIC Cochlear Implant Program, a
service of Royal Institute for Deaf and Blind Children
(RIDBC).

As the third female Ear Nose and Throat Surgeon ever to qualify in New South Wales, A/Prof
Birmans career and charitable works have made her a trail-blazer and inspiring role model for all
women.

The Sound of Silence: a digital storytelling project

ACT Deafness Resource Centre (DRC), PhotoAccess and Gen S Stories are offering a free digital
storytelling course to members of the Deaf and hearing-impaired community living in Canberra.

The course will provide professional support

for up to eight people to make a 3-5 minute
film about a personal story.

The digital stories will be produced as a

collection and screened at a public launch
during Hearing Awareness Week (August
2017). Theyll also be published on the
website of the ACT Deafness Resource Centre.

For more information, contact ACT Deafness Resource Centre on 02 6287 4393 or
glenn.vermeulen@actdrc.org.au
Report shines light on economic impact of hearing loss
Hearing loss is a significant issue facing the New Zealand population with 880,350 people in New
Zealand now living with some type of hearing loss.

This represents 18.9% of the population and costs the New Zealand economy $957.3 million a
year and the health sector an estimated $131.8 million each year.

These are some of the key findings from a research report commissioned by National Foundation
for the Deaf to look at the economic impact of hearing loss.

Report snapshot
880,350 people in New Zealand now live with some type of hearing loss,
representing 18.9% of the population.
Health sector costs estimated at $131.8 million.
Total loss of tax revenue is estimated to be $254.6 million.
Hearing loss costs the New Zealand economy $957.3 million.
Net value of lost well-being and social impact is estimated at $3.9 billion.
Total cost of hearing loss is estimated at $4.9 billion.

The purpose of this research has been to draw back the curtain on the economic cost of hearing
loss in our country which has never been done before says Professor Peter Thorne, Foundation
President.

Life Unlimited Hearing Therapy is contracted by the Ministry of Health to provide a national, free
independent hearing therapy (aural rehabilitation) service to New Zealand citizens and permanent
residents aged 16 years and over. Life Unlimited Hearing Therapy manager, Jessica Lissaman
welcomes the new report.

The impact on peoples lives can be huge. Hearing loss can be frustrating and lead to social
isolation with far-reaching impacts.

Read the full report at https://www.nfd.org.nz/help-and-advice/listen-hear-new-zealand-report/

MENTAL HEALTH
AND HEARING
LOSS
Find out how you can support
family, friends and clients

Learn more about how to support people who are hard of hearing or deaf and
may experience social isolation.

When: Friday 31 March 2017

Time: 9.00am - 11.30am, Morning tea provided.
Where: Level 3, JML Centre,
3/340 Albert Street, East Melbourne, VIC

Auslan Interpreted Event

Presenters:
Beyond Blue - Qualified Mental Social
Australias largest Worker, Counsellor and
national organisation Registered Provisional
focused on increasing Psychologist from
awareness about Able Australia.
anxiety and depression.

Chrissy Wright Alana Roy

RSVP:
Friday 24 March 2017 to Marley on 03 9473 1133 or marleyh@hearservice.com.au
Early intervention drives lifetime success for deaf
children
The Hon Jane Prentice, Assistant Minister for Social Services and Disability Services, recently
launched an Australian-first report into employment, education and social outcomes of children
with hearing loss

The report highlights how First Voice early childhood intervention programs contribute to positive
longer term outcomes for graduates, from childhood into adult life in spite of their hearing loss.
The results also revealed that deaf children who receive early intervention support, surpass
general population outcomes with high levels of education attainment, social participation and
employment.

Photo: Michael Forwood from First Voice; Jane Prentice MP; Rosie Gallen and Jonah Roberts; Jim
Hungerford from The Shepherd Centre

The event was held to mark World Hearing Day earlier this month at The Shepherd Centre in
Newtown, Sydney. Guests heard from Shepherd Centre graduates Rosie Gallen and Jonah
Roberts who spoke about the life-changing early intervention services they received which
supported the findings of the survey.

The outcomes of a Deloitte Access Economics cost benefit analysis were also released which
shows that for every dollar invested in a First Voice early intervention program, there is a $2.20
return on investment. These benefits include wellbeing, economic gains and financial benefits.

As the National Disability Insurance Scheme continues to roll out across Australia, the report
reinforces the importance of maintaining crucial funding for early intervention services which
continue to set up deaf and hearing impaired children for lifelong success.
Rod Sims is chairman of the Australian Competition and Consumer
Commission. He was speaking at the National Consumer Congress in
Melbourne.

"I feel it's my job, and that of the ACCC, to express concerns with certain proposed approaches to
privatising human services. This extends to the potential challenges policy makers will face in
delivering on the enormous benefits of the National Disability Insurance Scheme.

Those promoting the private provision of human services need to address key implementation
issues if they are to advocate change. Simply assuming, as we have often done, that the private
sector can do it better, without more, can be a recipe for a repeat of the VET-fee disaster.

So what is needed? The first step is to understand the difference between infrastructure assets
and human services.

The key differences are, first, that the performance of infrastructure assets is easily measured; we
can quickly tell if the assets are not delivering as they should. Second, the users pay for the
services and will complain loudly if they have concerns.

In the case of human services, performance is usually hard to measure and to compare. How
good is the education provided or the health service that is delivered?

In addition, services are often free or heavily subsidised. Users often do not have to pay for
them. Left alone, in these circumstances the pursuit of profit will provide clear incentives for
higher prices and poor outcomes. At best this means legitimate service providers fail to effectively
or efficiently deliver the public objectives intended and, at worst, it invites rogue traders to take
public funds and exposes often vulnerable consumers to unscrupulous practices. Simply saying
private provision is always better ignores these obvious dangers.
What is needed are ways to ensure private incentives are aligned with the desired outcomes.

If we are to proceed, then the focus must be on consumer safeguards which can work. This will
involve carefully designed policy settings, close monitoring by a specialist and well-funded agency,
and strong sanctions for non-performance. Effective policy settings are ones that seek to prevent
participation by businesses not capable of or interested in meeting the objectives, setting
benchmarks aligned with the objectives, and importantly allowing regulators to stop the flow of
funds to participating businesses who systemically fail to meet those benchmarks.

Policy makers should also look carefully at the role commissions and targets play in lead
generation and the potential for bad outcomes when not linked to quality.

While generalist regulators and laws such as consumer protection regimes can be expected to
deal with the outliers that manage to slip through an otherwise well-designed regime, this is not a
substitute for the specialist supervision and regulation required for high-risk areas.

The private sector is the preferred provider of goods where we have sufficient choice and must
pay for the service, and/or we can easily measure what we are getting. Where these conditions
cannot be met, naive statements that "private is better" are no substitute for well thought through
reforms. And if, after careful thought, appropriate safeguards are too difficult, then maybe this is
not a service suited to private sector provision."

Here is the link to the full article in the Sydney Morning Herald:
http://www.smh.com.au/comment/privitising-ndis-services-could-be-a-repeat-of-the-vetfee-
disaster-20170314-guxs7g.html

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