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Your missing risk factor? Untreated hearing loss costs an additional $22K per patient—here's what Johns Hopkins does about it.

December 4, 2018

    Few population health managers focus on hearing loss as a contributing risk factor of cost, but hearing loss is a costly and treatable condition hidden in plain sight. It's highly prevalent and impacts two-thirds of people over age 70. Two recent studies in JAMA Otolaryngology demonstrate how untreated hearing loss may impact your bottom line:

    • Greater chronic disease risk: 52% greater risk of dementia, 41% greater risk of depression, and 29% higher fall risk for those individuals with untreated hearing loss over a ten year period;

    • More utilization: 50% more hospitalizations and 44% higher 30-day readmission risk; and

    • Higher costs: 46% higher total health care costs ($22,434 per patient on average over ten years).

    Other studies also note how sustained hearing loss is associated with loneliness, a risk factor that costs an additional $1,600 per Medicare patient per year.

    Our team sat down with the study authors to uncover why this problem persists, and why and how care transformation leaders should prioritize addressing this need.  

    Treatment adherence to hearing loss treatment is low

    Less than 30% of those affected by hearing loss own or use an assistive listening device, and patients often wait seven to ten years to get a hearing device. That's due to several treatment barriers:

    • Hearing aids are pricy: Provider-prescribed hearing aids cost $4,700 on average, ranging from $1,000 to more than $8,000;

    • Stigma affects self-perception and acceptance: Stigma and ageism impact patient decision-making about their hearing, such as being tested, seeking treatment, and wearing hearing aids;

    • Fitting process is complicated and iterative: Hearing aid fitting can be complicated and usually requires multiple visits to ensure the aid suits the patient's lifestyle; and

    • Providers lack awareness: Few providers are aware of untreated hearing loss's impact on patients' quality of life and general health.

    Addressing hearing loss may be the low-hanging fruit you're forgetting

    Tackling hearing loss does not require a massive overhaul. In fact, small investments around screening and increasing access to hearing devices can go a long way.

    1. Screen early in primary care and provide staff decision-making tools: Due to stigma, few patients are forthcoming about hearing loss. Standardize hearing loss screening in primary care and ensure effective next steps by providing decision-making guides; and

    2. Incorporate hand-held amplifiers on clinical floors: Low-cost hand-held devices can help clinical and non-clinical staff better communicate with patients experiencing hearing impairment. Invest in distributing them across hospital floors and educating staff on when and how to use them.

    Johns Hopkins improves patient experience and staff satisfaction by addressing hearing loss

    Investments in the inpatient setting are easily scaled and have the quickest return on investment. Since hearing loss is a communication barrier, staff often have to repeat information pertinent to post-discharge recovery and treatment adherence. Patients with hearing loss are at increased risk of readmission and have less satisfactory experiences.

    Johns Hopkins' recent pilot treats hearing loss as a patient experience lever and promotes upstream audiologist services. Our team spoke with researcher and audiologist Nicholas Reed of Johns Hopkins' Cochlear Center for Hearing and Public Health to learn about the ENHANCE intervention, which included nurse training on communication strategies and provision of amplification devices.

    Now, nurses screen for hearing loss upon admission and offer hand-held amplifiers along with custom-built, easy-to-read instructions, increasing patients' ability to comprehend instructions. Throughout their stay, nurses tailor communication strategies with the help of sign reminders above all patient beds to follow best practice standards like rephrasing rather than repeating. Early results suggest Johns Hopkins staff are more efficient (e.g., going into rooms less often) and a substantial number of patients experience improved communication compared to other hospital stays.

    Thank you to the following individuals for sharing their time and expertise with the Population Health Advisor.

    • Jennifer Deal, PhD, Johns Hopkins Cochlear Center for Hearing and Public Health
    • Nicholas Reed, AuD, Johns Hopkins Cochlear Center for Hearing and Public Health
    • Margaret Wallhagen, RN, PhD, FAAN, University of California San Francisco
    • Charlotte Yeh, MD, AARP

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