A couple of months ago there was a great expose on ABC Radio National concerning commissions and hearing aid sales. It has really opened up an awareness and started conversations about the ethics of having commissions in hearing healthcare and the lack of disclosure of this practice.
Commissions may be paid to a number of staff within the organisation, including call centre staff, administrative staff and, of course, the clinicians themselves. It can start with the call centre employee being paid a commission for booking in a patient consultation after cold calling them from a database the company purchased that would have your name, address, age and phone number. During the call the employee would generally offer a free hearing screen to entice you to book in. Once you do, they are paid the commission. I have seen many patients over the years who have been very aggressively chased by these callers and badgered into making an appointment by an overzealous call centre staff member chasing their commission.
Once booked in, you would attend their clinic and have your hearing screen. The hearing screen is commonly conducted by an administrative employee. If you were to fail your hearing screen, they would book you in for a full hearing assessment appointment with a clinician. This appointment booking may result in a commission for the admin- istrative employee. Over the years I’ve had many patients booking in to see me for a full Audiological assessment in a state of panic as they’ve failed one of these hearing screens and believe they’re losing their hearing. Upon doing the assessment we find they have completely normal hearing and their results were most likely exaggerated by the administration staff member in order to receive their commission.
Finally, and most significantly, the actual clinician you see for your hearing treatment would be on the largest commission of all. Generally they would be paid a percentage on the actual hearing device you are fitted with. The more expensive the hearing device they fit you with, the more they receive. These commissions can be in the thousands of dol- lars and I believe can be a massive carrot in front of the clinician’s nose to upsell to more expensive devices with features that may well be unnecessary for the patient’s needs.
Of course not all clinicians are commission-driven, but the temptation is there. I frequently see patients with very basic hearing needs who’ve been recommended top-of-the-range hearing aids with features they would never use and are not congruent with their actual needs.
In my opinion hearing clinicians are meant to be healthcare providers with the sole purpose of giving you the best treatment for your hearing in an ethical manner. In any other healthcare industry commissions are generally prohibited and if there is any conflict of interest it has to be disclosed to the patient.
Until we remove commissions, which I believe can cloud a clinician’s judgement, patients have every right to question the motives of their hearing provider. At the very least commissions should be disclosed to the patient at the outset, especially given that almost every large hearing company in Australia pays their staff commissions.
My company is very proudly locally and independently owned and free of all commissions with all recommendations based solely upon evidence-based practice methods. Furthermore our margins are the same whether we treat you with a basic economy level or a top-of-the-range device, therefore removing any conflict of interest with our recommendations.
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