OTCs: An opportunity and not Armageddon

Dr. Mike Valente shares his experience with OTCs and why he believes integrating these devices in your clinic could lead to increased patient visits and revenue.

Between 2015 and 2017, expert panels reported on why hearing aids weren’t adopted. Cost, accessibility, and convenience were cited as the primary reasons. These meetings led to the Over-the-Counter (OTC) Hearing Aid Act leading to OTCs becoming available in Fall 2022 for mild to moderate hearing losses.

Upon reading those reports, I believed OTCs would become reality and began pondering how to modify our Clinic to accommodate this challenge. I never viewed OTCs as a threat because most consumers pursuing OTCs were not visiting our Clinics.  Rather, I viewed OTCs as an opportunity and catalyst for consumers to reconsider amplification.  

In 2018, I modified our practice to accommodate an ‘OTC-type’ device (i.e., entry-level aid) based on the evidence gathered in our Clinic.1 Rather than sending patients who inquired about OTCs to drug stores or other facilities, it seemed wiser to integrate OTCs using an unbundled approach. This strategy would provide patients with more personalized care than provided by most OTC or direct-to-consumer (DTC) online devices.

To promote this new approach our staff developed materials to counsel patients on the differences between our OTC device using an unbundled approach versus our traditional hearing aids using a bundled approach.

In 2022, I recorded three lectures for Hearing Health & Technology Matters to share how our practice integrated OTCs. Links to videos are below.

Addressing cost using an unbundled approach

To address cost, we had to reduce the charge our patients paid for hearing aids using our bundled approach. We successfully and exclusively used the bundled approach for over three decades, but this had to change in order to reduce the charge to our patients.  

To reduce the charge, I created an unbundled approach. I developed an Excel spreadsheet that accurately calculated our charge/hour (i.e., cost/hour + desired profit). In addition, a time analysis was completed for each visit type used in our dispensing practice. This created a “menu of services” supplementing our unbundled approach.

This unbundled approach resulted in offering hearing aids at a significantly reduced charge. We charged for the cost of the aids as well as the cost for a hearing aid evaluation, coupler measures for quality control and the fitting using REM.

All other services included in our bundled approach (e.g., pre/post validation measures, speech in noise testing, dehumidifier, hearing aid checks, replacing receivers, sending aids for repair, providing a loaner; replacing tubing, etc.,) were excluded. These additional services were reported as a “menu.” Patients could pick services they wanted. We counseled patients that charges would be applied for all post-fit visits.

Importantly, we kept our traditional aids/bundled model. Interestingly, in tracking our initial 6 months, we found 93% of our patients elected our traditional aids/bundled approach!

We felt this was related to the counseling tools we developed explaining the differences. In explaining how they arrived at this decision, patients often said, “I don’t want to be nickeled and dimed to death” and desired the expertise audiologists provided.

For a detailed discussion of how our charge/hour was calculated for our unbundled approach please watch my lecture, “Running a successful Audiology clinic: Is bundled or unbundled approach best.”

Addressing accessibility and convenience

The other two issues were obstacles in assessing service and the inconvenience of receiving service that typically required numerous appointments that were not always convenient for the patient. To address these issues, time was spent creating counseling tools on how our practice provided remote care (i.e., schedule Zoom, FaceTime) and remote fine-tuning for our patients residing in Missouri.

Most audiologists have been reluctant to adopt remote-fine tuning for many reasons. When creating and promoting these new services, we tried to overcome some of those perceived obstacles.  

For a detailed discussion on how we addressed the reasons audiologists have rejected remote-fine tuning and how we integrated these services into our practice please view “Successfully integrating remote care into an Audiology practice.”

Putting it together – integrating OTCs, remote care, and remote fine-tuning

The final piece of the puzzle was putting all these pieces together to integrate OTC devices using an unbundled approach along with remote care and remote fine-tuning into our practice.

For a detailed discussion of how this was accomplished please view “Successfully integrating OTC hearing aids into an Audiology practice” along with the other two videos.

Final thoughts

With numerous OTC or DTC devices, patients can order hearing aids, complete a hearing test, and receive follow-up care from home. These devices truly address cost, accessibility and convenience. Many of these patients, however, will not receive optimum benefit because these devices are not customized to the patients hearing loss using REM. In addition, follow-up care is not provided in many cases.

With the brief discussion offered in this blog and viewing the three videos linked below, you can decide if dispensing these devices using REM via an unbundled approach can be adopted in your clinic. Integrating these devices in your clinic would lead to increased patient visits and revenue, as well as provide a better outcome.

In addition, in 2018 we offered only one device. Today I suspect many additional high-quality OTCs would be added. In time, I predict many of our patients choosing OTCs will seek higher levels of technology and the services provided in your clinic. This approach follows my mantra that “if they come to your Clinic, keep them in your Clinic.”


1. Voss, A., Oeding, K., Bankaitis, A., Pumford, J., & Valente, M. (2018). Coupler and real-ear performance between PSAPs and hearing aids. Hear Rev, 25(11);10-18.