Hearing Matters Podcast

Professional Ethics in Hearing Healthcare with Dr. Michael Page

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What's the difference between following ethical codes and living ethical principles? In this thought-provoking conversation, Dr. Douglas Beck sits down with Dr. Michael Page, lead ethicist and author, to explore the complex ethical terrain healthcare professionals navigate daily.

Dr. Page draws a crucial distinction that transforms how we approach ethics: "If we live the principles of ethics, the codes of ethics just automatically fall underneath that." Rather than seeking the outer boundaries of permissible behavior, principled practitioners focus on making decisions that uphold trust and serve patients' best interests.

Through personal stories and practical examples, the conversation illuminates ethical gray areas we all face. When should you accept industry incentives? How do you maintain professional boundaries with patients? What happens when your role blurs between clinician and sales representative? These questions have no simple answers, but Dr. Page offers a thoughtful framework: consider whether actions are illegal, unethical according to codes, or simply immoral according to your principles.

The discussion delves into regulations like the Stark Law, Anti-Kickback Statute, and Physician Payment Sunshine Act, revealing how transparency shapes ethical practice. As healthcare becomes increasingly commercialized, understanding these guidelines becomes essential for maintaining professional integrity.

Perhaps most powerful is Dr. Page's assertion that "if we're not being honest with ourselves, there's no possibility of ethical practice with anyone else." This reminder that ethical practice begins within ourselves provides a compass for navigating the increasingly complex relationships between practitioners, patients, and industry partners.

Ready to deepen your understanding of professional ethics? Listen now to gain insights that will strengthen your practice and your relationships with those you serve.

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Blaise Delfino:

Thank you to our partners. Cycle, built for the entire hearing care practice. Redux, the best dryer, hands down Caption call by Sorenson. Life is calling CareCredit, here today to help more people hear tomorrow. Faderplugs the world's first custom adjustable earplug. Welcome back to another episode of the Hearing Matters Podcast. I'm founder and host Blaise Delfino and, as a friendly reminder, this podcast is separate from my work at Starkey.

Dr. Douglas L. Beck:

Good afternoon. This is Dr Douglas Beck with the Hearing Matters Podcast, and I am here today with my friend and lead ethicist, Dr Michael Page. Michael, good to see you.

Dr. Michael Page:

Thank you, always nice to spend time with you in these conversations.

Dr. Douglas L. Beck:

I appreciate that, and this is our second one in 2025. We did one a few months ago and it was so popular that I asked you to come back and let's talk a little bit about your new chapter, which is in the book by a trainer and Taylor right, taylor correct. What's the title of the book? I should know it, but I forgot.

Dr. Michael Page:

Here. Let me show it to you because it's really quite the textbook and I'm honored to be a part of that but Strategic Practice Management. It does focus primarily on audiology, but there are a number of healthcare professions that could benefit from it and I think I've heard you refer to it as a great resource and I call it a reference book. It's not a book that I would read from cover to cover, but great, great reference book.

Dr. Douglas L. Beck:

I won't mention that to Dr Traynor but for those of you who don't know Dr Page, he is a frequent national and international presenter and consultant on ethical practices and workplace trust, healthcare management and executive leadership, aaa National Ethical Practice Committee Chair, board Chair of the Utah Division of Occupational and Professional Licensing and Chair of the Advisory Board for the Utah Division for the Deaf and Hard of Hearing, as well as being a guest professor and adjunct faculty physician at the University of Utah, utah State University, brigham Young University, university of the Pacific and Salus University. So that's a quick update. So what I'd like to do I want to start with one of the quotes from your chapter that I found really endearing. So you talk about the risks we may and may not see and you talk about the study and practice of ethics is the complicated and convoluted navigation of vital relationships for the protection and goodwill of all. And it kind of begs the question when we talk about goodwill, whose judgment of goodwill are we talking about?

Dr. Michael Page:

Certainly so. Much of this, doug, is subjective. We always want things to be black and white, plus or minus, and so the subjective nature of all of this is reflected in that statement. So who's goodwill, and can we come back to any aspect of ethics that would give us some black and whiteness of these ideas? But let's talk about that in terms of codes of ethics versus principles of ethics.

Dr. Douglas L. Beck:

Yes, please.

Dr. Michael Page:

And codes of ethics. You and I have been subject to these codes of ethics for decades. Right, and basically that's what we study. When we talk about ethics, we talk about codes of ethics. That's what we study when we talk about ethics. We talk about codes of ethics. We go through a list of. It's a checkbox Can I do this or not do this? They'll let me do this to this extent, but not beyond that amount. All of those things become the codes of ethics. But if we take the higher road, which is the principles of ethics, then we get into some what of more? Even more subjectivity.

Dr. Douglas L. Beck:

but it's the subjective stuff that allows us to really look within, because I think the most important parts of ethics come from deep in our souls and you know you point out in part of your discussion about the code of ethics where for many of us, when you hear the code of ethics you ask, okay, what's the limit to that right? And we start to make sure that we're within the limit and hopefully we don't exceed the limit of ethical behavior. But the principle of ethics would say that you shouldn't be looking for the outer margin right.

Dr. Michael Page:

Correct. That's really correct. In fact, I think if we live the principles of ethics, the codes of ethics just automatically fall underneath that and we're not thinking about do's and don'ts anymore, we're just thinking about what's more powerful for us.

Dr. Douglas L. Beck:

I think that's a good way to look at it. And then people talk about personal ethics versus professional ethics versus medical ethics. Are those all the same, or do you see them as different?

Dr. Michael Page:

Well, they have different aspects to them, but certainly the principles of ethics could be applied to each one of those, and in the chapter we go through several sections principles of or ethics of self, ethics with patients, colleagues, industry, the profession as a whole. But I think the reason we wanted to start out with the ethics of self is because if we're not being honest with ourselves, there's no possibility of ethical practice with anyone else.

Dr. Douglas L. Beck:

And one of the things you said under the test of ethics, which I really enjoyed. While codes of ethics have certainly transformed over time, the best principles of ethics do not. They remain the same. Thank you.

Dr. Michael Page:

And that's I agree. Those principles will never change. But you and I both have seen the evolution of codes of ethics over the years.

Dr. Douglas L. Beck:

Yeah, because they apply to more specific situations. Right, and one of the major ones in healthcare in general, whether it's audiology or pharmacy or orthopedics, you know, has to do with our interactions with industry, you know. So you have people like you and I who are professionals, we are licensed, we have degrees, we do that stuff, but then you have, you know, without industry in any of these areas, there's very, very little profession left. You know, in pharmaceuticals, for instance, you could be a brilliant pharmacist, but if you don't have access to the drugs, it makes it rather difficult to solve the problems of the patient In our profession, without hearing aids, assistive devices, over-the-counter products, things like that, we can be the best audiologists in the world, we could have a brilliant diagnosis and treatment plan, but without the tools from industry, we can't necessarily facilitate those answers.

Dr. Douglas L. Beck:

Let's talk about some of the areas that we've all, I think, been concerned with is the interaction between professional and industry ethics. And now we're in 2025, and you see an awful lot of new companies coming on board in hearing healthcare, new manufacturers and distribution networks. Do you have any particular guidance for the interaction between industry and professionals that are more principled than, perhaps, rules?

Dr. Michael Page:

Sure, I'm going to call it a current plague, it's a modern day plague, and that is how we are willing and able to sacrifice the objectivity that we need with patients in order to satisfy either a financial incentive or some other type of incentive from industry. Some of this, for me, is something that I've watched over years, and if I can share a little story with you that became symbolic of my own change in understanding this particular principle, it was probably in the 1980s and I was at Children's Hospital in Salt Lake City. I was in charge of all of the purchasing of devices hearing aids, assistive listening devices, supplies and all of that and there was one particular vendor that began to sort of incentivize us, particularly with cases of batteries hearing aid batteries and so they'd send a note and say, hey, you know, buy 10 cases this month and we'll give you a $100 Amex gift card. Well, who doesn't want that? And so I was only going to order eight, but now I ordered 10. And in that shipment because I was in charge of receiving I received that $100 Amex gift card. And I looked at that and I thought, wow, it's a night out on the town gift card. And I looked at that and I thought, wow, it's a night out on the town, it's a night out on the town and in the 80s a hundred bucks went a long ways. But I took that card and I just put it in my desk and then every few weeks I was ordering more and that stack of gift cards got pretty substantial.

Dr. Michael Page:

There was something in me that just kind of said that's not yours, Even though I felt incentivized and I actually bought more than we needed in order to satisfy getting another gift card. And it was probably a couple of years later. Thankfully, at that time, these maybe time, these maybe. Thankfully, these didn't have expiration dates. But I was working late one night and cleaning out my desk and stumbled on this stack of gift cards. The value of it was several thousand dollars and I remember just distinctly looking at that and saying Mike, those are not yours, yeah, Not yours. And even though you could spend those, no one would ever know. That's right. No one would know. Patients wouldn't know, Supervisor wouldn't know. The next morning when I came to work, I took that stack, walked into my supervisor and I said these are gift cards that have come as a result of our purchases to this company. They're not mine. I'm just going to give these to you. I have no idea what happened to those. Who knows what happened?

Dr. Douglas L. Beck:

Well, that's a really interesting story and I think many of us have been in that situation. And what is the best answer? Because, look, there are companies and I'm not going to name names, of course who would say if you buy this amount of hearing aids, that amount of batteries, this amount of whatever the product is, there's an incentive. Now, yeah, you need eight, but if you buy 10, blah, blah, blah, what should the audiologist or the hearing aid dispenser or the ENT who receives that offer, what should they do with that? How should they?

Dr. Michael Page:

handle that? That's a great question and I think in our thinking there are three components that we should go through answering that question. One is there any aspect of this that's illegal? Is there any aspect of this that's forbidden in terms of being unethical? And then we're going to go to the third one, and that is is there any part of this that's immoral? And do we avoid immorality in our business relationships simply because it's legal? So is there something illegal about that?

Dr. Michael Page:

And there is some aspect of illegality in it in terms of what's allowed under the Safe Harbor Act, which was a law that was given during the Reagan era and it was in the hopes of bringing down healthcare costs and it allowed hospitals and healthcare entities to negotiate better pricing on goods and services. But it had to be in a contract. So if I negotiate a 30% discount with XYZ Hearing Aid Company, if it's in the contract, then we're legal. We're legal If XYZ Company calls and says on December 15th, end of the year, if you buy 10 more devices, we'll give you 35% discount. Well, if it's not in the contract, then it can be illegal. So that's the first part we want to go to. Is it illegal?

Dr. Michael Page:

But if we go to the unethical or the ethical part of that of the four principles of ethics. Are we in violation of that principle of ethics Because there's nothing in AAA's code of ethics or ADA's or ASHA? I don't believe that will forbid us from taking certain discounts. But they would say it was unethical if it became illegal. Yeah right, that's part of what we have to take into it.

Dr. Michael Page:

And then really the morality part of it is what you alluded to earlier, like whose morality, who's, yours or mine or everybody else's? And so we get less objective when we get into the morality part. But the guidance, I think the guidance back to your question first of all, is anything that they're proposing to us illegal? If it is, that's a hard no, we're not doing that. If it's not illegal, then is it unethical according to codes of ethics? And we may look at those codes and say, yeah, looks okay according to the codes. But then we take it to the principles of ethics and is there a potential in those principles of ethics for this arrangement that they're giving me to be devious or deleterious, as they say? And if that's possible, then our morality has to kick in and say the police aren't going to come get me, the DOJ is not going to come get me, my employer is not going to come get me, but this seems to be wrong, so I choose not to do it.

Dr. Douglas L. Beck:

Yeah, well, one of the things that I would propose for people going through something like that and I'm not the ethicist it seems to me, if you're buying batteries, let's use that as an example, and they give you a $100 gift card I might be really tempted to just say, hey, listen, just give me a $100 discount on the price of those batteries and we're fine. Or maybe, if I'm going to collect the gift cards for a couple of months, maybe I can I use those for my next purchase of batteries. Right, so it may be coming, just because to me that would seem like maybe that would solve the problem and get rid of it for you, because you're not tempted to use it for yourself. You're still using it as the a priori purchasing agent at the moment.

Dr. Michael Page:

I don't know. I'll take that one step further, doug, and that is not only please give me a hundred dollar discount, but let's put that in a contract so that we have that secure and that we're in line with the Safe Harbor Act and I benefit from that and we're in the legal part of that. And then absolutely yes.

Dr. Douglas L. Beck:

And one of the other things that I learned in the chapter, and I guess I knew this, but I hadn't thought about it until I read your chapter. So sometimes you have patients who you know you have a strictly professional relationship with. Mrs Smith comes in once a year, gets her hearing test, for whatever reason, and I reprogram her hearing aids to the most current one and I do real ear measures and all of that stuff. And after four years you know she's thinking of me as a friend, right, because she's coming in. But she knows who I am, I know who she is and we always have nice chit chat. You know how are the kids, how's the family? Blah, blah, blah. And after a while she says oh listen, I know that you're really involved with online stuff and I'm looking to buy a new phone. What would you recommend? Okay, so give us the upside and the downside of answering that as a friend or as a professional.

Dr. Michael Page:

Sure, I can take you to several examples of real stories just like yours that have happened, and one that is very analogous is while working in a department of rehab years ago, there was a physical therapist who was an avid biker and had been seeing this pediatric patient for months and months. And the family came in and said ah, we know you're an avid biker and you've been such a great part of our family and we want to go buy bicycles for the family so we can go ride together. And he came to me at the time and said should I do that? And my question was well, what's the risk? And he said well, I really can't think of any risk. And I said well, you go to the bike store with them and you help them select bikes that are within their budget.

Dr. Michael Page:

And let's say they're out riding with the family and the front wheel falls off of one of the bikes, causes a head injury in one of the kids that may not have been wearing their helmet or whatever that is. Or let's say they do the bikes and then they have another friend who comes and says those bikes are just worthless. Who told you to buy those bikes? And then they come back to you and say, wow, does that change your professional relationship? And I guess my quick answer to him was is it in the scope of your practice to make a bicycle recommendation to a patient of yours? And the quick answer to that is, well, of course not, of course not. And what I offered to him in lieu of that is maybe give them some resources to how, to you know, select the appropriate bikes or whatever else. Be helpful, be friendly, be kind, but also be able to establish the scope of your practice.

Dr. Douglas L. Beck:

Yeah, and I think that's one that is easy to fall into a trap. That is easy to fall into because you want to be a nice guy, you want to help your patient, you want to give them the benefit of knowledge that might be otherwise benign, but you could be setting yourself up and your patient for failure. So one of the things that just happened in my life which is a bit of an ethical dilemma for me I put a lot of stock in the fact that there are very, very substantial correlations between untreated hearing loss in at-risk patients over many years and the potential for that hearing loss to exacerbate cognitive decline. Now, when I say these patients have to be at risk, this is pretty much what Achieve said. This isn't something I created. They said patients who were older were at higher risk. Patients who have less education higher risk. Patients with multiple comorbidities, cardiovascular disease, diabetes, patients with multiple comorbidities, cardiovascular disease, diabetes, patients with greater degrees of hearing loss. So we're not talking about somebody with a ski slope loss at 6,000 hertz who's 27 years old. We're talking about people with perhaps a severe or profound loss. We're talking about patients, lower socioeconomic groups, less education, more comorbidities, all those things and I really felt like people were trying to get me to say hearing loss causes cognitive decline.

Dr. Douglas L. Beck:

I wasn't about to say that and I've never said that. What I've always said is, you know, that untreated hearing loss in at-risk patients as we just defined at-risk tends to exacerbate cognitive decline over many, many years. And I felt like that was a bit of an ethical dilemma because I didn't want to say that the evidence is clear one way or the other. But the preponderance of evidence is that it's at-risk people who we need to be concerned about, not just everybody with hearing loss, and, as a matter of fact, the vast majority of people with hearing loss don't have cognitive decline. So it felt a little bit awkward and a little bit off-putting and I'm curious to get your takes on that as an ethicist and as somebody who puts in a great deal of time thinking about what I can and can't say, what I should and shouldn't say.

Dr. Michael Page:

Words matter, especially these days in political arenas that we're in, that we're in the risk is anyone taking even a snippet of what you say and putting it in a different context can make it appear as if you said something that you didn't intend.

Dr. Michael Page:

And I think there's so much caution, especially in this arena, and we see a lot of fervor around this particular idea as well, and there are a number of individuals who want to take these concepts, turn them into hearing aid, sales which is the use of the word sell, as even another concept we could talk about. But it again comes back to what's the potential risk that I may not be able to see, and it takes someone admitting that there might be something that they cannot see. And that's probably one of the most problematic parts of ethics is that most of us and I'll say myself as well, I'm not willing to admit that I can't see everything. Yeah, of course, and the most educated person will have to be super vulnerable to say I may not see everything. In this context, in this situation, I may not see everything. You don't hear that from the voting at all.

Dr. Douglas L. Beck:

And you said something that to me is very striking is that you have to keep the original intent and meaning within context. You can't cherry pick your data and you can't cherry pick a sentence or a phrase. You have to keep it within context to truly be ethical, I think, and the essence of the word ethical is trust. I mean, ethics is based on trust and if people are cherry picking and floating out of context, as we see often in politics and sometimes in science, you know it becomes a real trust issue immediately.

Dr. Michael Page:

Yeah, yeah, I have to agree with you. And it all comes back to trust and there's some synonymous ideas totally with ethics and trust, for sure.

Dr. Douglas L. Beck:

Anonymous ideas, totally with ethics and trust, for sure. What do you think about the situation now where you have many manufacturers bringing products to market in the over-the-counter space and some audiologists and hearing aid dispensers are in favor and they voice their opinions to the consumers or the patients? Some are antagonistic or against it. Whether you're pro or con OTC, it's legal, it's FDA right, as long as you're following the FDA guidelines. Should audiologists and dispensers weigh in on this stuff? Or is it better, as we said earlier, is that within your scope of practice to comment on this?

Dr. Michael Page:

So tell me about that, first of all, I think the most important acknowledgement is that manufacturers and industry members are not health care providers. They're not.

Dr. Douglas L. Beck:

But there are situations where the sales reps are audiologists.

Dr. Michael Page:

That's true, and you'll notice that neither AAA nor ASHA I think none of the codes of ethics address audiologists functioning in a sales role, Right, you don't address that and that's a glaring misstep, if you will, that we're not addressing that. And I spent a number of years working in industry with cochlear implant companies and one of the first questions that I asked when I was in that clinical supportive role is, I said is this a sales role or is this a clinical support role? And I'll never forget the answer. I want to hear it. What was the answer? They said we're still trying to figure that out. Well, that was in 2005. That was in 2005. And one of the difficulties is that those roles that used to be clinical support, surgical support, they turned into sales roles and those roles turned into commissions and commission-based income and those kinds of things. But it's super important to remember that manufacturers, as good-willed as they may appear, are not healthcare providers.

Dr. Douglas L. Beck:

And in that situation because I am an audiologist, I'm licensed in audiology and I worked for manufacturers before and I work for one currently it seems to me that perhaps the smart thing to do is to disclose that if you are the regional sales director, you're the account manager. You know. Make sure that's on your card, make sure that you introduce yourself that way so people understand kind of what your role is and who's who and what's what. Does that help alleviate any of those problems?

Dr. Michael Page:

I don't know that it does. I mean, anything that adds transparency is always good. It's always good, but I think the mistake that we see with industry members that are audiologists is that it's an unspoken conflict with people. So when I used to go in and do integrity tests on cochlear implants, I would introduce myself as a representative from this company and I would say I'm an audiologist and so you could see in patients' eyes they were like, oh well, yeah, I guess that's good. Yeah, I mean, but they could see the difference. And then clinicians oftentimes would struggle between Michael, are you functioning as a clinical provider, are you an audiologist, or are you here actually to have a good experience so that we'll buy more devices? And they'd never say it like that, but I would when I was clinically active I would see audiologists coming in that kind of a conflict role.

Dr. Douglas L. Beck:

I think it boils down to the wisdom of Solomon, right, but I think it's important to highlight that it could be a discrepancy right between your roles that you have to your license and your state and the consumers and patients you take care of versus your employer. And they're all important. It's not like you know, like one isn't important. They all are. Do you anticipate AAA or ASHA or IHS or anybody is going to tackle this?

Dr. Michael Page:

I think at some point they're going to have to, but I have not heard Heidner hair of any wind of change in that way. I think. Audiologists it's one directive that I was given by one implant company was Michael, you're not functioning as an audiologist when you go into that role, you're representing the knowledge that you have.

Dr. Michael Page:

But, for instance, I'm not licensed in Kansas, in Mississippi or any of the other cities or states. I'm not licensed there, so I was not allowed to function in the role of a clinical provider and you're not to touch a patient without that audiologist being present and understanding. Again, you're advising that audiologist but of course we had to touch a patient if we're doing integrity testing or otherwise like that. But it was a careful role.

Dr. Douglas L. Beck:

I'll tell you after spending the better part of a decade in the operating room and I'm happy to share some of these stories. But I won't give names or details. But when there's a new drill, when there's a new surgical instrument, when there's a new protocol, sometimes you know physicians will allow manufacturers, reps, to come in and show them how to use a tool in surgery, and you know they also have classes. You could learn it in a temporal bone lab or you could learn it, you know, on a cadaver study or something like that. But a lot of the ongoing manufacturer's education occurs in real time in the operating room and I, you know all these same questions.

Dr. Douglas L. Beck:

I mean for us it seems relatively minor. Right, that you know we're talking about hearing and listening and cochlear implants and hearing aids and very, very important stuff, but not like a kidney transplant or a CABG. You know coronary artery bypass with a graft, and I'm not pointing fingers, but I'm saying that these things where you have a very, very smart manufacturer's rep who is helping to educate and guide the surgeon during surgery, that could easily be the same sort and maybe by thinking about it in those terms, it makes it more clear that that's what the issue is is that you have a salesperson telling the surgeon how to set the drill, and maybe that's okay, maybe that's not okay, but I think when we take it at that level it becomes a lot more serious than somebody saying, okay, turn on implant electrode number seven.

Dr. Michael Page:

This is so reminiscent and I've spent probably that much time in the operating room as well, in fact functioning as an electrophys monitor guy for spinal cord fusion, spinal fusions and things like that. But I remember, specifically in the implantable device arena, being in the operating room, being in the surgical field, and I could see what the surgeon was doing. And there were just a time or two these are highly skilled people, but there were a time or two when I thought, hmm, I want to tell you to do that differently and you're tempted, but who can't? But what I would offer them is have you considered XYZ and so many people, audiologists, who are in this role? They become highly skilled. And there were a time or two in these operating rooms when it was over and the surgeon would say, wow, I'm so glad you were there today. That changed the course of our case and you feel grateful and I'm thankful that changed it. But is it in the scope of my practice? And those are the questions we ask ourselves.

Dr. Douglas L. Beck:

Well, when I started in the operating room was probably 1984, and it was a major ordeal then and people used to say, well, why is that audiologist doing the neurophysiologic monitoring during skull base surgery? And fortunately ASHA back then had a statement in their scope of practice saying that neurophysiologic monitoring was a scope of practice. But it was long before it was in other scopes of practice and it was always disconcerting and yeah, it's an issue. All right, I want to move on. Let's talk a little bit. Can you tell me what the Stark Law and the Anti-Kickback Statute have to say about these sorts of things? What is the Stark Law? What is the Anti-Kickback Statute?

Dr. Michael Page:

Sure, anti-kickback Statute is am I receiving remuneration for? Am I being incentivized? Right, basically, am I being incentivized and a lot of that. The history of that anti-kickback statute came from even civil war time and other times in the country. But anti-kickback statute would be some of what we've talked about already and that is, are certain companies trying to incentivize us into sales, purchasing or others of their devices? So technically, under the Safe Harbor Act, as long as it's in a contract, it is not considered kickback. If it's not in a contract, it could be considered a kickback and that means that if I buy certain devices or a number of devices, then I get something in return.

Dr. Douglas L. Beck:

So, michael, tell me a little bit then about the Stark Law.

Dr. Michael Page:

How's that different from the other topics we're discussing Sure Stark Law comes into the principle of self-referral and that means that if I'm going to recommend a treatment for you, if you're my patient, will I send you to a place that benefits me in the short term or the long term as well? So, for instance, my wife's a pediatric nurse practitioner and if she in her practice were to see kids that needed hearing evaluations or treatment for audiology-related issues, if she were to send them exclusively to my practice, that could be considered a violation of Stark Law. But Stark Law differs from state to state and federal and statewide as well, so it may or may not apply here. But the idea is she would refer kids to my practice. I would make money based on that, which would come home to our home financial pool, and then she would in turn benefit from that as well.

Dr. Michael Page:

Okay, but what about the surgeons who own surgical centers under different corporations? Is that a violation or is that legal? Where I provide that surgery, I prefer to do it at this surgical center, and here's why. So there's. I know that's been a legal battle in a number of states.

Dr. Douglas L. Beck:

Well, and realtors with title companies same sort of deal, right? Sure, you know, just sold you a house, and blah, blah, blah. And we're going to use this title company. And they don't mention that they own a piece of that, you know anyway. Okay, so that's what the Stark Law is self-referral. Whether stuff is legal or not, we're not attorneys, we don't know, but that's the one that always gets me right For outpatient procedures. Oh well, we're going to recommend ABC Surgical Center and it's, you know, outpatient, and blah, blah, blah. And then you look and you say, oh, it's the principle of that that matters.

Dr. Michael Page:

And if you stay with the principle of Stark Law, it even comes back to us. For instance, if I were an audiologist and I were on the clinical advisory committee for XYZ Cochlear Implant Company and I happened to do primarily that device, the principle of Stark Law would make us ask about that device. The principle of Stark Law would make us ask about that. Now it may not be illegal, but I know a number of audiologists who are on those advisory committees and the expectation from that company is that they get a greater referral number because of that association.

Dr. Douglas L. Beck:

Yeah, tell me about the Physician Payment Sunshine Act. That seems to me that came in with the Affordable Care Act and it seems to be a very clever watchdog sort of a service. Tell me what is the Physician Payment Sunshine Act and how does that work.

Dr. Michael Page:

My only regret about the Physician Payment Sunshine Act is that it doesn't pertain to audiologists. Generally it doesn't, but essentially it's a way for watchdogs to keep track of the relationship between members of industry and physicians not physical therapists, not optometrists, not audiologists. But, for instance, I can go to the physician I think it's physicianpaymentgov, I think, or openpaymentsgov. I can go to that website and look up any physician in the country and see who has given them money, who took them to dinner, who took them on a cruise, who brought backpacks or whatever else.

Dr. Douglas L. Beck:

Yeah, and that's the transparency you were talking about earlier.

Dr. Michael Page:

Yes, and the obligation in open payments comes to the industry member or the industry company. So if a member of Pfizer goes and visits a physician in the area and takes them to lunch, the lunch costs $23. They have to come back and log that in, show a receipt, post that online and so that shows up under the physician receiving that money and so it doesn't apply to audiologists yet, but I wish it would.

Dr. Douglas L. Beck:

Yeah, it makes good sense to me, because then you're totally transparent and if you take somebody to dinner, you take them to a show it's apparent for the entire world to see and do with as they see fit.

Dr. Michael Page:

One other piece about that which I think is really critical and we often pass by on Physician Payment Sunshine Act is you can go to that site and look up any company. So I could look up any of the CI companies. I could look up any of the pharmaceutical companies and then they will rank order the physicians that have received money from them so you can see who their biggest suitors are.

Dr. Douglas L. Beck:

And sometimes as a patient, you just don't even care right, you like the physician, you know the physician's competent, you know the audiologist is great, whatever, and so that's fine. But at least the knowledge is available to you if you seek it. So you know, for people who find that interesting it would be available. Do you think that's going to descend from physicians down to the rest of healthcare practitioners sometime in the near future?

Dr. Michael Page:

I'm surprised that it hasn't and honestly I think if we really understood the value of that site, it should attract legislators to make a change that way. But it would monumentally expand the scope of that, which would be probably 10 times what it's tracking with physicians, because there are so many other ancillary healthcare professionals.

Dr. Douglas L. Beck:

Let me change topics again. The FTC the Federal Trade Commission considers an advertisement's overall quote net impression to determine whether it misleads consumers. The audiologists may be guilty of deception if they misrepresent their treatment, their services or their outcomes. The AAA Code of Ethics states an audiologist may not guarantee outcomes. And then you had a specific call-out that you were familiar with. Can you tell us about that?

Dr. Michael Page:

Well, I'm not sure which one you're referring to, but maybe I'll tell you the story, because that could be it. I remember years ago being on the Ethical Practices Committee for AAA and someone took a picture of a billboard for a hearing professional of some kind, an audiologist actually, and the billboard said hearing results guaranteed. And that's really all it took because they had to go and that was kind of confessed to AAA. There was a cease and desist order and that really did come back down to are we deceiving someone by guaranteeing results?

Dr. Douglas L. Beck:

Of course I mean surgeons can't guarantee results, right, right, they don't, nobody can.

Dr. Michael Page:

Surgeons will tell you right up front we're going to make an incision in your belly and you might die from it. Yeah, I mean, they're obligated to say the risk, right.

Dr. Douglas L. Beck:

These are the risks and complications that are correlated on rare occasion with this procedure and you have to sign it. That are correlated on rare occasion with this procedure and you have to sign it. You're aware of that and you probably have to have a co-signature of somebody who said yeah, I saw him sign.

Dr. Michael Page:

So deception also comes back to what you mentioned earlier and that was the cognitive decline relative to hearing loss. I mean that could be seen as a form of deception if that research has been taken out of context or used for other purposes other than its original intention.

Dr. Douglas L. Beck:

Yeah, All right. Well, michael, once again, totally fascinating. I always enjoy catching up with you and I want to urge people to get the book and, in particular, I read the chapter that you wrote on this. We just did the greatest sense of that chapter. There's so much good information in there and I think the practitioners will find it to be very useful. Michael, you're a joy to speak with. Thank you so much for your time.

Dr. Michael Page:

Always enjoyable. Thank you so much, doug, my pleasure.

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Blaise M. Delfino, M.S. - HIS

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