Interview with John Luna National Director of Sales, Symphonix® Devices, Inc.

AO/Beck: Hi John: Thanks for joining me here today.

Luna: Hi Doug. Thanks for the invitation.

AO/Beck: I'd like to discuss some of the sales and marketing issues that relate to middle ear implants. However, before we get into that, can you please tell me a little about your professional history?

Luna: Sure Doug. I've been on the manufacturing side of the hearing healthcare industry for about 9 years now. Prior to that, I was in a private practice audiology clinic, where I served as an associate hearing aid dispenser, working on sales, marketing, counseling and hearing aid fittings with patients. I earned my bachelor's degree from the University of California at Santa Barbara, in speech and hearing sciences. So, I've been involved in both sides of the profession. I originally thought I would get my master's in audiology, but I really loved working on the manufacturing side of the profession, and the more I got involved with it, the more I loved it. I really enjoyed the activity in the early 1990s....programmable, directional dual microphone, High-Pro and NOAH were just hitting the mainstream offices and it was very exciting to be involved with those products as we were becoming a computer literate profession.

AO/Beck: Very good John. Tell me about your current position at Symphonix® please?

Luna: Sure. My title is National Director of Sales and as you can imagine, that means I'm involved with many aspects of the company. I oversee the North American sales organization including territory managers and our field clinical specialists.

AO/Beck: Of course that begs the question - does Symphonix have an international presence as well?

Luna: Yes, we do. Internationally, Symphonix has partnered with Siemens for distribution in the European Union. So for the readers in most of Europe, they can go through their Siemens international representatives to learn more about Symphonix.

AO/Beck: John, many professional offices and audiologists will see middle ear implants as threatening to their basic revenue stream. Can you address that for me?

Luna: Yes, I can. Basically, middle ear implants represent an additional option for the hearing healthcare professional and more importantly - for the patient! The device is not going to be for everyone. These devices offer new solutions and alternatives and they allow the audiologist and the otologist new opportunities to work together for the benefit of the patients.

For example, our research indicates that typical audiology practices might have some 4000 charts. About 240 of those patients, or about 6 percent, would probably choose the Vibrant® Soundbridge, if given the option. In other words, this small portion of patients represents people who have demonstrable mild, moderate to severe hearing loss and who are looking for non-traditional treatment options for their hearing loss. Maybe these are patients that didn't get accustomed to wearing something in their ear, or maybe the occlusion issues were too much. Maybe they didn't like the way the traditional hearing aids looked cosmetically. Regardless, these 6 percent need amplification, but either failed or didn't do well enough with traditional acoustic amplification to be considered successes. These are the people who have the best opportunity to succeed with middle ear implants. These patients are looking for hearing solutions, not another hearing aid.

AO/Beck: What about the issue of being cut out of the revenue stream?

Luna: I think audiologists who explore opportunities available with the Vibrant Soundbridge will see that the middle ear implant patients need audiometric diagnostic work, and after surgery they'll need follow-up work and tune-ups, and of course, that too, generates office fees. Specifically, beyond the pre-operative audiometric diagnostics, about 8 weeks after surgery, the patient comes back to the audiologist for activation of the external audio processor, which is similar to the dispensing of a digital hearing aid.

AO/Beck: What does it cost to get involved with these technologies?

Luna: The costs are essentially time. Most audiologists already have all of the fitting software on their desktop software via the Siemens CONNEXX™ package. The Symphonix icon is there and it is very similar to the Signia™ platform. So actually, many of the audiologists already know the basics regarding how to program the Symphonix system, it's just a matter of getting up to speed on the hardware and the specifics related to the Vibrant Soundbridge. Of course we have lots of people out there and if the audiologists would like to start exploring these options, all they have to do is give me a call and I'll get them setup with the appropriate reps for training and to further the discussion.

AO/Beck: Suppose you're in a big dispensing practice, and the bread and butter of the group is traditional amplification sales and service. What is the profile of the patient that you present this option to?

Luna: The basic candidate is a patient with a mild, moderate or severe sensorineural hearing loss and normal middle ear function. The patient should be an adult who has tried traditional acoustic amplification. After that, as many of us say with digital amplification, you shouldn't prejudge candidates. I think you should present this as another treatment option to all patients, the same as you would ALDs, BTEs, CICs and other products to. In other words, if we only presented digital hearing aid options to wealthy patients, we would do a great disservice to all patients. I think this might be similar.


AO/Beck: That's a great point John. I can certainly recall fitting patients with expensive digital hearing aids who at first glance, didn't seem to have the resources or the interest in digital products.

Luna: Exactly, we've all seen that time and time again. Patients always tell us, Better hearing is worth it .

AO/Beck: John, before I forget, what's the toll free number for Symphonix please?

Luna: The audiologists can call our office at 1-800-833-7733 to have their local territory manager setup an initial meeting.

AO/Beck: What about the audiologist who is interested in middle ear implants, but they are not working with an otologist at the moment, or they simply don't know any ear surgeons implanting the Vibrant Soundbridge?

Luna: Once the audiologist contacts us, we can help create a working relationship with otologists in their area. Obviously, some of the offices will be across the street, and sometimes there will be a little distance between the audiologist and the otologist. We can help get the professionals together to work with a single patient - that hasn't been a real problem.

AO/Beck: John, can you spend a few minutes discussing costs and reimbursement issues please?

Luna: Sure. Costs are obviously an important issue. The fees charged and the reimbursements vary, just as with all medical and audiology-based products and services. Nonetheless, the best thing to do is have the entire thing pre-approved by the insurance company if possible. Some commercial carriers will cover it, but each has their own unique variation and each one really needs to be explored and approved ahead of time! Some patients pay the whole thing out of pocket, and there are combinations too, of private pay and insurance coverage. Again, each situation is unique.

Some audiologists charge a flat fee, and I've seen anywhere from $1500.00 to $3000.00 for total service packages including the pre and post-op audiometric evaluations, post-op tests and initial activation with follow-ups included for the first two years. Other offices go with hourly or office visit fees. For most patients, the total cost with everything, the product, the surgery, anesthesia, all fees and services, the total price might be anywhere between $14,000 and maybe $16,000. When reimbursement is available, the patient may wind up paying only their deductible, or zero out of pocket, or maybe a couple of thousand dollars, Again, each patient and their insurance situation is unique, and the best thing to do is to pre-approve the whole thing whenever that's possible.

AO/Beck: John, thanks for your time. This is very interesting and it's a whole new area of practice for many people. I certainly appreciate your time and expertise in this arena.

Luna: Happy to work with you Doug.

AO/Beck: John, please give me the website address again, and the toll free number for professinals looking to learn more about your products and services.

Luna: Sure Doug, 1-800-833-7733, and the website is simply www.symphonix.com.

AO/Beck: Thanks John. Let's get together again in a few months and we'll schedule an update on this topic.

Luna: Sure Doug that would be great.