Practice Spotlight: The Clinic on Wheels
Sycle was pleased to kick off its Practice Spotlight series on World Hearing Day. Each Practice Spotlight will focus on a particular audiology practice, cover its unique approach, get a firsthand assessment of the market and trends, and look at how each clinic uses technology and the Sycle platform to manage its practice.

The series looks to capture the real-world experiences of diverse audiology practices and explore the various ways clinics and Sycle align in their mission to meet the hearing needs of individuals throughout the world.

Our first guest is Dr. Natasha Dewald-Nielsen. Dr. Dewald-Nielsen obtained her bachelor’s degree in Speech Pathology from Minot State University, graduated from the University of Washington with her master’s degree in Audiology, and completed her Doctor of Audiology degree from the University of Florida. She holds a Texas State license for Audiology, a National Certification with the American Speech and Hearing Association, and is a Fellow of the American Academy of Audiology. She brings with her 22 years of experience and specializes in amplification and rehabilitation of hearing disorders and hearing aid fittings and management. She is the owner and operator of Austin, TX-based Hears to You. Natasha is a former leading audiologist in the Palm Springs, CA region and is now serving the Austin, TX area. She was named audiologist of the year in Austin for five consecutive years. Information about her clinic can be found at HearsToYouTX.com or on her Facebook page.

Sycle: Natasha, can you tell us about your background and your practice?
Dr. Dewald-Nielsen: Yes, thank you for that introduction. I’ve been an audiologist for almost 30 years. I’ve had practices in Canada and California, and now in Austin. We are Austin’s first Mobile Audiology Clinic with a state-of-the-art hearing testing and hearing aid fitting equipment facility onboard our specially outfitted van.
Sycle: What prompted you to go in that direction?
Dr. Dewald-Nielsen: There were several factors that came into play. We wanted to limit the overhead expense and stress of maintaining multiple offices and staff – particularly during the pandemic – and it became clear from our research and experience that there was an underserved population comprised of people in nursing homes or who were homebound, or in more rural or less accessible areas who needed our services. So, we began bringing the services to them.
Sycle: So here you are, you started a new practice in a new city and were the first to offer a mobile service. How did you get started?
Dr. Dewald-Nielsen: It was a grassroots effort with a letter campaign to home healthcare agencies, nursing homes, and independent living facilities. I offered free screenings and cleaning checks – or more for free cleaning checks. This doesn’t typically generate revenue, but it was a way to gain trust to go into their building and offer free screening and cleanings – and it eventually led to business and referrals. I also began to interact with physicians serving those facilities, working with them, and getting referrals from them. I also offered lectures at senior centers and anywhere I could interact and meet with people potentially in need of hearing services.
Sycle: You’re a one-woman show – which is awesome – and it’s unique as you don’t see that many one-person practices in the industry. How do you manage your practice while you’re on the go and all by yourself?
Dr. Dewald-Nielsen: Well, I’ve been using Sycle for years, even when I was back in Palm Springs and in an office with staff and a more traditional setup. Working with the software I created a callback and recall process. It’s a system that works for me, gives me more flexibility, and allows me to basically go paperless. I enter data into Sycle, and it populates throughout, and I integrate all that into eDocs and can view it all on my phone or iPad if I don’t have my laptop available. Somebody might call while I’m driving and I’ll pull over, open my iPad, and make and change appointments on the fly.
Sycle: The tools that we offer to take care of that are key. Being paperless is key to your being able to manage your practice on the go. How did the market in Austin respond to your mobile practice?
Dr. Dewald-Nielsen: I’m the one coming to the clients, so they don’t have to get a ride. I do get a lot of phone calls from family members saying “can you help my mom or dad?”, especially when the pandemic hit and everything was locked down. Instead of losing business at that time, we actually saw an increase.
Sycle: What do you think about upcoming technologies and the OTC (Over-the-Counter) market?
Dr. Dewald-Nielsen: I’m not against OTCs at all if they’re done right. My only concern is whether the person who’s putting that wearable or hearable on has had some sort of a hearing test to make sure there’s not a medical necessity. But I think if people get into some sort of amplification and stimulation earlier then the better it is for them.
Sycle: How many appointments do you think you cover in a typical week?
Dr. Dewald-Nielsen: When the facilities I visit let me use one of their rooms I can see 12 to 15 people a day. If I’m driving around, I might see only seven or eight people a day given the traveling time.

Additional questions submitted by our readers:
Q1: Would love details on hardware choices, van set-up, etc.
Dr. Dewald-Nielsen: Ford Transit, tall roof, regular length – but could also operate with longer vans. I use the MedRx Avant audiometer, RE Live speech map system, and a Dell laptop. The sound booth is at the rear of the van and my desk and the patient seating are closer to the front of the van.
Q2: How do you determine unbundled pricing? I would love to itemize, where do you start?
Dr. Dewald-Nielsen: I recommend that you do homework on rates in your area. Calculate your overhead and what you need to cover expenses and don’t forget to include what you are worth.
Q3: How do you account for your personal safety when entering patients’ homes?
Dr. Dewald-Nielsen: Honestly, the homes that I visit are usually those of the elderly or disabled. If I am seeing a younger person, it is in my van and I can keep the sliding door open, weather permitting.
Q4: Does the patient reach out to you from the facilities you service, or does the AD refer the patients? Or both?
Dr. Dewald-Nielsen: If it’s in a memory care setting, then the nurse usually calls or emails me. But if it’s Assisted Living, then I usually get a call from a staff member and I reach out to the family for consent to treat and pay. If it is Independent Living (IL), the patient calls me directly, and that is usually a referral from another patient in the building.
Q5: How do you find the traveling doctors?
Dr. Dewald-Nielsen: I look online and Google them. Mobile physicians are everywhere. Also, look for home healthcare agencies or senior resource agencies like “A Place for Mom” or similar home-based care organizations.
Q6: I like home visits because you can acoustically address everything in their environment. Throwing in 2-3 extra visits in the first month helps to reduce/eliminate returns. How to get physician referrals is my biggest question?
Dr. Dewald-Nielsen: I don’t seek MD referrals, at least not anymore. Since Medicare doesn’t cover hearing aids, and reimbursement for 92557 is so low, I prefer private referrals.
Q7: Do you work more hours now or the same or less?
Dr. Dewald-Nielsen: Way less hours, allowing me more time with my family. I am home right now at 9:30 a.m. doing chart notes and will leave in 15 min. to start my patient visits. I will be back home by 3:45 p.m. today.
Q8: What are your annual revenues?
Dr. Dewald-Nielsen: I won’t answer this other than to say my take-home amount is triple what it was when I owned two busy offices and had sales over one million a year. I generate less in sales but have a higher profit margin with such low overhead!
Q9: How do you determine unbundled pricing? I would love to itemize, where do you start?
Dr. Dewald-Nielsen: When I quote a patient on a set of hearing aids, I separate the aids from my fitting fee and initial consult fee on the invoice, and it is clearly written on my warranty page that we sign that the professional fees are non-refundable and apply to the visits within the trial period only. All future visits will incur a fee, payable at the time of visit. Often, I will email invoices to a family member to pay.
 

View the recorded webinar here.

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