Now that people around the world are practicing social distancing and self-quarantine as a result of the COVID-19 pandemic, the demand for remote hearing care solutions is rising precipitously. To be sure, remote hearing care is not new, it’s been discussed in audiology research circles for more than 20 years, been piloted and launched by Government Services audiologists and used by clinicians serving remote geographic locations.
For those unfamiliar with TeleHealth, the World Health Organization defines it as “the use of electronic means to deliver information, resources and services related to health”. TeleHealth covers many domains, including electronic health records, mobile health, and health analytics. TeleHealth (also called eHealth) has the potential to place information in the right place at the right time, providing more services to a wider population and in a personalized manner. It is primarily intended to supplement in-person appointments, but in some remote locations it replaces in-person visits due to geographic distance or provide shortage.
Additionally, over the past few years most major hearing aid manufacturers have launched remote hearing care solutions in their fitting software that can be accessed by the hearing aid wearer using a smartphone-enabled app.
To better understand how remote hearing care can be put to immediate use in a clinical practice, we turned to Suzanne Younker, AuD, Your Hearing Network’s Director of TeleHealth. Dr. Younker has considerable experience in the application of TeleHealth in audiology from research and development to implementation and training through her experience as Audiology Services Manager for HearUSA and her current roll with Your Hearing Network. She also recently authored an article on TeleHearing Care for HHTM.
HHTM: Dr. Younker, please tell us how clinicians can immediately equip their practice with telecare solutions.
SY: A fortunate consideration in identifying TeleHealth equipment needs is the flexibility that encompasses this topic. As mentioned in the introduction, most people today have smartphones that can accommodate a hearing aid manufacturer’s application that allows remote hearing aid programming to occur without having the patient come into an office. Even without the use of an App, the smartphone is still a powerful tool for connecting providers to patients via audio-video communication in order to address concerns to the extent that counseling and demonstrations can provide a resolution.
In order to provide two-way interactive engagements between provider and patient when not using a manufacturer’s App, the provider must first download an audio-video platform App that is considered “Non-Public Facing,” such as, Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, Whatsapp video chat, Zoom, Skype, etc. As an alternative, the provider may use one of the newest office management systems’ audio-video feature available through systems such as Sycle, CounselEar, and Blueprint (coming soon).
Once that is set up, provider would schedule an appointment, send the appointment link to patient via email, and patient would access the link through that email. Pending the platform, patient may be asked to install the App if on a smartphone, or, install the software to a desktop/laptop.
Another equipment array that is more sophisticated for audio-video communication is the use of a desktop or laptop, and an audio-video camera or a conference calling camera. Logitech has a host of options for these pieces, with prices varying depending on added features such as remote control for camera angling and volume control. The last piece that is critical in maintaining quality audio communication is a headset with a boom microphone and in-line volume control. Speaking into a boom mic affords greater voice fidelity than speaking through a free field to a computer’s microphone.
Some practices find themselves with a clinic that is open for business, staffed with a front office staffer, yet, provider cannot be on-site and is either home or located at another clinic. When a patient does not have a hearing aid programming App and is needing programming changes, the off-site provider can still perform reprogramming services using a few more pieces of equipment. Notably, the patient must come into the clinic for this service.
Many clinics have hearing aid programming software on a computer with audio/mic/speaker and video/camera capability. If a remote provider has access to a laptop/desktop with audio-video capability, providers can provide programming services from wherever they are to the patient located at the clinic. Again, an audio-video interactive platform is required to be installed on both the clinic computer and the remote provider computer. The front office staffer acts as “facilitator” to this TeleHealth service and will require some instruction on connecting hearing aids to programming device. The ability to offer this service when a clinic is open for business, yet, an on-site provider is not an option, is particularly beneficial to new hearing aid users who are struggling with sound quality issues.
In the scenario where full hearing care services including otoscopy, testing, hearing aid consultations and fittings need to be provided at a particular clinic (satellite office, rural area office, etc.), however, provider is not able to be physically located at that clinic (working from home, working from main office, etc.), the TeleHealth method of providing these services is very effective. For this to be completed, the installation of specific PC-Based testing equipment (video-otoscope, audiometer, etc.) is required in addition to the audio-video pieces mentioned above. The testing equipment must be PC-Based in order to be accessible remotely through an audio-video conferencing platform by the provider located at another location.
HHTM: Please share with us what clinics needs to do for getting their staff up to speed with training on telehealth:
SY: Utilizing Facetime seems to be the easiest method of interactive audio-video communication and may require the least amount of training. Many patients use this already to communicate with friends and family.
Providers who are using a different audio-video platform can view tutorial videos on the platform’s website for easy instructions. However, the patient who is connecting with the provider on that platform may need initial verbal instructions on how to navigate the launch page to active the microphone and video features. This can be done with an initial instruction session via telephone/cellphone and then re-start appointment through the platform.
When implementing a full-service hearing care TeleHealth service method, clinics can take the DIY approach and trial through the steps until the flow of the TeleHealth appointment is smooth and satisfactory. This will take some time and some techy expertise. As an alternative, there are “turnkey” services available for hire where equipment management, implementation, and coaching from a professional and experienced trainer becomes a valuable resource. Communication skills required of a TeleHealth remote provider are a little different as the need to establish and maintain trust with an off-site patient during the evaluation and consultation process.
When it comes to effectively engaging with a patient in real time over a TV screen and a speaker, the remote provider could seek coaching professionals to assure they can maintain positive communication behaviors and relationship building skills. Additionally, the facilitator who is with the patient during the TeleHealth appointment will need to be trained on how to manipulate basic equipment components in order to assist the remote provider in completing the hearing care visit.
HHTM: Can you address billing issues related to use of TeleHealth?
SY: Billing for audiologic services when performed via TeleHealth varies between national and state rules. Currently, CMS and Medicare recognize only specific providers to be able to bill TeleHealth services: physicians and certain non-physician practitioners such as:
- nurse practitioners,
- physician assistants
- certified nurse midwives,
- certified nurse anesthetists,
- licensed clinical social workers,
- clinical psychologists, and
- registered dietitians or nutrition professionals
There are bills in the legislation that expand the provider list to include audiologists such as the Medicare Telehealth Parity Act 2017. This bill is supported by all of the audiology professional groups. It is noted that the current COVID-19 Public Health Emergency Waiver for relaxing TeleHealth rules does not change the approve provider list.
On a state level, most states authorized TeleHealth hearing care services reimbursement through Medicaid and a number of states have authorized audiologists to bill other state-based insurers such as Kansas which has specifically identified most audiology CPT codes as approved TeleHealth services.
Regarding Medicare Advantage hearing aid benefits, without billing as fee for service, most Medicare Advantage and Third Party Administrators allow the application of a hearing aid benefit when services are provided through TeleHealth. The rule of thumb for individual insurance plans, other than Medicare as a primary, is to contact their representatives and ask for their policy on reimbursement for TeleHealth hearing care services.
HHTM: Many of our readers are hearing aid wearers. Please share with them what they may need to know to better utilize TeleHealth services:
SY: TeleHealth is a modern method of providing healthcare to people in a more efficient and effective manor without sacrificing quality of care. More and more healthcare services are being implemented in this fashion because it increases a patient’s opportunity to receive quality care without having to wait long for appointment dates and without having to travel long distances. TeleHealth for hearing care services is proven to provide a satisfactory experience and outcome just as if the provider was “knee to knee” in the same office. In fact, the VA has been implementing this method of hearing care services for many years and multiple patient satisfaction surveys indicate that the experience was “better than” a person-to-person onsite visit. If your hearing care provider has implemented TeleHealth services for their patients, you should feel very comfortable knowing that they are embracing high-technology efforts towards improving your access to their excellent care.
HHTM: Dr. Younker, any other words of wisdom or final thoughts on the use of TeleHealth
TeleHealth is here to stay. The current situation of COVID-19 has solidified the need to implement alternative methods of providing hearing healthcare to current and future patients.
It is no secret that our senior population is growing substantially and living longer. Hearing loss prevalence is directly proportional to this growth requiring our services even more. Knowing the negative outcomes of untreated hearing loss such as diminished cognitive function, poorer mental health, and social isolation, it is our responsibility to be prepared to provide the necessary hearing loss rehabilitation. Hearing care providers must accept TeleHealth as an expanding technological solution if they plan to stay involved in increasing our seniors’ access to hearing health care.
HHTM: Here are some additional professional resources on telehealth (remote hearing aid adjustments) from major manufacturers:
Additionally, professionals interested in expanding their skills in telehealth and other areas of patient care can also earn free CEUs/CPDs with the Ida Institute’s free Learning Hall courses: https://bit.ly/32k5iMH. Ida is currently covering costs for Learning Hall badges until April 14th, 2020.
Suzanne Younker, Au.D., CCC-A, FAAA, is the Director of Telehealth at Your Hearing Network. Dr. Younker is a 29-year hearing healthcare provider with a vast array of experiences in providing direct care and fostering quality care for colleagues. Specifically, Dr. Younker has coordinated hearing instrument trainee programs while educating and mentoring trainees, provided skill oversight for quality assurance and compliance in a corporate setting, managed and resolved consumer service issues, performed operational duties for company functionality, and, in the past few years, coordinating and managing Telehealth implementation services.
