At the time of writing this article, much of the world is under stay-at-home orders as a precaution due to the COVID-19 pandemic. Audiology clinics have closed their doors in areas where the service does not qualify as essential. Many individuals with hearing loss are left wondering when clinics will open again, adding to their stress.
To stay connected with patients and minimize gaps in care, many audiologists are looking into teleaudiology. Despite its potential to expand access to hearing care, research shows that most audiologists have never engaged in teleaudiology. According to an international survey of clinicians conducted before COVID-19, nearly 85 percent of audiologists surveyed reported they had no experience with teleaudiology.1
While it may not be possible to convert all hearing health care services to teleaudiology at this time, now is the time for clinicians to adopt remote strategies to connect with clients and help those who need access to an audiologist but are unable to leave their homes. Simple tools, including videoconferencing and telephones, are within the reach of every audiologist.
SAMPLE PATIENT SCENARIOS
The following two hypothetical scenarios demonstrate how COVID-19 can negatively impact patients seeking audiology services and offer ways for clinicians to adapt aspects of their practice to a teleaudiology service delivery model.
ADDED BENEFITS DURING COVID-19
Teleaudiology is a useful tool for increasing access to audiology services for clients, particularly when stay-at-home orders are in place. Fast communication from a provider can help ease clients, and their families’ anxieties, as well as help them have uninterrupted access to listening and consultation. Additionally, when a client connects to their audiologist from within their home via teleaudiology, it eliminates the need for masks and other protective measures. One potential unanticipated benefit is that clinicians and clients may enjoy the added social interaction of connecting virtually while quarantined. Finally, conducting services via teleaudiology can save time because transportation is minimized. In areas of the country that have limited local options for hearing health care, teleaudiology can bridge the geographic gap between client and provider.2 Clients such as Sylvia, who live far from an audiologist, may request to continue having remote appointments on a long-term basis to reduce the transportation burden.
LIMITATIONS & IMPORTANT CONSIDERATIONS
Some limitations must be acknowledged. As mentioned, not every hearing health care service will easily translate to remote service delivery. Services such as diagnostic audiometry and initial hearing aid fittings require additional equipment and a trained facilitator at the patient site3. However, much will be possible via teleaudiology, including hearing aid troubleshooting, aural rehabilitation, warranty questions, and tinnitus management. Additionally, teleaudiology may not be appropriate for all clients and in all situations. For example, individuals with low technical literacy may not be good candidates for teleaudiology.
Here are additional considerations:
- Audiologists who are new to teleaudiology may have questions about licensure and reimbursement policies. Licensure requirements vary by state, so it is recommended that clinicians check with each state's licensing board before engaging in services. According to guidelines set by the American Speech-Language-Hearing Association (ASHA), teleaudiology providers should be licensed in the state in which they are practicing, as well as the state in which the patient is located. Payment for teleaudiology services varies widely across public and private payers. At the time of writing, services delivered by audiologists via teleaudiology are not covered by Medicare.4 Private insurers in many states have policies that allow coverage for teleaudiology-delivered services. Providers should contact each payer to verify that they will provide reimbursement before providing service via teleaudiology. Additional services may be realized through private pay or an out-of-pocket option. Audiology professional organizations have advocated for teleaudiology-related legislation, including licensure-alternate models and expanded Medicare coverage.
- The COVID-19 pandemic has upended daily lives and created tremendous uncertainty. Transitioning to remote service delivery takes time, even under the best circumstances. Support yourselves and your families, and make changes as you are able. The Centers for Disease Control and Prevention (CDC) provides guidelines and recommendations on managing stress in yourself and others during the time of the COVID-19 pandemic.5
- Clients with hearing loss may have difficulty understanding speech in a videoconferencing session, particularly if their device is malfunctioning or if the visual signal is degraded, making it challenging to lip-read. Ensure equal access to communication through the use of live captioning (e.g., Google, Communication Access Realtime Translation), or subtitles that can be integrated into a videoconferencing platform, such as Zoom. Video remote interpreting services can also be used for those who use American Sign Language.
TELEAUDIOLOGY TIPS FOR VIDEO CONFERENCING
- Use a headset to improve the signal-to-noise ratio, but do not block your mouth with the microphone to avoid the loss of visual cues.
- Keep some examples of supplies and devices on hand to help demonstrate cleaning and troubleshooting.
- Eliminate noisy distractions by closing windows to the outside and turning off televisions and radios.
- Wear a plain-colored shirt and sit in front of a neutral background that contrasts with your skin color.
- Optimize lighting by placing a small lamp three feet in front of you.
- Ask for support from the client's communication partner and/or health aides.
TELEAUDIOLOGY BEYOND COVID-19
The use of teleaudiology does not have to end when the pandemic ends. Consider these long-term strategies.
- When possible, continue to provide remote services to clients, particularly those with mobility or other health issues, transportation barriers, and those with scheduling constraints.
- Help define how remote audiology services are delivered and reimbursed by advocating for teleaudiology-related legislation, when appropriate.
- Review information provided by professional groups such as the American Telemedicine Association6 and ASHA.7 Exchange ideas with fellow clinicians on discussion boards in ASHA's Special Interest Group on Telepractice, SIG 18. Share what you learn with colleagues and investigate potential teleaudiology-related training for staff.
Telehealth (in any health field) is becoming ubiquitous. Eventually, clients may expect to be able to see their providers remotely. Now is an opportune time to learn simple teleaudiology strategies so that, when appropriate, clinicians may continue to provide remote hearing care services post-pandemic.
1. Eikelboom, R. H., & Swanepoel, D. W. (2016). International survey of audiologists' attitudes toward telehealth. American Journal of Audiology
, 25(3S), 295-298.
2. Coco, L.; Sorlie-Titlow, K; Marrone, N. (2018). Initial Teleaudiology Planning Assessment for the State of Arizona: Geographic Workforce Analysis. American Journal of Audiology
3. Coco, L.; Davidson, A.; Marrone, N. (Accepted) The role of patient-site facilitators in teleaudiology: A scoping review. American Journal of Audiology
4. United States Social Security Administration (2020). Social Security. Special Payment Rules for Particular Items and Services. Retrieved from https://www.ssa.gov/OP_Home/ssact/title18/1834.htm
5. Centers for Disease Control and Prevention. (April 1, 2020). Coronavirus Disease 2019 (COVID-19). Stress and Coping. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html
6. American Telemedicine Association (ATA). (2020). Telehealth Basics. Retrieved from https://www.americantelemed.org/resource/
7. American Speech-Language-Hearing Association (ASHA). (2020). Telepractice: ASHA state-by-state. Retrieved from https://www.asha.org/advocacy/state/