In light of the COVID-19 pandemic and its impact on audiology practices, the Academy of Doctors of Audiology (ADA) organized a town hall meeting on March 23rd to discuss pressing operational and compliance issues and to share helpful resources. Central to the discussion was telehealth, which is in the spotlight as audiologists and hearing care providers find ways to provide remote, contact-less care.
While the HHS Office for Civil Rights has the eased restrictions on the use of non-HIPAA-compliant telehealth communication technology during this public health emergency, audiologists must practice caution before providing tele-audiology services.
Kim Cavitt, AuD, key speaker at the town hall, outlined the key issues, starting with understanding the insurance coverage of tele-audiology.
On March 17, the Centers for Medicare and Medicaid Services (CMS) expanded access to Medicare telehealth services to enable more patients to get virtual health care during the COVID-19 pandemic.
"CMS is expanding access to telehealth but not coverage," Dr. Cavitt noted. "Before, some providers have coverage for face-to-face interactions but did not have the same coverage in telehealth. That is what is being expanded upon—that if they have coverage for face-to-face interactions, now they have that coverage in telehealth."
The issue with audiology, however, is that many hearing health care services that could be provided via telehealth are not covered even if these were done via face-to-face interactions. The recent CMS expansion of telehealth with the 1135 waiver did not include this change, nor did it eliminate the order requirement for specific audiology services.
"What that means is that we still need a physician order for covered services, and we still are a diagnostic-only profession in the eyes of Medicare," explained Dr. Cavitt. "They will only cover things via telehealth if they expanded that—which they have not yet—at a national CMS level… So, in terms of coverage of telehealth, that is still going to be limited."
Another area of concern is the communication tools to use for tele-audiology. HHS temporarily allows health care providers to use online tools such as Skype, Facebook Messenger, Google Hangouts, and Apple Facetime to communicate with patients. Of note, the use of public-facing video communication tools such as Facebook Live and TikTok are not allowed in providing telehealth services.
However, Dr. Cavitt recommended that audiologists check with their state licensure board to determine their capacity to provide telehealth. "Does your state allow an audiologist to provide telehealth in a best-case scenario? Have they made any special considerations for other practitioners in light of COVID-19?"
Stephanie Czuhajewski, MPH, CAE, the executive director of ADA, echoed this recommendation in her follow-up email after the town hall meeting: "We encourage you to check with your state audiology association and/or to independently look for any executive orders that may have been put into effect, which may impact your ability to provide telehealth services."
The availability of tele-audiology technology and resources poses another challenge. Dr. Cavitt noted that the vast majority of audiologists do not have the equipment nor the capacity to provide diagnostic services via telehealth. A good start is to reflect on resources at hand: "What can you—in your practice setting, systems, and resources—provide via telepractice?"
Audiologists can provide various services remotely such as tinnitus management and counseling, auditory rehabilitation, and communication needs assessment. They can also virtually assist patients with their devices by troubleshooting hearing aids or cochlear implants as well as providing device support and counseling.
"I want to also stress that all these procedures may not have coverage, and may have to be private pay situation," Dr. Cavitt cautioned.
For audiologists that provide bundled services, payment for telehealth services should be further reviewed, she added. Are they going to charge for telehealth for hearing care services that would have been part of a patient's bundled care—paid off at the day of hearing aid fitting? For those providing unbundled services, telehealth services can be offered as pay-as-you-go. Audiologists will need to explore payment services, such as Venmo, PayPal, etc., and determine how patients can remotely pay for telehealth services.
Amid these issues, Dr. Cavitt underlined the importance of reaching out to patients in this time of isolation.
"It's not about dispensing or selling anything; it's about human communication," she said. "There are things that we can do… to let them know that we're out there for them, that we still want to be engaged and be part of their communication journey, but we just can't do this in a face-to-face encounter."
For more details on the ADA town hall meeting and resources, visit https://www.audiologist.org/audiologists/covid-19-resources.