The COVID-19 pandemic has many private audiology practices grappling with what services they should provide, how they should provide them, or whether to stay open at all. The big question for most providers falls under the Centers for Disease Control and Prevention (CDC) and federal and state guidelines as to whether they offer an “essential service” or not. We asked Jennifer Grace, AuD, the clinical director at Newport-Mesa Audiology Balance & Ear Institute in Newport Beach, CA, how she and her staff have responded to these vital questions.

Q: With various state-wide “shelter-in-place" directives during the COVID-19 pandemic, how has your audiology practice responded to the question: Is audiology an essential service?

A: We’re closely monitoring guidance from the CDC and federal health officials, as well as California’s Public Health Officer who defined and designated essential services as “critical to protect health and well-being of all Californians.” As we see patients for hearing loss, dizziness, vertigo, and balance dysfunction—including many with significant hearing loss or severe and acute dizziness and vertigo who are at higher risks for isolation, depression, and falls—we’ve kept our clinic open for select in-office appointments as we feel that this care is critical to protect these patients’ health and well-being.

Q: How do you determine which services are essential in your practice?

A: We’re providing in-office appointments for patients with significant hearing loss and acute dizziness, vertigo, and balance dysfunction and for whom our services are clearly essential to their health and well-being. For less critical patients for whom our services are not as essential to their health and well-being, such as hearing loss patients who require hearing aid repair or service, we provide curbside appointments and home shipping options directly from the manufacturer. Likewise, for patients with less critical chronic dizziness or imbalance, as well as for vulnerable populations, we’re providing phone consultations and web conferences.

Q: In these ever-changing and unknown times, what best practices are you implementing when providing services?

A: To safely provide medical services during this time, we have been closely monitoring guidance from the CDC, local and state legislation, and occupational safety boards, as well as our national audiology boards. Based on the guidance we have seen, we are currently implementing the following:

• Screen patients during phone scheduling and at check-in
• Encourage patients to stay at home, if possible, and offer:
• telephone and web appointments
• mailing of repaired devices directly from manufacturers
• Clean and disinfect surfaces frequently
• Implement curbside hearing aid checks
• Practice physical distancing during in-office appointments:
• Room patients immediately upon arrival
• Allow patients to wait in vehicle until ready to be seen
• Implement wearing of personal protective equipment among the staff: gloves, face masks, etc.

Q: Are there any COVID-19-related considerations for patients in your specialty?

A: Yes, particularly in the area of screening patients for vestibular dysfunction with symptoms of dizziness. Because viral insults can cause vestibular disorders, we must be very careful to screen patients who are experiencing dizziness as a result of the coronavirus.  We have developed custom screening protocols during phone scheduling and check-in to intercept patients who have dizziness that may be a result of COVID-19 and redirect them to appropriate care.

Q: What role does telehealth play in the essential services you're currently providing, and what issues have you encountered in this new type of health care delivery?

A: Wherever possible, we inform patients seen in in-office appointments about transitioning to telehealth, which provides maximum protection for patients and staff. However, there are barriers to telehealth inherent to some of the specialized services we provide, such as in the assessment of acute dizziness, vertigo, and balance disorders that require the use of in-office diagnostic equipment. For specialized hearing devices such as Lyric, patients must come to the office for the device to be professionally placed in their ears.

Reimbursement for audiology-specific telehealth services is another major barrier. While some private-pay insurance carriers allow audiologists to bill for telehealth, the CMS at present does not reimburse for these telehealth services, as they do for physicians and other specialists.

So, like everything in the current COVID-19 environment, the answers are not clear cut. These are unique times when many of yesterday’s answers and solutions are out-of-date today. The situation, and official guidance thereto, is ever-changing and evolving, so private audiology practices must adapt too. We must stay attuned to what public health officials are saying while listening to that small voice that got us into health care in the first place. What’s best for our patients, our staff and their families? The answers lie somewhere between the art of caring for people and the science (and business) of health care delivery.

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