On Friday, March 20, 2020, the entire group of audiologists I work with at the University of Pittsburgh Medical Center (UPMC) was taking care of patients in person. Three days later, Monday, March 23, 2020, we were providing all of our services remotely.
We had been thinking about expanding into telehealth over the past year, but we had all sorts of reasons why it wouldn’t, couldn’t, and shouldn’t work. And then one day, it had to work or we wouldn’t have been able to take care of our patients.
There’s nothing like a crisis to create change in the moment and to make one wonder, “why didn’t we do this before?”
For audiology, there are a myriad of reasons why we didn’t pursue telehealth previously and those barriers changed almost overnight as well. In March, the Secretary of the U.S. Department of Health and Human Services waived certain provisions of the Health Insurance Portability and Accountability Act (HIPAA).
Roger Severino, director of the Office for Civil Rights, explained, “we are empowering medical providers to serve patients wherever they are during this national public health emergency. We are especially concerned about reaching those at risk, including older persons and persons with disabilities.”
The Centers for Medicare and Medicaid Services (CMS) indicated that health-care providers subject to HIPAA rules could use a range of remote-communication technologies that previously were not considered HIPAA-compliant to ensure that patients could be reached by whatever means were available.
Legislation passed in March (the Coronavirus Aid, Relief, and Economic Security (CARES) Act) with specific language that gave CMS waiver authority for any requirements relating to the coverage of telehealth services under Medicare.
On April 30, 2020, CMS announced that “all professionals who are able to bill Medicare for their professional services will be considered eligible telehealth providers for the duration of the COVID-19 public health emergency”.
CMS also added four cochlear implant codes (92601, 92602, 92603, and 92604) to the list of codes eligible for reimbursement when provided via telehealth. This is only a start; a foot in an incredibly important door. The Academy will continue to work to expand coverage to include the services we are providing via telehealth.
Importantly, we also saw state licensure boards react to patient needs by expanding who can provide telehealth services at this time.
Given the global health crisis and these sudden changes to telehealth accessibility for health-care providers, audiologists have risen to the occasion and provided our essential services remotely.
As we moved into June 2020, we saw a return to in-person care, but what of telehealth will remain in our practices? What is our responsibility to our patients and our profession?
Our patients are going to demand that we continue to provide remote access and we have clearly established that we can provide important evaluation and management services through tele/video visits.
Our responsibilities include refusing to be left behind as the provision of telehealth moves ahead. This includes the following:
- Creating office set-ups that dedicate space, time, and technology for tele-/video-care visits.
- Demanding that the e-records we use include audiology in telehealth documentation.
- Using documentation language that acknowledges the care we provide, whether over the phone, through a video visit, or via e-mail communication.
- Understanding state and federal guidelines related to our provision of telehealth services.
- Charging appropriately for these services, whether we are reimbursed by an insurer or by the patient.
We must use this time of change to move our profession forward, resist any movement to rescind privileges that have been afforded to us, and demand further access. Support of the Medicare Audiologist Access and Services Act (HR4056, S2446) is critical.
This time has highlighted the need for direct access and for audiologists to be identified as practitioners to be included in the changes we are seeing in Medicare.
In addition, support of the interstate licensure compact is essential to enhance the expansion of telehealth care.
Just when you thought you couldn’t work any harder, this is a time to be engaged and a time when we can see real change for our profession and, therefore, enhanced care for the patients who need us during and after a global health crisis.
Your responsibility goes beyond patient care; you have a responsibility to your profession.
Catherine Palmer, PhD
American Academy of Audiology