Practice Management

Practice Management

Message from the Academy Executive Committee

Message from the Academy Executive Committee

(March 22, 2020)

Work Together, Stay Informed, and Help Flatten the Curve

The message from the CDC and from your state and local governments is clear: The goal in navigating the COVID-19 pandemic at present is to flatten the curve. This means that containment of the COVID-19 virus is not possible, as you are aware from news reports. Without a vaccine or treatment, the only way to manage this with the health-care resources in the United States is to spread the number of infected people over time (flattening the curve).

This spreading out allows our health systems the bandwidth to care for ill people. In other words, if everyone is ill at the same time, more people will die because there is no way to provide enough care. If this same number of people are ill but enter the health-care system at different points over an extended period of time, the health-care system can more effectively manage care and many more people will survive.

The only way to flatten the curve is to practice social, or rather physical, distancing; literally to keep people physically away from each other. To this end, all “non-essential” businesses are being asked to “close.” Although this must happen no matter where a region is in terms of the virus, the sooner an area does this the better the result in terms of decreasing new cases of the virus and slowing the spread.


Many feel the concept of “non-essential” and “closed” are difficult depending on what you do and how you feel about what you do. Most people feel their business is essential for one reason or another. An “essential” business is defined as “life-sustaining.” This could be a hospital or a grocery store and will include businesses that supply groceries and resources for hospitals. There are other examples, but you get the idea. This means that without these businesses, lives would most likely be lost. “Closing” means closing your doors—not seeing anyone in person. It does not mean cutting off support from your customers/patients. The only way to flatten the curve is to stop people from interacting in person and one way to cut down on person-to-person contact is to close the doors of non-essential businesses.

Is providing support to individuals so they can hear and stay connected to loved ones during this time, access news reports and other important information, and support the hearing devices that may be worn by essential personnel (physicians, law enforcement, etc.) essential? Absolutely. However, the current need to keep people from face-to-face encounters requires that these services be provided creatively, using technology that allows physical distancing.

Audiology practices are “non-essential” in terms of the life-sustaining definition. We need to close our physical doors, so individuals do not come in person. As the CDC recommends, we need to all behave as if we already have this virus. We need to stay away from everyone and keep them away from us. But at the same time, we need to support our patients and provide the very essential care that promotes and supports communication. We must be innovative and figure out how to do this virtually. Some of you already do this and for others, you’ll need to gear up immediately. Virtual care can be as simple as making sure you update your website and signage on your door, so people know how to reach you by phone.

You can provide a tremendous amount of care virtually including trouble shooting non-functioning devices or suggesting amplification apps used with headphones that could help until a person can see you again. Perhaps mailing simple amplifiers to individuals in assisted living or skilled nursing whose hearing aids may not be functioning to help them communicate. You may have a first responder whose hearing aid is lost or damaged; you can manage this replacement without ever seeing this person at a time like this, it just takes some creativity.

The most important thing we can do to protect our patients right now is shut our physical doors and support them through telehealth mechanisms. I do not mean to imply this is easy or that this doesn’t have a tremendous cost to our practices. It does, but we must do no harm and we must be part of the solution that flattens this curve.

The Academy is engaged with Congress at this time requesting inclusion of reimbursement coverage of audiologists in the COVID-19 relief legislation. The Academy also has supported the language to include health-care providers in the small business loan proposals that are going before Congress. The staff and Academy leadership will be relentless in seeking legislative and regulatory solutions to support our members in private practice and other practice settings.

We must all work together to stay informed and seek innovations in practice during this time as we support the public health measures being recommended by the CDC and our local, state and national governments. For additional information, you may want to visit the Academy’s website for COVID-19 Clinical Recommendationsarticles on telehealth, including the Tele-audiology toolkit, and other COVID-19 resources

Stay at a distance, wash your hands, and don’t touch your face—the best advice the CDC can give at this time. Be well.

Sincerely,

Catherine Palmer, PhD, Academy President
Angela Shoup, PhD, Academy President-Elect
Lisa Christensen, AuD, Academy Past President
American Academy of Audiology Executive Committee

COVID-19 Resources

COVID-19 Resources

Academy Urges CMS to Lift the Medicare Physician Order Requirement and Allow Audiologists to Provide Services via Telehealth

April 2, 2020: The Academy submitted a letter to CMS urging them to exercise their regulatory authority to waive the physician order requirement currently required before a Medicare beneficiary may access the services of an audiologist. The Academy’s letter also requests that audiologists be added to the list of providers able to reach beneficiaries via telehealth.

April 3, 2020: COVID-19 Telehealth Update: Audiologists are beginning to employ creative solutions to assist their patients while mitigating the risk of further transmission of the virus. Some former face-to-face visits are now being handled via telephone, video, and/or remote connection to hearing aid devices.  Many audiologists are wondering if these remote services can be billed and reimbursed. This guide will help you understand options that are available to audiologists at the present time.

Treasury Department Releases Application Form and Fact Sheet for Forgivable Small Businesses Loans

Small businesses and sole proprietorships can apply starting on April, 3, 2020. The application form can be found here.  


 

COVID-19 Weekly Updates

See a recap of this week's news and resources. A new Academy update will be posted each Friday.


Practice Management Resources


Telehealth Resources

Telehealth and Medicare/Medicaid

Below is a resource list with information on the provision of telehealth services. The Academy will post additional information as it comes available.

Toolkits and Resource Centers


Free On-Demand Seminars (via eAudiology)


Government Resources


Public Awareness and Educational Resources


Communication Access Resources 


Free CEU-Eligible Online Education

The Academy is committed to ensuring audiologists have access to virtual educational resources during this challenging time. 

On-demand telehealth seminars are now available on eAudiology.org, and live webinars are scheduled throughout April. New webinars will be added each month. Please check the schedule of upcoming webinars to see the full list of offerings.

Brought to you by the AAA Foundation’s Educational Fund. Thank you to those who donated their AAA 2020 + HearTECH Expo Conference refunds toward this educational fund.


Mental Health


Resources for Students

COVID-19 and Clinical Recommendations

COVID-19 and Clinical Recommendations

(March 16, 2020)

COVID-19 and Our Audiology Practices

The best recommendation for all practices is to follow the CDC recommendations. You will want to access the CDC website on an ongoing manner to have the latest information. This is a changing situation and you will want to be up-to-date to protect your patients, your staff, yourself, and your families.

You also will want to monitor state and local recommendations that may impact your practice.

Large Health Care System

If you are part of a larger health system, the recommendations will be clear and will come from the health system. In large health systems, audiologists may have an alternate role depending on the state of emergency in that area (i.e., may be enlisted to answer phones, etc.).

Private Practice

If you are in a private practice, it may be less clear what steps you may want or need to take. The recommendations below are meant to assist you in this situation. Please keep in mind that this is a changing situation in our country and although these recommendations are appropriate today (March 16, 2020), things may have (will have) changed by the time you are reading these recommendations and you need to continually update your procedures based on CDC recommendations.

Governing Bodies

If your local governing bodies require that you need to suspend business or if you have decided to suspend your business, you will want to make sure your patients can reach you. On your website and through email communication you can let them know how they can best reach you. In this way you can continue these relationships during this time and at a minimum provide device trouble shooting advice remotely.

Helpful Tips

Many of our industry partners provide the capability of making hearing aid response and programming adjustments remotely. If you don’t already do this, you may want to implement this type of virtual care at this time. Although audiologists cannot receive payment from Medicare for telehealth services at this time, you can bill appropriately and receive out-of-pocket payment for these services as you would typically.

If your practice is open at this time, you will want to communicate to patients through your website and through electronic communications your process for disinfecting the clinic environment and for engaging with patients (e.g. not shaking hands in greeting, having hand sanitizer available, etc.).

For many individuals, they will feel more comfortable knowing what procedures are in place. See the CDC guidance for details on sterilization, disinfecting, etc.

Minimize Contact and Disinfect

Many clinics who are able are leaving the door to the clinic open, so the doorknob is one less surface to touch. They are not having individuals sign-in so community pens are not being touched. Reducing the number of surfaces that need to be touched is a good goal. It is reasonable to encourage patients to use hand sanitizer when they enter the clinic space for everyone’s safety.

Do not shake hands in greeting and minimize physical contact in general. You will want to wash your hands frequently which is already an expected practice in a health care setting, but you will want to be even more vigilant. Do not touch your face; this is a primary way to avoid exposing yourself to anything that is on your hands (this is always a good practice but one we want to be especially aware of in the current situation).

You will want to disinfect all surfaces including chairs, tables, counters, and door handles between patient visits. Throughout the day, wipe down community spaces with disinfectant (e.g., door handles to the restroom, keyboards, etc.). Make sure you wear gloves when disinfecting, these agents should not touch your skin. Review the CDC recommendations for cleaning.

Keep in mind, the current CDC recommendation is to limit human contact as much as possible. Therefore, all non-essential appointments should be postponed. Each of you will need to work within your own clinic environments to determine who these individuals are and how they should be managed—just keep in mind that the overarching goal is to limit contact.

Conduct Phone Screenings

You may have patients who are not taking this public health threat seriously, but we need to insist they follow recommendations coming from the CDC. Patients should be screened through telephone before scheduling to come.

The following triage can be used when speaking to patients on the phone:

  1. Determine if they truly need to come into the clinic in person or if their issue can be handled virtually.
  2. Focus on supporting current patients and encourage new patients who do not have an emergent situation to access your clinic later in the year (remember, the current goal is to reduce human contact as much as possible through social distancing so if a patient does not need to be seen in person, they should not come into the clinic at this time.
  3. Ask the following questions of anyone wanting to be seen in person to determine if it is safe for them to come into the clinic at this time.
    • “Are you having fever, cough, or shortness of breath?” If answer is “yes,” this individual should contact their primary-care physician (PCP) by phone immediately. 
    • “Have you traveled to China, Japan, South Korea, Italy, Iran, France, Germany, or Spain in the last two weeks?” If answer is “yes,” this individual should not come into the clinic at this time. 
    • “Have you been in contact with someone diagnosed with Coronavirus (COVID 19)?” If answer is “yes,” this person should not come into the clinic at this time. 

If the answer is yes to any of these questions, the individual should not be scheduled and should be referred to contact their PCP by phone for further instructions. It is just as important that you screen yourself and your staff with these same questions. If the answer is “yes” do not report to work and do not interact with staff or patients.

Patients who pass this screening and must come in to see you in person, should be asked to be accompanied by no more than one individual and when possible should come unaccompanied. Again, this is one more way to limit human contact.

Offer Drive-Through Service

You may want to consider “drive through” device support. If you are in a location that would be conducive for someone in your office to meet a patient at their car, the staff member can have a tray (covered with a sheet that can be disposed of) that the person deposits the hearing aid (or other device) onto from the car. The hearing aid can be cleaned/restored to function and then delivered back to the car. This can minimize patients encountering each other in the waiting room and coming in contact with many different staff members. 

Minimize Waiting Room Time

If you are in a single person practice, you may want to schedule any in-person visits in a way to minimize patients spending any time in the waiting room or interacting with other patients. Remember to disinfect the seating and common surfaces in the waiting area.

Be Available

Hearing and communication are essential in a time of emergency. Individuals need to access news reports from television and Internet. In a time when people are practicing social distancing, they need to be able to communicate virtually via phone and other virtual platforms with loved ones. Hearing plays a central role in many of these communications so even if your practice is not physically open at this time, your patients will be very grateful to be able to reach you for advice.

If you care for individuals with balance challenges, this can be a very scary time if they are having difficulties and don’t feel that they can safely access health-care institutions. Again, being available to consult virtually will help these individuals navigate what course of action is in their best interests.

Support Each Other

We also acknowledge that for our members in their own practices, this is a time of financial insecurity with the need to cancel appointments or with patients choosing not to pursue assistance with their hearing issues currently.

You may be an individual in a high-risk group and may feel you cannot see patients at this time. In addition, we know that some of you are facing child-care concerns, as schools and day care centers close under the recommendation of state and local governments. You may not be able to support your practice in person if you need to be home with young children. Some of the virtual strategies above may help.

This is a time when audiologists may be able to support each other by a larger practice offering to support patients who are typically seen at a one-person practice who cannot remain open at this time. This is a time for creative solutions to stay safe and to maintain support for our patients who need to continue to communicate effectively.

Sincerely,

Your Academy Board of Directors


Resources

Academy Comments to CMS Highlight Disproportionate Impact of Expected 2021 Medicare Payment Reductions on Audiology

The Academy submitted a letter  to CMS to supplement related comments submitted collectively with other physician and non-physician provider groups about the impact of the expected 2021 reimbursement reductions. The Academy letter highlights some of the nuances of these planned reductions in relation to providing audiological care. 

Academy Comments to CMS Highlight Disproportionate Impact of Expected 2021 Medicare Payment Reductions on Audiology

The Academy submitted a letter  to CMS to supplement related comments submitted collectively with other physician and non-physician provider groups about the impact of the expected 2021 reimbursement reductions. The Academy letter highlights some of the nuances of these planned reductions in relation to providing audiological care. 

CMS Final 2020 Payment Rules for Medicare MPFS and OPPS

Late Friday, November 1, the Centers for Medicare and Medicaid Services (CMS) posted the final 2020 payment rules for the Medicare Physician Fee Schedule (MPFS) and the Hospital Outpatient Prospective Payment System (OPPS). These rules contain proposed policy and payment changes under the Medicare program.   

2019 Joint Committee on Infant Hearing (JCIH) Position Statement Released

This current 2019 document builds on prior Joint Committee on Infant Hearing (JCIH) publications (2013 JCIH supplement on Early Intervention and 2007 JCIH Guidelines), updating best practices through literature reviews and expert consensus opinion on screening; identification; and audiological, medical, and educational management of infants and young children and their families.

Read more

Announcing Future Hub Presenter Meg Soper

Explore the topic of mindfulness and how important it is to take time for ourselves each day so that we find balance and thus can find the energy and inspiration to perform to the best of our abilities. 

Read more

The Audiologist’s Obligation to the Vertiginous Patient

The Audiologist’s Obligation to the Vertiginous Patient

If you’ve ever experienced vertigo, then you’re aware of how horrible this type of dizziness can be. Certainly, talking to a few patients will give you a better understanding of the impact of this symptom on your life. It is incapacitating and there is often a sense of lack of control that can bring on an exacerbating anxiety contribution.

Most audiologists, and frankly many people, have become more familiar with benign paroxysmal positional vertigo (BPPV). There are videos online to help show people how to treat this problem and it is possible to do this successfully. Alternatively, it has been estimated that the annual costs associated with BPPV in the United States exceed $2 billion. How is it that something you can watch on your phone still costs this much to manage?

The reality is that patients (and often health-care professionals) have no idea which ear to treat or treat the wrong type of BPPV with a standard repositioning maneuver. They order many expensive tests (some studies indicate 75 percent of patients with BPPV undergo costly MRI scans). The audiologist is literally in the best position to be able to accurately identify the ear and canal. It should stand to reason, then, that the audiologist is also in the best position to implement the correct management technique to bring about a positive outcome.

Similarly, some would argue that vestibular migraine is one of the most common causes of vertigo and other dizziness. In fact, some recent work suggests that patients diagnosed with other primary causes of vertigo often have vestibular migraine as a secondary diagnosis. The reason for this relationship that appears to exist between vestibular migraine and other causes of dizziness is unknown. What is known is that lifestyle modifications can be very effective in addressing migraine in general.

For example, elimination of triggering food/drink has been shown to cause a significant reduction of migraine symptoms in 63-93 percent of participants. Restful sleep is another factor that seems to improve symptoms of migraine. One study found a 49 percent reduction of headache frequency for the experimental group compared to the control group (25 percent) at six weeks follow-up.

Missing meals or fasting is a trigger in as many as 57 percent of migraineurs. Other researchers have shown that by increasing physical activity through exercise, a 40 percent reduction in migraine headache frequency can be realized. Recommending a “migraine diet” is cited as a first line of intervention in almost all comprehensive articles on management of vestibular migraine. This is a helpful management technique that can be provided by audiologists to the benefit of many patients with this type of migraine.

Management of vestibular impairment is in our scope of practice. By intervening as one of the front-line health-care providers who work with patients with dizziness and imbalance, we can create improvement for the individual. This will decrease the burden of health-care costs, lost days of work, etc.

After attending the Practice Management Specialty Meeting, you will be ready to identify and manage all types of BPPV and provide an initial solution to many patients with vestibular migraine.

About the Presenter

Richard A. Roberts, PhD

Richard A. Roberts, PhD, is vice chair of clinical operations and an assistant Professor in the Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee.

Learn more from his presentation at the Academy’s Practice Management Meeting, January 9-11, 2020, in Hawaii:
"The Audiologist’s Obligation to the Vertiginous Patient".

Medicare Audiologist Access and Services Act of 2019 Introduced in the Senate

On September 9, 2019, U.S. Senators Elizabeth Warren (D-MA), Rand Paul (R-KY), Sherrod Brown (D-OH), and Roger F. Wicker (R-MS) introduced the Medicare Audiologist Access and Services Act of 2019 (S.2446).