As schools and businesses close the week of March 16 due to social isolation and on-site shelter guidelines related to COVID-19, private practitioners are holding back treatment in person. To maintain their services during this time of uncertainty, many have adopted telepractice – a new way for some.
State and individual payer regulations vary depending on telepath coverage. Check state and payer websites regularly for up-to-date information. ASHA continually updates web pages on telepractice and COVID-19 (also listed below in the resources section) and also posted new provide private services to Medicare Part B beneficiaries.
Whether in a solo practice or the owner of large interdisciplinary clinics, audiologists and speech-language pathologists adapt their practice model to continue to serve clients – as best they can – and to keep their businesses afloat. Here’s what some are saying.
Susan Arnold, MS, CCC-SLP, Professional Speech Association, Coral Springs, Florida; President, American Academy of Private Practice in Speech Pathology and Audiology
Susan Arnold spent the week of March 16 canceling a three-day conference, trying to convert her practice to telepractice, and answering questions from AAPPSPA members.
Arnold is proud of the way private practitioners across the country have come together to help each other. “Someone calls an insurance company, stays on the phone for hours, gets a response and sends the information to our mailing list,” she says. “Everyone shares information, supports each other and joins.”
After canceling the AAPPSPA annual conference, originally scheduled for April in Orlando, Arnold is struggling to find ways to help members win the CEUs they counted on, perhaps by moving the sessions online. She is also trying to set up video conferences with relevant information – one of the scheduled speakers, a financial planner, makes a free video conference to answer questions, and is working to find a lawyer to do the same.
Like his colleagues across the country, Arnold is trying to shift his practice – which includes physiotherapy and occupational therapy, as well as speech therapy services – to telepractice. “There is a steep learning curve,” she says. “We have never done it before.” She predicts that of the firm’s “few hundred” speech therapy clients each week, only its private clients and adolescent and adult clients will be ready to try the new format.
“This situation is really unknown,” she says. “No one really knows what to do.”
Erika Shakespeare, AuD, CCC-A, Audiology and Hearing Aid Associates, La Grande, Oregon
Shakespeare shared his experiences by email:
What impact has COVID 19 had on my small rural private practice? How has it affected me, as a business owner, supplier, human being? It is always difficult to know where to start when discussing something that has been, and still is, very disruptive. Disturbance – it’s a word that has been thrown out a lot in audiology in the past two years. Right now, I long for the days when my biggest concern was how to deal with threats to the hearing health of my patients from internet sales, chains or big box stores, and access to services for veterans. The past few weeks have been this fluid attack on my feeling of confidence and security. I expected a top-down approach to management and advice on how to behave as a business owner – it didn’t happen. I have a responsibility to my community, my staff, my family and myself to act. Controlling the spread of this pandemic virus requires a bottom-up approach; we do not have leaders who will show us the way. It is ours. It is up to me to make decisions that will protect and influence those around me.
About a month ago, I started planning and talking about strategy with my staff and family. It’s hard to believe that just three weeks ago, I canceled my flight to Kansas City for the National EHDI conference for the sake of safety for my community and the risk I could pose to the vulnerable population that I served. Just two weeks ago, I sent my first memo to my patients and staff about our plans to respond to the spread. Today, our waiting room is closed, we limit our services to “roadside” visits and remote hearing aid programming to ensure that our patients always have access to their hearing so that they can stay in touch with their families and sources of information.
We have established protocols and processes that are updated and changed daily, based on local district health and national recommendations. New expressions like “social distancing”, “self-imposed quarantine” and “refuge on the spot” are part of our daily lexicon. It’s a whole new world and I don’t feel brave anymore. But I will continue to remain adaptive and fluid to keep things afloat for those who depend on me for their own survival.
Courtney Wright, owner, KidPRO, Nashville, Tennessee
Perhaps, thinks Courtney Wright, the data it collects on the effectiveness of remote processing will be the silver lining of the coronavirus cloud.
Wright changed his practice – which offers combined speech processing and applied behavioral analysis – to telepractice only on March 18, after spending two days exploring the platforms, seeking insurance and educating families.
And although most of his families are ready to try telepractice, some local insurers do not cover it.
“Families don’t necessarily know what it means or what it will look like,” says Wright. “But they are hopeful and positive, we will find out together.”
But it also recognizes that some clients may not be suitable for telepractice – if, for example, the child needs a distraction-free environment, or if a child is simply learning a skill and is not yet ready for it. generalize at home. She is also exploring the possibility of using telepractice for direct parent training.
Some large insurers in the Wright area cover telepractice, while others do not. “We call these insurance companies every day,” she says, “and the parents send them emails saying, ‘Everyone’s on board with telepractice coverage, why don’t you?’ “”
Wright wants to use this time to prove the effectiveness of telepractice so that insurers have no reason to refuse coverage. “My goal is to extract data that demonstrates that this is real, that it works – let’s keep doing it,” she says, “and let’s share it with insurance companies.” Because when the pandemic is over, telepractice would still be a great option in some situations: the car breaks down, a sibling is sick, so the parent cannot bring the child to an appointment or that a child is ready to “ graduate ” from treatment and wants to practice skills in the family environment. And we could expand our range of services geographically, especially in underserved areas. “
Hallie Bulkin, MA, CCC-SLP, Little Sprout Therapy, Bethesda, Maryland
In Montgomery County, Maryland, where Little Sprout Therapy is located, schools are closed for at least five weeks. Bulkin’s practice has 23 SLP contracts, mostly part-time, which provide services to approximately 130 clients each month in clients’ homes, schools or daycares.
“The success of the practice is important,” says Bulkin, who is trying to convert all clinicians and clients to telepractice. But not all clinicians and clients are on board.
At least 50% of his families have refused telepractice – they think their insurance company won’t reimburse, their child won’t cooperate, or school will resume soon.
Bulkin, who believes the schools will be closed for much longer, will contact these families after two weeks. She plans to collect telepractice success stories from her clinicians and share them with clients in the hope that the stories – and the recognition from parents that their child is losing – will convince parents to try the services remotely.
Some of his clinicians are also wary of telepractice. And it’s not just the old SLPs who aren’t comfortable, says Bulkin. Young clinicians are concerned about client behaviors and their ability to pay attention. One of his SLPs, who has experience providing telework services to a toddler, shared advice.
“I am grateful,” said Bulkin, “because my therapists are contractors, not employees, and I have no facilities. I feel it a little less than the others. We will get through it. We will resist to the storm. “
Robyn Merkel-Walsh, MA, CCC-SLP, Ridgefield, New Jersey
In his solo practice, Robyn Merkel-Walsh specializes in oral motor therapy for eating disorders, myofunctional disorders, tongue and lips and myofunctional disorders. She sees about 25 clients a week.
“Now I have no patients per week,” says Merkel-Walsh. “My practice is very convenient, and I’ve never done telepractice,” but she’s trying to find a way to make it work.
She is taking online courses to learn about telepractice and hopes her clients can adapt. “In my practice, the parents are always in the room and are always trained,” she says. “I demonstrate, and the parent is the assistant and engages in a therapeutic activity. I would steal people’s money if I went for therapy and sent them home. “
Merkel-Walsh gives parents a personalized calendar with noted illustrations of the exercises the client needs to practice at home, which facilitates the transition to telepractice. She does not know if her patients will accept or adapt to online treatments, which she considers a maintenance program to avoid regression until resumption of normal practice.
For customers who are concerned about the reimbursement of telepractice or who do not wish to participate in online processing, it offers free 15-minute video recordings. “I don’t want to abandon my patients because they can’t pay me,” she says. “I have patients who are two weeks after surgery and count on me to monitor them.”
Merkel-Walsh, who rents office space, expects revenues to drop to less than half. His catastrophic business insurance does not cover the coronavirus pandemic.
“At first we thought it had been short lived, but now I don’t hear any practitioners saying,” We’re fine, we’re going to get through this, “she said. “Therapists are increasingly saying, ‘Will our patients be there when we get back? Will they get used to not having therapy? Will they lose their jobs and be unable to return? “No one thinks they’re going to go back to a full schedule. I’m going to have to restructure my future job – maybe develop myself in other areas, maybe keep telepractice as part of my practice. [The pandemic] will forever change the way we view our practices. “
Amy Wetherill, MA, CCC-SLP, co-owner, The Pediatric Development Center, Rockville, Maryland
Wetherill and his partner, occupational therapist Tracy Wilson, have 49 employees and two locations, with 1,200 pre-pandemic clients. She wrote by email:
My staff have been incredible. We closed our office late on Monday March 16 afternoon and worked around the clock to learn telepractice. Therapists have volunteered to be team leaders … learn one day – teach their team the next day. Billing and the front office called insurance companies to verify the benefits of telepractice for all BlueCross BlueShield customers. Medicaid now pays in Maryland! Today (March 19), everyone communicates with their family and tests it. The kids say, “Let’s do it again!” When will you come back?”
Currently, 83 sessions are booked for next week – we need at least 560 hours per week to pay and pay for expenses. Our goal is at least to break even, so no one should be laid off, even temporarily. We are ready to tap into our line of credit or put money back into the business, but we pray that we do not need it. We don’t expect to make any money ourselves during this time, but I just want to be able to keep my entire staff and continue to serve my community well.
The “we can do it” attitude abounds at PDC. I was moved to tears more than once this week.
Marnie Millington, MS, CCC-SLP, co-owner, Children’s Speech and Feeding Therapy, Needham, Massachusetts
Marnie Millington and Arden Hill have never argued so aggressively.
They started on March 14 by posting an online petition calling on local insurance companies to cover telepractice services for their practice. In less than 24 hours, they had more than 1,000 signatures and are quickly approaching double.
And when the Massachusetts governor later ordered insurance companies to reimburse telemedicine to medical and behavioral health providers – without specifically including SLP – Millington began to contact his office, as well as those of his US senators and state officials, to clarify whether speech language services were covered by the directive. She sent the petition to them, along with information indicating that other states regularly cover telepractice and noting the financial crisis facing SLPs.
No government official – or the local journalist she contacted – was interested.
“What we do is so important,” says Millington. “The language is like the Massachusetts Turnpike. All trucks drive on it – the math truck, the reading truck, the social truck. Language is a fundamental element of human experience. “
But while state legislators have not reacted, some insurers have done so: The state’s Blue Cross Blue Shield program – which covers approximately 60% of its customers – has agreed to cover telepractice services at the same rhythm than face to face. “It could keep us afloat,” says Millington.
But Harvard Pilgrim, another large local insurer, agreed several days later to cover the service – at 80% of the normal rate. Millington filed a complaint about the lack of parity with the Assistant Insurance Commissioner, how 100% the insurer agreed.
Millington and Hill are trying to determine payment details for uninsured customers. “It’s devastating for our families,” says Millington.
Millington closed the doors to its brick and mortar practice on March 20, after an approximately 50% week of attendance at its clinic, whose seven SLPs usually see about 200 clients each week, many with multiple sessions.
“From an ethical and medical point of view, the only thing to do is to switch to all telepractice,” she says.
“As a concept, the majority of families are excited about telepractice,” she says. “The children are delighted with our presence in their kitchens and dining rooms, and the parents are delighted to be electronic assistants. The generalization capacity is greater – now you are at home! If we can reopen the clinic, telepractice will be a big improvement in face to face service delivery. “
Millington did not particularly enjoy making endless phone calls and receiving negative responses, “but I fight for the families we serve and for the working lives of seven employees, my partner and me.”
Sue Ellen Krause, PhD, CCC-SLP, Krause Speech and Language Services, Chicago
With the requirement of an on-site shelter in Illinois, Sue Ellen Krause transformed her solo practice into telepractice only.
Krause, who specializes in children’s language, phonology and fluency, said her school-aged students were very successful in telepractice because they were comfortable with her and working on screen. Most of his clients have echoed what a high school student – during his first telepractice session – said to him, “I’m glad I can attend this treatment session. I prefer to see you in person, but I’m fine. “Others are fully adopting the new method and she has seen a very small drop in her practice.
As a sole proprietor, Krause does it all – from planning to assessments and processing to billing – by itself. Insurance isn’t a problem, thanks to the Illinois governor’s mandate that insurers cover telepractice. But attracting new customers is a problem, as it cannot perform the assessments remotely. Krause says she has a new family who was ready to go on board, “But now we have to wait until this veil is lifted, and there is sure to be someone coming to my office,” she said.
“I hope this situation does not last very long,” she said. “I think telepractice works, but in some cases it’s not as desirable as face-to-face. But right now, I’m in good health and so are all of my client families – and our goal is to keep it going. “
ASHA: Telepractice (linked to COVIDs)
ASHA: General telepractice
Infection control and social distancing
ASHA ethics: customer abandonment problems can arise when clinicians cannot provide services that meet their established treatment plans. If you are unable to provide continuous services, try to give as much advance notice as possible about your closure; give clients options, including home exercises / activity suggestions and / or referrals to others; and document the reason for the service disruption, including any additional options or information you have provided and / or state or county regulations that may be in place (such as on-site shelter orders) .
Carol Polovoy is editor-in-chief of The ASHA Leader. firstname.lastname@example.org
Jillian Kornak is a writer / editor for The ASHA Leader. email@example.com