I have been pondering writing on this topic for some time. It is important, and we need as a field to be talking about it.
Telepractice access to care for patients/students receiving SLP services was just emerging prior to the COVID years. Then, virtual therapy as a topic utterly exploded when telepractice access was needed — as the reality of COVID-factors presented. COVID brought tele-practice to the forefront.
While COVID brought the need for virtual services completely center-stage, I would maintain as a multi-service delivery SLP provider that the need for this type of access goes way beyond COVID factors.
There are major reasons why a patient may desire the option for virtual services, and I would like to unpack this topic, as well as encourage you in your role to advocate for continued virtual service reimbursement for all ages of patients that would quality — even if the COVID-pandemic national health crisis may wax and wane.
I would like to make a few points that are noteworthy:
- Not every patient or patient type is going to be an appropriate candidate for telepractice. Our American Speech-Language Association Code of Ethics (and each state has an equivalent) dilenates the parameters of when telepractice can be utilized for speech pathology services. However, each patient that would receive equivalent services, based on clinical factors and geographical factors, virtually as compared to in-person delivery needs to have the option to pursue this. Our role is to determine if the service delivery model of virtual visits is possible, then offer it in that case.
- As of the writing this blog post, as a clinic owner that offers in-person vs. virtual vs. combination factors, I am waiting. I am waiting for the decision-makers to make a ruling if the Public Health Emergency (PHE) of COVID continues, which they consider each quarter — to decide if CMS (Center for Medicare and Medicaid Services) will continue to allow reimbursement via virtual visits/telepractice. On October 13, 2022, the decision was made to again extend the PHE. There have been some new developments, such as the Considerated Appropriations Act of 2022, which provided a 151-day extension of tele-health reimbursement for indicated patients once the PHE ends. However, this is not a long-term solution.
- I do not feel telepractice as an option should be forced or denied, as long as the patient is eligible due to clinical and other factors. Rather, it would benefit patients the most to have it as an option, depending on how they themselves value all factors at play (factors listed below).
It is my recommendation that we all advocate for telepractice as an option, if patients would be eligible for it based upon clinical factors. Who will benefit? The patients we will come into contact with in the immediate timeframe and in the future. Their access to care is always important, not just because of a time-dependent piece of legislation.
I encourage everyone to please reach out to legislators/decision-makers in your area and relay that the following factors make virtual access a necessity to qualified paitents:
— Limitations to access to in-person care locally.
I receive calls each week from patients in my state who are driving hours each way for access to outpatient care, as the closest outpatient provider clinic for SLP is hours away. It is extremely taxing for these patients and families. Especially in states that are larger, wider and have more surface area — people who need SLP services value the option to see if they would be eligible clinically for virtual SLP care. For those who are homebound, or at-risk of being homebound — such home health and Medicare Part B care organizations can really help. For SLP patients who do not have these services in their area, it is important for them to have virtual services as an option. Also, we have to ask ourselves — if a patient is traveling hours for one SLP visit, I have to wonder if we could do more effective in setting-up the patient up for success in having the energy in order to participate fully in visits.
— Medical conditions may not be congruent with seeing providers in-person.
Contagious diseases and immunocompromised conditions are not limited to the topic of COVID. Some patients may have conditions other than COVID that make virtual care an attractive and desirable modality.
— The financial cost of travel.
While some insurance plans do reimburse for mileage utilized in order to access in-person services, not all do. And many patients may not have the executive functioning abilities to navigate such systems. The barrier of traveling to a major town that has in-person access — and the financial cost involved, may be just the reason a person may decide to not pursue services. Removing the financial barrier by making services available through technology may allow for patients to be more willing to take that first brave step toward seeking treatment.
— The time and energy cost of travel.
Whether it is 10 minutes or 100 minutes, when patients need to travel from place to place for services, it is an investment. Especially with patients with multiple health conditions, time needed to travel could be used to rejuvenate or spend time on tasks to assist them in their recovery. Just like the financial cost of travel, there is only so much time and energy and some patients opt for telepractice as a service delivery model due to these.
— In-person options locally have already been fulfilled.
I have had patients contact me about seeking telepractice services from major cities. They sought out additional options for treatment because they had already exhausted available local options, and for various reasons, they were avenues they would like to continue pursuing.
— There may be local/in-person options, but a waiting list/delay in starting services, and this may be payer-specific.
A patient who is seeking services may decide they would like to pursue telepractice because the in-person options have a waiting list/delay in services. A patient may decide to start services via telepractice until the in-person options arrive. Also, a patient does not have the control of which payer sources different clinics or home health agencies can accept. While some patients can decide during open enrollment which plan they choose, not all patients have this option (and it is not always near open-enrollment time).
— Personal factors.
Some patients, due to various biological, environmental, cultural, personality, or other factors — do not feel comfortable with home health staff come into their home. Or, they may not feel comfortable going to an outside location that they do not have control over, and all of the issues that could potentially come with it. Some patients like the idea of having therapy in the comfort of their own home, but prefer it not involve (an outside) person physically being in it. In addition, some patients seem to participate in a different/more effective manner in visits when in a virtual visit, and this may be a reason a patient or family member may desire to seek it out.
There are I am sure other major factors as to why any patient may seek virtual services. Modifications and allowances are the name of the game with virtual visits. While not every patient will be a candidate for virtual care, it is extremely helpful to remember that we can advocate for patients, who are eligible, continue to have this as a option — for those who may desire it.
COVID hit the country, and the entire world — hard.
There were so many cause-effect results to patients and families by this PME, so many lives lost and others impacted forever.
My hope is that this effective thing that came out of the pandemic— access to virtual services in the SLP world (that is a helpful option outside of the pandemic) not be forgotten or dimmed out.
Let us take virtual access and implement it as a “forever” option, all things considered.
Wilson Nice, SLP, is the owner of Nice Speech Lady, a medical SLP platform for functional, practical and evidence-based SLP clinical resources.
Nice has been publishing complimentary tools for SLPs since February of 2018.
She is a hybrid outpatient clinic owner — serving adults and children, in Socorro, New Mexico.
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