Friday, 13 March 2020

How should audiologists respond to the COVID-19 health emergency?

Posted in ADA News

The COVID-19 virus is having a profound impact on the daily lives of all Americans, especially audiologists who serve a large senior population or who live or work in a heavily affected community or geographical are.

First, audiologists should educate themselves on the virus and its effects and consider implementing the CDC guidance, specifically, workplace school and home guidance.  This site offers the most up to date, definitive information on COVID-19 and its mitigation.

Here are some mitigation and social isolation considerations audiologists could consider:

Evaluate your practice’s financial situation and financial safety net. Should your practice fall within a containment zone or need to close for any length of time, it is important to answer these questions before the situation arises.

  • How many days, weeks or months could you financially survive without income?
  • What local, state, and federal governmental resources, subsidies, low-interest loans, or stimulus offerings are available to you and your business?
  • Do you have business interruption insurance and, if so, how does it address public health emergencies?
  • Can you reduce your business expenses and overhead expenses over the next few months, and if so, how?

Request that patients and staff stay home if they are sick, have symptoms, or are in a high-risk group. This should be factually and consistently communicated via your social media posts, website, email blasts, and appointment reminder calls. If you worry about patient illness/contamination, consider implementing a screening tool such as a temperature check, using a forehead or ear thermometer, at all patient visits. These thermometers are readily available through many retailers.

Consider implementing a stringent, no exceptions infection control policy and consistent procedures. These include handwashing, offering tissues, and hand sanitizers to your staff and patients. wearing gloves and masks when in contact with patients, wiping off hearing aids and office surfaces using disinfecting wipes after each patient, sterilizing reusable ear, tympanometry and otoscope tips and cerumen removal tools, and creating sterile surfaces using sterile pads. Oaktree Products has great resources on infection control and offers numerous infection control products. There are also some excellent training resources available at AudiologyOnline.

Reduce the number of patients, especially those in high-risk groups (60+ years of age, patients with co-morbidities) seen in your office for non-emergent, follow-up care. As allowed by state licensure and considering your HIPAA security and privacy implications (transmission security), consider implementing telepractice for hearing aid programming, hearing aid follow-up, orientation, counseling and auditory rehabilitation. The American Speech-Language-Hearing Association (ASHA) has a great listing of state by state telepractice and hearing aid dispensing laws. Also, please note that, given the lack of an interstate compact, typically you must be licensed in the state in which the patient currently resides in order to provide care via telepractice.

Finally, please consult with your malpractice and/or liability insurance vendors to see if any special coverage or riders are required for telepractice. Some office management and electronic health record systems have HIPAA compliant telepractice delivery systems built into their software. If allowed to provide telepractice in your state, please understand that there is little to no third-party coverage for telehealth provided by an audiologist. If you attempt to bill these services, please make sure to change your place of service code to 02 (telehealth). For a Medicare beneficiary, you would add also the GY modifier (item or service statutorily excluded or does not meet the definition of a Medicare benefit). You will also need to determine how you plan to monetize, if required, the care being provided via telepractice. Your practice may need to implement an instant payment program, like Venmo, Zelle, Square, or Quickbooks, for your business.

Consider an alternative “drop off” or “pick up” program for hearing aids in need of repair. This will help reduce the number of patients congregating in your clinic or lobby. Create a drop off box for your lobby, secured outside your office, or at the front desk of assistive living, skilled nursing, or senior living settings you work with, in order to continue servicing malfunctioning hearing aids and accessories. Implement more mailing and courier service deliveries of repaired devices.

If you are starting to see patient cancellations and reductions in patient visits and have underutilized providers or staff, consider offering your staff unpaid leave without requiring them to access their vacation, sick or unused paid time off. This may help staff solve childcare difficulties they have encountered due to school closures or quarantines. If you operate more than one office location, consider consolidating your locations for a window of time.

This will reduce your coverage and infection control management requirements, as well as your utilities (especially if you pay for heating and cooling). If you reduce your practice footprint for a given period of time, clean your way out of the space or spaces you are temporarily closing. Make sure to be transparent with your patients and communicate the rationale for such closures.

Finally, if you provide home visits or concierge care, please reconsider your policies related to visits to patients’ homes or offices, especially if you live in a containment zone or an area with several quarantines or identified cases.

  • Consider asking patients if they are under any voluntary or mandatory containment or quarantine.
  • Consider asking patients if they have a fever, cough, or unusual fatigue before visiting their home or office.
  • Utilize a mask, gloves, hand sanitizer, and infection control procedures in all patient interactions, especially if your patient is 60+ years old or has significant co-morbidities.
  • Consult with your malpractice and/or liability insurance vendors to see if any special coverage or riders are required for home visits.
  • Develop an emergency plan in the event you encounter a patient in distress or in need of medical attention.

These suggestions are NOT intended to alarm audiologists. Rather, they are intended to help audiologists and their staffs create a preparedness plan that protects themselves, their staffs, their patients, and their business interests as we, as a country, encounter an unprecedented health emergency.