By: Courtney Massey, Cassidy Forth, & Cara Stump
What is tele-practice? Why should I care? These are questions you were probably wondering when you read the title of this post. We hope that by explaining what tele-practice is, how it is used in the field of speech-language pathology, and how it could be used in the future, you will see why it is so important for us to advocate for this important service delivery model to be reimbursed by insurance companies so that it can become a widely used tool and help a great deal of people overcome their communication disorders.
Knowing there are people that are not receiving care who could be receiving it through tele-practice is saddening, especially when you realize that it is because insurance companies do not cover tele-practice for speech-language pathology. There are many reasons that tele-practice should be implemented in therapy and covered by insurance companies, and we plan to outline some of these below.
The American Telemedicine Association defines telemedicine as “the use of medical information exchanged from one site to another via electronic communications to improve a patient’s health status”. The American Speech-Language-Hearing Association, the governing body for the speech-language pathology profession, has defined tele-practice as “the application of telecommunications technology to the delivery of audiology and speech-language pathology professional services at a distance by linking clinician to client/patient or clinician to clinician for assessment, intervention and/or consultation” and is in support of the adoption of this service delivery model. You may hear the term “telemedicine,” “tele-practice”, “telehealth,” “teletherapy”, etc. used in the literature; however, all of these words mean the same thing and are used to reference the act of providing a service in an online format rather than face-to-face interaction. With the evolution of technology that is continuing to grow, we must also evolve and take advantage of this new way of connecting people who may not otherwise be able to meet with various healthcare professionals. Tele-practice is an amazing new way for people to get the care they need in a more convenient way; as patients and healthcare professionals are evolving to accept and embrace this new service model, insurance companies must also realize that it is a valid and effective way of assessing and treating patients and should therefore be reimbursed in the same manner that face-to-face sessions are reimbursed.
There are several benefits to utilizing teletherapy as an SLP. There are many rural areas throughout the United States that do not have access to services. Teletherapy allows everyone to have access to therapeutic services as long as an internet connection and computer are present. Previously, patients had to travel hundreds of miles to see specialists but now they can see specialists from their own home; this is allowing specialists to promote themselves as a professional, their knowledge, and their services to people all over the world. A specialist could also use teletherapy to teach other professionals their skill sets and potentially allow more professionals to develop expertise. Teletherapy could also be cost effective - currently some SLPs travel from home to home over multiple counties to provide services. This is costing companies an abundance of money in mileage fees and reimbursing individual professionals for gas. Being able to provide even half of their sessions via tele-practice instead of driving to each individual home would save companies thousands of dollars per year.
Many states are recognizing the need for speech and language therapy provided by telepractice and are beginning to provide laws and regulations that govern SLPs in this practice. These new laws are allowing SLPs in many states to provide tele-practice, but it is billed to the patient at the full expense because it is not covered by insurance. Many people who may benefit from the speech and language services may not be able to afford the out of pocket costs.
Medicare, a federal program for people who are 65 or older, is a source of insurance that does not currently consider speech-language therapy via tele-practice as reimbursable. Medicaid, a program for low income families, and private insurance have not set up reimbursement standards for speech and language teletherapy services. In other words, insurance has not stepped up to cover tele-practice services, because they don’t believe there is a high enough need and desire by the people who have their plans to actually cover it.
Tele-practice for speech and language therapy should be covered by all insurances (federal, state, and private). In addition to the many benefits listed above, people should have the right to all options for their healthcare needs. With the addition of tele-practice coverage under insurance plans, more people will have options to speech and language services they may not have previously been able to attend or receive due to reasons, such as time, location, availability, and affordability.
The most important thing you can do is to advocate! Advocate for your family, friends, colleagues, neighbors, and anyone else who would benefit from tele-practice! Being silent on a cause/policy or hoping that the issue will arise will not result in change. The best way to advocate for reimbursement of teletherapy is by supporting current efforts and writing to anyone you can! A few potential points in your letters could include: personal experiences with tele-practice, personal experiences of not being able to receive services, a lack of available resources in your area, cost reliefs, and much more! Several states already have policies in place, therefore, research may be required before writing your letters.
American Speech-Language-Hearing Association (2018). Telepractice. Retrieved from: https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589934956§ion=Key_Issues#Reimbursement
American Speech-Language-Hearing Association. (2018). Reimbursement of telepractice services. Retrieved from: https://www.asha.org/Practice/reimbursement/Reimbursement-of-Telepractice-Services/
Dudding, C. (2013). Reimbursement and telepractice. SIG 18 Perspectives on Telep
ractice, Vol. 3, 35-40. doi:10.1044/teles3.2.35
Frailey, C. (2014). A primer on medicaid telepractice reimbursement. The ASHA Leader. 30-31.