The State of Telepractice in 2014 Telepractice is an ever-expanding service-delivery option, with more U.S. speech-language pathologists and audiologists adopting it every day. But reimbursement policies continue to lag behind the trend. Features
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Features  |   December 01, 2014
The State of Telepractice
in 2014
Author Notes
  • Janet Brown, MA, CCC-SLP, is director of ASHA health care services and ex officio for Special Interest Group 18, Telepractice. jbrown@asha.org
    Janet Brown, MA, CCC-SLP, is director of ASHA health care services and ex officio for Special Interest Group 18, Telepractice. jbrown@asha.org×
Article Information
Practice Management / Telepractice & Computer-Based Approaches / Features
Features   |   December 01, 2014
The State of Telepractice
in 2014
The ASHA Leader, December 2014, Vol. 19, 54-57. doi:10.1044/leader.FTR3.19122014.54
The ASHA Leader, December 2014, Vol. 19, 54-57. doi:10.1044/leader.FTR3.19122014.54

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Watch speech-language pathologists and audiologists discuss how clinicians can use telepractice to surmount treatment barriers and serve otherwise unreachable clients.
Across the United States, speech-language pathologists and audiologists seem to be adopting telepractice enthusiastically, and the indications are many: ASHA’s Special Interest Group 18, Telepractice, has grown to more than 1,000 affiliates in its first four years of existence; telepractice will be a discrete topic area at next year’s ASHA convention; and even a simple Google search of relevant terms reveals multiple listings of companies providing telepractice services and recruiting employees.
In two decades, telepractice has grown from being confused with follow-up telephone calls to a service-delivery method recognized by most SLPs and audiologists—even if they don’t engage in it.
These signs are encouraging. But given the known challenges to telepractice reimbursement and licensure, to what extent has it really taken hold in the United States? To find out, SIG 18’s coordinating committee—led by Michael Campbell—collaborated on an ASHA survey fielded to SIG 18 affiliates and other members who indicated they had expertise in telepractice. Here’s what the survey said.
Where clinicians provide telepractice
Most speech-language pathologists who responded to the survey were self-employed (44 percent), whereas audiologists doing telepractice were employed primarily by a federal, state or local government agency (48 percent). SLPs mostly provided services to clients located in homes and schools (50 percent homes, 52 percent in elementary and 40 percent in secondary schools). Audiologists most frequently delivered services to clients located in Veterans Affairs hospitals or medical centers (37 percent) or clients’ homes (30 percent).
Paying the bills
Concerns about reimbursement limitations initially prompted the SIG 18 coordinating committee to conduct this survey. Lack of reimbursement is a strong disincentive for private practitioners or institutions to develop telepractice programs. On the survey, 55 percent of all respondents—audiologists and SLPs—said they or their employer are reimbursed for telepractice; 20 percent were unsure if there was reimbursement. Private pay by clients was the most frequently reported source of income, followed by departments of education and school districts.
Medicare’s lack of coverage for many professionals providing telehealth (the term used by health care providers) services casts a significant pall over the reimbursement landscape in health care, because Medicare largely influences the actions of other health insurance payers. ASHA and other professional and telehealth advocacy groups have repeatedly pressed for the expansion of Medicare reimbursement, but telehealth reimbursement by Medicare remains severely limited by profession, procedure code, geographic location and type of setting.
Reps. Gregg Harper (R-Mississippi) and Mike Thompson (D-California) introduced the Medicare Telehealth Parity Act of 2014 (H.R. 5380) at the end of July. This act is the first legislation that would authorize Medicare to reimburse audiologists and SLPs for teleheath services. Though it is unlikely to pass in 2014 and will need to be reintroduced in the next Congress, this bill is a step forward for ASHA members who wish to provide telepractice services.
Medicaid coverage policies vary by state. Details about Medicaid coverage are frustratingly difficult to ascertain, due to the lack of written regulations addressing telepractice. In states like Virginia, where Medicaid reimburses telepractice in schools, the reimbursement rate is so low that it could not support a telepractice business model even if expanded to other settings.
Some survey respondents reported receiving payment from private insurance. As with Medicaid, it may be difficult to find written policies regarding telepractice even though state mandates may stipulate that services covered by the plan must be reimbursed when delivered via telehealth (see “Two States Pass Telemedicine Coverage Mandates,”). However, contacting a payer and making the case for telepractice services has proven successful in building a relationship with the insurer and educating the insurer about telepractice (see “Why CareFirst Champions Telepractice,”)
At home or abroad?
Beyond U.S. borders, survey respondents reported delivering services to clients in a large number of countries on every continent except Antarctica. These client locations include countries that have their own professional associations and accreditation processes, such as the United Kingdom, Australia and New Zealand, as well as countries that do not have identified professional organizations or credentials—such as Fiji, Ghana and Peru.
ASHA’s guidance about international telepractice is to check with the client’s country to determine if there are requirements to practice. International practice may be more appealing to clinicians because of licensure and payment limitations in the United States. Clients abroad most likely pay privately, eliminating the need to deal with insurance.
Interstate telepractice and licensure
Stateside, the largest numbers of telepractice providers responding to the survey were based in California (22), Pennsylvania (21), Ohio (19) and Colorado (14). Clinicians reported delivering services to states that included California (48), Ohio (28), Pennsylvania (25) and Florida (21). The survey also gauged attitudes toward licensure to help inform ASHA’s stance on a policy addressing interstate licensure for telepractice. Many (48 percent of SLPs and 23 percent of audiologists) considered the requirement that clinicians obtain a license in each outside state (in addition to their home state) a barrier to practice.
Half of respondents preferred a universal license that would allow them to practice in any state in addition to their home state. Their second preferred option (38 percent) was an interstate licensure compact that would allow clinicians to practice in participating states, with a coordinated information system regarding any misconduct or malpractice. However, only 37 percent believe that their state provides adequate consumer protections in telepractice treatment.
In September, the Federation of State Medical Boards, which represents 70 medical and osteopathic boards, endorsed model legislation that would create an interstate medical licensure compact to streamline licensure for practice in multiple states while still protecting patients.
Waiting in the wings
Although awareness of telepractice is growing exponentially in the professional and consumer worlds, its potential to benefit students, clients and patients is far from fully realized. Access to affordable software and equipment for telepractice continues to expand alongside the research literature, but lagging reimbursement remains a substantial challenge. In the future, telepractice inevitably will be incorporated more fully in academic programs, supervision and service delivery. SIG 18 will continue to monitor, cheer and support that evolution.
1 Comment
December 29, 2014
Kym Meyer
ASHA should look into inappropriate uses of telepractice
My daughter has autism and attends a virtual online public school. We also live in a suburban area with lots of resources. As part of her IEP, she needs a social skills group. In the past, the virtual school contracted with a local SLP group. Now they're contracting with a telepractice group for all services (OT, speech and counseling). While I understand how telepractice can be beneficial in most cases, it's unclear how a child with autism can make effective progress in a social skills group, when the kids are not in the same room. We are challenged with getting her together with peers who will have anything to do with her. She certainly doesn't need MORE screen time. But this is the contracted model, whether or not it's appropriate (and I certainly can't find ANY research on virtual social skills groups on teens with autism. If anyone knows of such research, please pass it along).
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December 2014
Volume 19, Issue 12