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Telehealth Under Threat: Protecting Access for Adults and Families | Otter.ai

Telehealth Under Threat: Protecting Access for Adults and Families

Jeanette Benigas29min

Speaker 1

00:03

Welcome to the Fix SLP summer school series where we're schooling the system all summer long. If you're ready to challenge the status quo in speech language pathology, you're in the right place. Subscribe so you don't miss an episode, and if something fires you up, leave us a message on the minivan meltdown line at fixslp.com, grab your favorite summer beverage and let's get to work.

Jeanette Benigas

00:29

Hey everybody, welcome back. It's Jeanette. We are coming close to the end of summer school. Summer's not done yet. A lot of us are back to work if we had the summer off, but we're still going hard for summer. Today, we have Katie Brown from neurospeech solutions. We will get with her in a minute. Preston was just given the week off because there were too many women up in this podcast today, so we didn't need all those voices. Because right now, I have Mikayla Treynor. Mikayla is our Director of advancement and partnerships here at Fix SLP, she's been working her little buns off to get our team just a little bit of money. So Mikayla, you connected with a medical supply company befitting you. They are sponsoring this episode today, and I asked you to come on, they are an AAC device company, amongst other things. They are exclusive to Michigan, but this is applicable to any state touching Michigan, like if you live in Ohio or Illinois and you practice in Michigan, you can still use them to get devices for your patients in Michigan. So Mikayla, because you are a practicing SLP across the lifespan in Michigan, I asked you to come on, just to give us a really brief overview about who they are, and then we'll hop over to Katie.

Mikayla Treynor

01:57

Befitting You is the AAC device company that I use, and what I really like about Befitting You is they have this small town family like feel to them, where you're connecting with people I know the representatives. I have their numbers, I text them, I email them, and they just save me so much work, as far as evaluations go and repairs, they come directly out to me, and they'll go to wherever my clients are to fix their device and to provide education, and I think that that is so important, because so many of my clients are eventually going to leave me, but it doesn't mean that they're not still going to need support with their AAC device, and befitting you genuinely cares, they go above and beyond, and they have helped me so many times in tough situations.

Speaker 1

02:57

And they don't require the CCC, do they

Mikayla Treynor

03:01

They do not.

Jeanette Benigas

03:03

Good for them! We love a company that's modernizing so much work was done in Michigan in the last year. They dropped the CCC requirement for Medicaid right at the end of last year 2024 and befitting you, medical supply, got right on top of it and changed their policies. If you all want to check them out, you can go to befitting you, med, supply.com, find out who you can connect with for an AAC eval. So thanks guys over at befitting you for sponsoring today. We really appreciate you. I'm going to head over now. Mikayla, thanks for jumping in. I'm just going to jump over to Katie now, and Katie and I are going to talk about all things telehealth today.

Jeanette Benigas

03:50

Katie, thank you for joining us again. I should say again, everybody. I call myself out. I'm living a life of stress right now. Sent Katie a link a couple days ago. I said, I'll see you in 90 minutes, and then didn't show up. So Katie, thank you for showing up twice and being so kind and patient with me. Of course, I'm excited to have you because we have collaborated before. I don't know how long ago that was, because I live my life by the hour, but we collaborated on a telehealth post because you are passionate about telehealth and you were doing some advocacy. And we always say, like, Hey, if you guys are doing advocacy and want to come beside us, let us know. And you did that, and I didn't jump at the chance. Of course, I, like, looked at your stuff first, and was like, Yeah, this is great. Let's put it out there. So we collaborated, and now we're finding ourselves in the same telehealth position we were in, I think, when we collaborated before. So we're going to do another collab this week. But why at first, before we get to that, tell us who you are and what you do. And I will preface by saying Katie works mostly with. As adults, but there are pediatric implications here as well. So don't tune out this applies to everybody, and everyone should take action. So all right, Katie, who are you? What do you do? Tell us all the things.

Katie Brown

05:13

I'm Katie Brown. I'm a speech pathologist based in Buffalo, New York, and I own a private practice called Neuro Speech Solutions. And at my practice, we specialize in adult neurogenic communication, cognitive swallowing disorders. And having started neuro speech solutions back in 2019 I've really been able to see the evolution of Medicare and telehealth from both sides, and what it looked like pre pandemic, during pandemic and post pandemic. You know, things opened up during the public health emergency, and we were able to see individuals through telehealth, and now we have extensions and uncertainty, and we're essentially just like waiting for the rug to be pulled out from under us. But I think I can speak for myself and I'm sure many others when I say that my patients and many other individuals across the country, telehealth has really just been the key to actually getting care, which is why I'm passionate about making sure that Medicare keeps telehealth going for SLPs.

Speaker 1

06:18

And as someone who is... we just... pre recording I was telling you about all of my family's ailments and how I am the sole care partner right now of two people who cannot and should not be driving, one who is elderly and one in his late 30s, telehealth really has been a godsend for us. We need this living the life now of someone who is on Medicare and someone who is not. We need this service. We need it. It cannot go. I can't do it. I can't fix SLP and not have telehealth for my two people that can't drive.

Katie Brown

06:56

Right? Think about how many hours that not just the individuals with Medicare, but also care partners, everyone just spends in the car going to and from clinics, waiting in the waiting room for the doctor, just being essentially held captive for things and and I would say that's like one of the least concerns of why we need Medicare telehealth. You know, it's a huge one, but also just in general, people who physically can't even get to doctor's appointments, right? Because there are plenty of people who physically cannot get to doctor's appointments. And if SLPs are removed as telehealth providers, that's it. We're, yeah, we're losing access to care. You would have to pay privately for those services, which is just unrealistic, really, for many, many people.

Speaker 1

07:48

It's a problem. Our... oh... we're preaching to the choir right now, our healthcare system is in shambles. If we can do our part as Katie and the Fix SLP team and this platform, we have to reach people. We're gonna do it because it's one of the reasons why I started this, this platform. It's why we're here. So what have you done? Because I was really impressed when you reached out to me whenever that was before, and I was like, wow, she's really good. I'm probably gonna have to, like, get her on the team eventually. There's a plan here always, you know that, right? Yeah, there we go. Team's working behind, yeah, yeah. People who are doing things end up working for monopoly dollars. That fixes. So what have you done? Tell us about what you did.

Katie Brown

08:33

So, I mean, I think the thing is, I do help mentor other SLPs as well. People who are going into private practice. A lot of people are worried about going into adult focused private practices. And I feel like there's, there's definitely fewer adult focused private practices than pediatric in general. And Medicare is generally, like the really scary piece of it, right? Because we can't opt out of Medicare. We have to accept Medicare, and we have to bill Medicare for Medicare covered services. So with my practice being adult focused, the vast majority of my patients are Medicare aged who either have traditional Medicare or Medicare Advantage. And you know, we've been going through this like timeline right where we were given, essentially, we were given, a waiver to treat individuals by telehealth because of the pandemic, where before, the only healthcare professionals that could were physicians, and you know, anyone who's working directly under a Physician, so a PA or an NP, and even then, there were some pretty stringent restrictions. There were, like, geographic and site limitations prior to that pandemic, but then it really just kind of opened up this whole new world, April of 2020, that's when legislation was enacted that allowed, essentially. Everyone to bill Medicare for telehealth services, and I have seen some truly amazing improvements in my patients who were solely telehealth, where people say, like, oh, telehealth is not equal to in person. And sure, that could be the case for some patients, but that shouldn't be a blanket statement. I have done swallowing treatment with people by telehealth, and I'm amazed at what they can do.

Speaker 1

10:29

I'm glad you brought that up, because it was something that I was going to pop on you and forgot to tell you I wanted to bring up. Was the pushback that we sometimes see, especially from our own colleagues, about the limitations there. And I have been of the mindset that if someone doesn't have access, it is better than no care at all. And I I had to do a mindset mind set shift there, because since the pandemic, I became a telehealth provider for a nursing home in the Upper Peninsula of Michigan, a company that that my main company that I have been PRN for for over a decade, owned. They recently sold, so I'm not doing it anymore, but they owned a nursing home up there in the Upper Peninsula. And I most of their buildings are in Ohio, and they have a couple in Pennsylvania, and they could not find coverage for that building, so they had gone months without an SLP, and my regional manager lives behind me, and that was included in his region, and he said, Jeanette, if I can work it out where either we're traveling together or we're going up there, could you give some coverage? Would you take a few days? You just heard me give all my care partner woes I'm doing. It's like a seven, eight plus hour drive doing all those calculations. And I'm like, You couldn't pay me enough. You have to pay for Mary Poppins and a cook and, you know, like all the things. So I just said, what I proposed was, Well, how about you just get me licensed in Michigan. If the company pays for me to get licensed in Michigan, I'll do telehealth, and then it would be cheaper for you to pay an aide or an assistant or something, to help the person with a device in front of them, if they don't have the cognitive capacity to do that, it will be cheaper for the company to do that than pay to send me up to the up once a month to give three days of treatment or whatever. And they loved it. And so now here I am facing, going into this situation as an SLP, kind of, with the mindset that, like dysphagia treatment should never be done coming out of the pandemic. I don't know if I'm a believer in this yet, but then, as we did it, and there was someone standing by, sometimes, not always, we made it work. And and I became a believer that, yes, exactly what you said, not always is it appropriate. But in this particular instance, this building hadn't had speech therapy in months. They were backed up with a line a mile long of people who needed looked at, and I was literally the only person who could give them any care at all. And that's when I was like, Yeah, I'm I'm hard in on this telehealth. We have to keep this going, and then as providers, be ethical, right? Like if nursing homes are asking us to do this across town because they don't want to pay us the travel and mileage to get to the building on the other side of town or the building an hour away, and we know that there are people there who would be better served in person than the answer's no, you know, it's going to be on us ethically to push back when people are trying to abuse it. But there are a lot of situations where it's the only option, literally the only option. So off my soapbox there, but having gone through it as a provider.

Katie Brown

14:02

I'll hop back on the soapbox honestly, because I, you know, I live in New York State. And when people think of New York State, who aren't from New York State, they think of New York City. New York State is huge. I live in Buffalo New York. It takes me eight hours to drive to New York City, and most of that drive is rural. I mean, rural, there's not much. So I in my clinic, we get calls all the time from people hours away from us that say I got therapy by the one SLP in my area, the one SLP in my area, does ei or is the school SLP that sees people afterwards, and, you know, I was discharged, and I think I can do more. And we go, okay, great, let's, let's try telehealth. And it's just like expanding that access, especially in areas where people are not able to get specialized care in their area. It's a no brainer. It. In my mind, yeah, and you know, I think also keep in mind here that although, when we think about Medicare, we think about older adults, but Medicare isn't just for older adults. Many young, younger people qualify too adults, even children. Anyone who is living with a long term disability with chronic illnesses, telehealth can be so beneficial for them, and they can actually have Medicare too. I have someone in my clinic right now who's 22 years old. He had a traumatic brain injury at 19 years old from a car accident. He is currently on Medicare because he was on long term disability for 24 months, and that is essentially the period that you need to wait in order to be eligible for Medicare. So there are plenty of people who are under 65 who rely on Medicare as well. And if this telehealth is taken away, it's going to clog up everything at this point, telehealth has become a way of life. I use telehealth myself. You know, I've I was talking to Jeanette before this. I worry about a snowball effect of Medicare says, Okay, no more telehealth. And then Medicare Advantage Plans say, Okay, we're also not going to do telehealth. And then the commercial side of those plans say we're not going to do a telehealth either, and then Medicaid says, Okay, no more telehealth. Everyone else is doing it. So So that's it. Everyone just needs to go in person or pay privately for telehealth services, which is not realistic for so many people.

Speaker 1

16:36

I wanted to frame this up earlier because some of our listeners, especially our school SLPs and our pediatric SLPs might not fully understand this, and you brushed over it, you said it, but they might not fully understand one of the reasons that reimbursement and compensation in adult care continues to be a problem is that Medicare is a Federal regulation that if you are providing a health care service to someone who is Medicare, age, Medicare eligible or has Medicare, they don't even have to have Medicare. They could be 70 years old and never opted in. And technically, per this regulation, it still covers them, a health care provider is not allowed to accept cash for a Medicare eligible service from someone who is Medicare eligible. And so what that means is if Grandma Betty needs SLP services at the age of 81 because she's bed bound and there is no home health SLP, in the area. Technically she's Medicare age Medicare eligible. Probably has Medicare even though there's not a provider. I as Jeanette can't drive to her house and charge them privately, and so that's a problem. We can't opt out. Currently, doctors are the only ones who are allowed to opt out, and it's all or nothing. They have to choose to opt out for everyone or stay in for everyone. They can't double dip. That's the problem here is that legally, we can't do it. So if telehealth goes away, it's no longer a Medicare eligible service, which means we could take cash for it. However, now it becomes a privilege thing some of the people who need us most in lower socioeconomic statuses and communities won't be able to pay privately for these services. So everybody needs to have access, not just the people who have the money to pay for it. Everybody deserves the right to access telehealth services, regardless of age, gender, socioeconomic status. Period. I'm going to die on that hill.

Katie Brown

19:04

I absolutely, I'm in 100% agreement with you. A lot of people will say telehealth is a luxury. We all did it before. Well, no, think about people who can't safely drive. Do we really want them trying to drive? You know, do because, because that's when people make risky decisions. They say, well, I need this, so I'm just gonna drive around the block.

Speaker 1

19:30

Okay, so what did you do? We've got these issues now. What? What did you create? Because it's really good. What did we have before that we're gonna do again. What did you do?

Katie Brown

19:39

So I'm actually expanding at this time, but essentially, what I have is several different letters and templates that we can immediately send out to our representatives, to our senators, to our house representatives to let them know that speech pathologists need to continue to be able to access telehealth services. Services through Medicare. So I developed some letter templates. Depends on your amount of time that you are able to commit right now. Maybe Jeanette only has five minutes right now to be able to commit to something so she can use the pre made letter and send it to her Congress representative. I'll have pre made ones, and I will also have some that are more templated, where you can insert things relevant to you in order to make them a little bit more personalized. So I have that. I also have a letter that you can use to inform any of your patients about what is happening, because I think it's important that they know that their telehealth access might be revoked at this point, I also developed a template for patients to write to their representatives. Right? It's not just the healthcare workers who are being impacted. It is also the patients who are receiving telehealth care. And if we want to talk about, what do I want to do with in therapy Monday morning, you could do this letter with your patient, yes, and have them send it out, right? And then also different ways that you can format things for email versus sending a letter, as well as teaching you how to find the correct people to send it to.

Speaker 1

21:20

With the CMS crisis, with the new grads, where we put out resources to send a letter to Dr Oz to reverse the decision. Somebody had set out the cutest little table in their office with pre made envelopes and stamps with the letters for their patients, or their patients loved ones to send and then like a little box, so she took care of getting them into the mail and set it all up. So if you have a brick and mortar practice, it doesn't even have to be an adult practice, because remember, if you have a pediatric practice, people like me are bringing their kids in, who are also dealing with mom and dad and Aunt behind the scenes, that they too probably could care about this. So she made it very easy. And I wish I could remember who it was, because I would give her those props right now. I would call out her name and her business, but she just made it so easy for them with just a little station at the front so anybody with a brick and mortar location can do that tomorrow.

Katie Brown

22:26

Yeah, so, so right now, access is going to end September 30, 2025 that is our last day we are allowed to bill Medicare for SLP services if Congress doesn't do something about it, which is why I developed these letters and these templates to send to our representatives in Congress, because right now, they are at the helm, and they have the power to be able to do one of two things. First would be to do another short term extension, which is not the end goal, I would tell you right now, that's the most likely scenario that's going to happen. Right now I am ready to personally commit the time to start trying to advocate for permanent access. There is currently a a law that was introduced HR, 1614, it's called the expanded telehealth Access Act, which specifically lists speech, PT, OT and audiologist as becoming permanent telehealth providers, and then they wouldn't be able to say you can't bill for Medicare.

Speaker 1

23:44

So Katie has put together an actual website. I just Katie, I just told you I was going to say it. Why don't you say it? Tell us what it is.

Katie Brown

23:53

So it's medicareforslps.com\telehealth-advocacy, and that's where you can download all of the free resources. You can learn a little bit more about what's going on, and you can also find your politicians that you need to send your letters and emails to.

Speaker 1

24:11

It's nicely done. Well, set up. That's a lot to remember. So what we're going to do, as always, is we're going to link this up at the top of fixslp.com we have four colored bars there that I'm constantly rotating in and out depending on what's going on for now, that's your go to spot. So you will go to fixslp.com click the link at the top and it'll take you right to the site. Thank you for doing this. Thank you for being the voice of the independent, autonomous clinician that isn't relying on a big membership association or other group to do the thing. You know this is a problem, and you took it on yourself, and you are doing the thing. And that is awesome. So you guys, if there's a thing that needs a dress be a Katie, go do it. Let us know, and we will come beside you and get it out there and help you out as much as we can, because this is what it's about. It's us taking our profession back, and this helps us, Bill, make more money, reach more people, and it also helps the people who need us, increase the access to us. So everybody wins if we keep telehealth going. So thank you for being the person.

Katie Brown

25:36

Of course, it's definitely a win win. And thank you so much for having me on your podcast, and also for helping to distribute these materials to people, because I know that you have a much wider reach than I do, and just very happy that people will be able to use these and we can make a difference.

Jeanette Benigas

25:54

Tell us again where people can find you online.

Katie Brown

25:57

You can find me on Instagram. My handle is @neurospeechsolutions. I go in waves of being active on there, but it depends on how busy I am in real life, but all of that will be posted there.

Speaker 1

26:12

So Katie has a Medicare for SLPs course, so she's going to set up a promo code for you guys if you're interested in learning more about billing Medicare or getting into the adult space as a private practitioner. Her course is one that you could take. I think it is very appropriately priced, because she's going to give you $100 off if you use her promo code, and we'll get a little piece of that too to help support us at Fix SLP, I just told her, you're probably not charging enough, giving all this money away, but that's a conversation for another day, because we do still, as educators, still need to make money, right? The code is Fix SLP, you will get $100 off the course it is six hours, Katie, of PDH?

Katie Brown

26:58

Yeah, of PDH.

Jeanette Benigas

27:00

So last fall, we did a whole series on continuing education. She is not an ASHA CE provider, but you can use her course for professional development if your state or even ASHA, because ASHA does not require Asha approved CEUs, you can still use those just if you're tracking yourself or using the free account at Speech Therapy PD, you just get the certificate that's six hours of continuing education that you can use for your cycle unless, of course, your state requires something a little different. So you will still go to her website, which we will have linked up in the show notes. Katie, thanks for doing that.

Katie Brown

28:06

Yeah, of course!

Jeanette Benigas

27:43

Before we go, I just want to thank Befitting You Medical Supply for sponsoring this episode. Mikayla talked about it at the top, but go check them out for your AAC devices. If your patient is in Michigan, we didn't say this at the top, but we're talking teletherapy. You might live in California, but if you're giving teletherapy services in Michigan, you can access them for AAC devices, and being that they are right in Michigan and so hands on with their clients and patients using their devices, it actually might be a godsend, because they'll get in there with your patient and help them troubleshoot and d o all the things so befitting you. Thank you so much. Everybody. Go check them out. We'll see you next week. Thanks for fixing it!

Jeanette Benigas

28:30

Thanks for listening to the Fix SLP podcast. If this episode help you feel more informed or empowered, take a second to leave a five star rating and review. It helps more SLPs find us Fix SLP runs on $5 sustaining partnership donations that small monthly support pays for everything behind the scenes, including our website, legal fees and advocacy work. Want to be a part of it. Join us at fixslp.com enjoy the sunshine. Stay scrappy, and we'll see you next time!

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