Dr. X’s review went something like this:

1 STAR Rating: “If I could leave a negative star review, I would. Avoid Dr X. My mom was on vacation when she fell.  Unfortunately, she was “cared” for by Dr. X.  Dr. X said, ‘unless my mom wanted to play professional sports, she did not need surgery’. My mom was in a lot of pain and when she returned home, she saw another doctor that said my mom needed surgery right away or she would lose mobility!  The HELPFUL doctor couldn’t believe that Dr. X didn’t even change the bandages…. Dr. X, bring light and good health to the world by retiring.”

Like anyone who receives a review like this, the doctor was upset and completely disagreed with the reviewer’s account of the visit. He immediately instructed the staff to post a response with the “facts”, and then began to pressure his team to have Google delete the reviewer’s comment. As you can imagine, even if the reviewer isn’t responding, the outcome is not positive for the practice or the doctor; and if the reviewer is responding, the outcome likely only gets worse.

So, we know that bad reviews happen, even to the very best of providers.  How should we handle them, and how can we manage the conversations within the clinic and with the providers?

Step One: Consider your options.

The first rule of Review Club: work the plan. It’s easy to allow any review, especially a not-so-great-one, to feel very personal.  The key to success is the consistent, long game. Just like managing any situation that isn’t going perfectly within the business, the goal should be to consider your options and work the plan. This is the very reason there is a Customer Review Strategy in place to begin with; it is the clinic’s time to shine.  An emotional response, particularly a direct response including any details around the patient visit, may not only validate the patient’s identity and easily be a HIPAA/privacy violation, but it often fuels the fire. Consider the options and work the plan; but what is the plan?

Step Two: Remove.

Does the review qualify as inappropriate in Google’s eyes? Getting rid of a Google review is not necessarily simple, but it isn’t impossible either.  Google only removes reviews if the reviewer breaks one of Google’s user policies. 

Google Review Policies:

1. Spam and fake content that is posted to manipulate ratings. This includes posting multiple times, including from different accounts.
2. Off-topic posts that are general in nature, such as political commentary or personal rants.
3. Promoting actions be taken or items purchased that fail to comply with local legal regulations. Such restricted content includes promoting alcohol, gambling, guns, pharmaceuticals, adult services, and more. 
4. Illegal or depict illegal activity, such as copyrighted content, endangered animal products, graphic violence, human trafficking, etc.
5. Terrorist in nature.
6. Sexually explicit or in any way sexually exploits children.
7. Offensive, obscene, or profane.
8. Dangerous, considered harassment or intimidating, or that incite hatred.
9. Impersonating others or having false representation.
10. Dishonest or biased. This includes posting reviews of your own business (or having a current or former employee do it for you) and trying to manipulate a competitor’s ratings.

So, does this review qualify for deletion under any of these policies? In this instance, our review does not qualify for removal.  If you believe, after reviewing the policies, your business can prove the reviewer broke one of Google’s policies, you have a chance to present your case. I’ve included an abbreviated overview of how to contact Google support below.

To contact Google’s support for small businesses:

1. Go to Small Business Support
2. Scroll down and select “contact us”
3. Select “customer reviews and photos,” and then “manage customer reviews”
4. Choose to receive help via phone, web chat, or email

Using any of these methods, one can expect help within 24 hours. If the practice chooses to contact Google via email or chat, it is helpful to have a screenshot of the review in question ready to go.

When the Google support team reaches out, it is up to the practice to explain why the review should be removed. Be ready to explain why the review is in violation of policy and defend your request to get it removed.

CLICK THIS LINK to request to delete a review from Google.

Step Three: Respond

If having Google remove the review isn’t going to work for the practice, the easiest way to have a review removed is having the patient remove it themself.  Typically, this is accomplished by contacting the patient offline with hopes to better understand what happened and find a way to resolve the issue.  Where this approach can become risky is when a well-meaning practice representative accidentally validates a patient’s claim during the casual phone conversation, for instance, by apologizing for the incident or mishap.  Apologizing opens the door, if only a crack, to admission in a malpractice action and trying to have the patient see it “your way” may inflame the patient instead of inspiring them to remove a post. 

Additionally, engaging with the reviewer may prompt more online discussion.  There is nothing stopping a patient from replicating their comments on multiple online platforms.  Businesses that have the most success responding to poor reviews utilize only their most experienced, skilled and disciplined staff, and those team members stay within a very defined framework.  Additionally, having some sort of fix readymade that directly addresses the patient concern is imperative.  The caller must have a plan to resolve the issue going into the conversation.

Step Four: Move On.

Sometimes time is the best healer. When a practice has an active reputation program in place, one bad review won’t be disruptive in the bigger picture; and confronting the reviewer is most often, not worth the risk.  If the practice has an active program to solicit reviews, in a few weeks this review will be buried by an overwhelming number of other reviews that for the most part, should be very good.  If this is a one-off, the manager or clinical supervisor can make note and move on.  If there seems to be a trend within the practice, this time is a great opportunity to meet with the provider or team to realign, fix a process or define a new approach. 

Overall, having an active reputation program in place, understanding your Customer Review Strategy and working your plan to consider, remove, respond or move on will improve the online reputation of your practice and the providers that work within it.

As we think back to the first days of the pandemic lock down, it brings back vivid memories of uncertainty; fear for ourselves and our patients and wondering how we could continue to serve our patients who were already predisposed for isolation by the pure nature of hearing loss.  Never in our lifetime had we been asked, or in some cases told, to shelter-in-place due to a medical threat. The healthcare world was managing difficult questions of how we keep people safe while still being able to serve their medical needs.  The discussions were swirling in the media, in phone conversations with colleagues and within practices on what is considered “essential healthcare services” when a community is faced with a global pandemic?  Some classified “essential” as anything required to save a patient’s life; others considered anything that negatively impacts a patient’s quality of life as “essential care”.  As a medical provider that witnesses the impact on the overall health and wellness that even an untreated mild hearing loss can bring, knows that for most, untreated hearing loss has substantial consequences when the world is managing normal circumstances. Now to be isolated at home, without support systems like family and friends, created an environment where a patient’s only contact with the world is through a video or phone call, television, radio, and social media.  We argued that hearing care services were even more essential in everyday life, now more than ever, hearing was a person’s primary lifeline.

At that point, we started asking ourselves, how can our physicians and providers meet patients where they are: in the community, at their homes, and on their connected devices. Although some of these changes will reverse as the world feels safer and more comfortable, we believe that there has been a fundamental shift in the delivery care.  We already had digitally enabled care in some ways, through apps and our patient portal, we needed to expand our care delivery and inform our patients.  We ultimately learned to connect to our patients in new ways, through: telemedicine appointments, remote-programming schedules, drop-off services and curbside care; and we are not looking back. 

To make patients feel as safe as possible and meet the social distancing guidelines, medical professions were able to start providing telehealth visits to meet their healthcare needs in a time that being in an exam room with a patient was not “safe”.  In audiology, we can provide a vast number of services via telehealth, however, we must have our patients positioned to move to this type of care.  What do I mean by this?  Remote programming has been available in hearing instruments for quite some time, but not widely adopted due to licensing concerns as it relates to telemedicine and audiology.  But once again, COVID 19 created a window where prior telehealth regulations by insurers were loosened so patients could be provided healthcare as it was needed, and providers could receive payment.

In hearing care, we had the answer – remote programming.  Thankfully, the hearing instrument manufacturers had been incorporating remote programming capabilities for quite some time. That said, many of us did not wholly appreciate the effort until COVID hit unexpectedly. And even then, many of us were not fully prepared to deliver it to the bulk of our patients. Our practice had written hearing aid delivery guidelines that include activating any remote programming capabilities in the hearing instrument. So, in theory, as part of our clinical protocol, all instruments are to be set up for remote care services.  Guess what happened when the pandemic started?  We quickly discovered that for whatever reason, many providers had not initiated the remote capability.   As I investigated the reasons why it had not been done, the first reason was time, they didn’t have enough of it during the delivery of the technology to add another feature and counsel on it.  However, the biggest reason was they didn’t think the patient would use it.  And for the most part, at that time, they weren’t wrong.  Most of our patients set in-person appointments for their follow-up and on-going hearing care.  When we look back now, we just weren’t planning for a pandemic-like environment.  We had been delivering care one way, for a very long time; and only for extreme cases, like illness or distance, did we ever really use any type of phone consult, telemedicine visit or remote programming capability as a practice.  Wow.  We were wrong about adaptation when there are extenuating circumstances and other available care channels to receive help. 

This is where the Curbside Care Channel journey began for ENT and Allergy Associates of Florida.  To service our patient’s hearing instrument needs, we first had to have all hearing aids prepared for remote programming, which for most patients meant we needed their instruments in the clinic. However, at this time during the pandemic, we couldn’t have the patients physically in the hearing aid clinic, and thus, Curbside Care was born.  While servicing the patient this way, we could wear proper personal protective equipment, do the proper patient attestation, take temperatures, and mostly stay at the required social distance. Best of all, we could take the patients hearing instruments from them and prepare them for remote programming while they sat in the safety of their own car.

The next hurdle was figuring out how to inform our patients about the new way to visit the office. We wanted them to know that we were here for them.  The fastest way to engage with them was on our social media of course.  We went “Live on Facebook” on ENTAAF’s Hearing Clinic social channel and talked about the new way to visit the office, how the Curbside Care would allow us to assist them safely, what remote programming meant and communicated that they did not have to be our patient to get help. 

As providers, we focused on how we could manage the situation within the government guidelines and still find solutions that would meet the needs of our patients while protecting the staff.  Even though what we came up with may even seem outside-of-the-box, we simply focused on how to meet the needs of the patient by managing them “where they were”; and in this case, they were in their car. After all, some practices still utilize the care channel of ‘at-home’ care, and take care of patients where they live, we surely could be creative enough to manage care if they would drive to us.

Considerations when adding or maintaining this modern delivery channel:

1. Put a clinical guideline in place that requires that if remote programming features are available, they are activated at time of fitting.  Next, add this feature to your chart review process to monitor provider compliance.
2. Assess the parking spaces around the practice to determine best parking spots to assign as Curbside Services.
3. Assure you have adequate signage designated for the curbside area and that you have communicated to the patient how to notify the office when they arrive.
4. Familiarize and train support staff on services that can be provided curbside and how to triage patients between face-to-face care, drop-off service, remote programming appointment and curbside care.
5. Become familiar with all manufacturers remote capabilities allowing your team to manage patients that may have purchased from other locations. Understanding what is available also allows the practice to determine if there are other products that may meet the needs of current patients.  
6. Develop manufacturer specific checklists listing the required steps the provider must execute to enable remote programming capabilities in products.
7. Regroup with your providers and staff to discuss benchmarks around different care channels, talk about how they are doing, and what they are seeing with patient outcomes.  Remember, there is always a way to improve the experience for both your patients and the team that is providing the care.

Hopefully, we are turning the corner on this pandemic.  With that, many patients are still not comfortable being in the office, and for many, having to come into the office is a burden. We believe that Curbside Care and Remote Programming Appointments are here to stay in the world of hearing care.  Moving forward, we will continue to deliver hearing care in these newer channels.

Third-party administrators (TPAs) in the hearing aid industry are not new. One of the largest, TruHearing, has been around since 2003. Beck, Braun, & Abel published an article in the Hearing Review discussing managed care, their perspectives, and has a historical outline that some may appreciate that is beyond the scope of this piece.

The issue for many in the industry are that TPAs have gone from accounting for a relatively small portion of revenue for many businesses, to a much higher percentage of their revenue. Some of our clients have claimed it has become as high as 30% to 45% of their hearing aid business and all while fitting fees continue to decline. 1st Choice is simply a program designed to give clinics more avenues to get the right hearing solution on their patients. 1st Choice believes patients get to make the choice of whether they want to use or waive their insurance benefits and that care, services and outcomes are in the control of the patient/provider relationship.

When it comes to health insurance, transparency is key, particularly transparency of benefits to the provider and to the patient. Just as we pay for insurance and hope that we never have to use it because we are lucky enough to have a safe and healthy life, insurance carriers hope for the same, primarily because they are business. The less claims they have to pay, the more profitable their business. To be clear, there is nothing wrong with that. That is one reason why they have actuaries on staff. They are in the business to make a profit just like any other insurance business i.e., auto, life insurance, etc.  For example, with life insurance, I pay a lot of money every year to protect my family’s future, but I sure hope they never have to file a claim. In the meantime, my carrier is happy to collect my premium. However, for that premium, I expect quality coverage and I expect transparency of what my life insurance benefit covers and when it might be null and void. I expect to know and understand these terms before it is needed. I should not have to jump through hoops to find out and understand those terms, and should not be difficult for my family to process the claim if the benefit had to be executed. 1st Choice simply believes that should apply to hearing aid insurance also.

From most of our experience, it seems that when it comes to health insurance, and specifically hearing aid benefits, understanding the benefit is almost always a hassle for both the provider and the patient.  I have hearing loss myself and have worn hearing aids for almost 40 years. I decided to call the member number on my insurance card because I knew I had a hearing aid benefit from my insurance’s yearly benefits booklet. I just did not know what the actual terms were as they were vague, and essentially said: “Call this number for your benefits”.   

I then spent 2 and a half hours, in a grocery store parking lot, on the phone with the representatives of my insurance company simply trying to understand what my hearing aid benefit was. I told them that I currently wear hearing aids and was looking to understand what my benefit was as I would like to get hearing aids later this year. I just needed to be able to plan a budget. I could not get this information despite talking to two different representatives.

It should not have to be that way for patients. It should also not have to be that way for clinicians, who are in the business to be clinicians and provide care. No one in the patient/provider relationship should have to struggle to get clear confirmation of benefits to relay to their patients.

To achieve their goals, insurance carriers have partnered with TPAs to manage these hearing aid benefits, and therefore their costs. Again, to be clear, there is nothing wrong with that.  However, transparency, quality of the benefits and adequate reimbursement are key to this being a successful delivery model.

Providers deserve to be in control of the audiological treatment and recommendations of their patients. Patients should receive quality benefits, or at least options, to meet those recommendations. For example, if my insurance offers a fully funded entry level hearing aid with little or no out of pocket cost to me as a patient, that may look good on paper, but is it appropriate for me as a patient? I personally have a severe to profound bilateral loss and entry level technology may not be appropriate or recommended by my provider.  So, does my plan allow for me to upgrade? Is my provider able to get adequately compensated? Do I need pre-approval? What is my out-of-pocket cost?

Maybe more importantly, why is it so difficult for my provider (or a patient) to get answers to these questions?

The TPA/hearing aid insurance benefits issue is indeed not going to go away anytime soon if at all, however, its impacts can be mitigated. Insurance plans and hearing aid benefits vary widely, and their prevalence often varies regionally. With three years of research and development, 1st Choice has worked on finding a solution that benefits not only patients but adequately reimburses providers for their services and keeps them and their patients in control of their care. Patients always have a choice when it comes to their hearing healthcare and 1st Choice helps give them a Better Choice.  

1st Choice Believes There Is A Better Way.

• Providers and Patients should not have to settle when it comes to insurance – there is ALWAYS a choice.
• Providers should be in control of hearing aid recommendations, not TPAs or insurance carriers.
• Fitting Fees to the provider should be adequate for the services rendered.
• Providers should have a say in the services provided to a patient.
• Technology levels should not have to be sacrificed to match inferior hearing aid benefits.
• There should be transparency for providers and patients to their hearing aid benefits.
• An alternative solution to TPAs and poor hearing aid insurance coverage should be easy for the patient to understand, simple for the provider to order and offer a better outcome for BOTH.
• In the end, it is ALWAYS the Provider’s recommendation AND the Patient’s Choice.

Daniel J. Tibbs, Au.D. is the Chief Innovation & Audiology Officer at Amplified Resource Group, LLC., and can be reached at dtibbs@amplifiedresourcegroup.com

I have been in the Hearing Healthcare Industry for over 30 years.  In that time, we have experienced many seemingly insurmountable obstacles that eventually were solved.  The solutions to these obstacles seem to appear sooner when we, as the providers, start with the patient and work backwards to the solution.  We must ask first, “What is in the best interest of the patient?”.  As a manager of a team of audiologists, I also ask myself, “are we also taking care of what the provider needs to do their very best work?”.

For the past 10 years in our practice, third-party payer networks have been a source of endless frustration for our patients and providers.  First, insurance verification is a time-consuming process that often confuses patients, discourages providers and costs money.  Many practices find they need to add long and ongoing training to help clinical staff handle more and more insurance conversations with patients. Even smaller practices are finding the need to hire full-time office staff to manage verification & training support, which can cost upwards of $45,000 plus benefits annually. Secondly, many of the third-party insurance programs restrict the hearing instrument brand and level of technology that can be fit.  This takes the provider out of the clinical decision process, and puts the patient’s needs last.  Finally, denied claims, partial and delayed reimbursements, reduced fitting fees, and required free follow-up care, results in a low revenue, zero-profit financial outcome for the practice, making it difficult to maintain high-quality provider staffing.  

We review & adjust our third-party payer mix as necessary. For patients who have benefits where we are out-of-network providers, we now have a hearing aid benefit solution.

After much research and testing, 1st Choice Hearing Benefits is our first choice.

We have rolled out this program across our practice and are seeing wonderful results as it relates to patient satisfaction. Also, our providers are happier, and profitability with this patient benefit category is increasing.  The program can be used as an alternative for any patient. The patients love it because most of the time it is less expensive than if they claim their benefits.  My providers like it because they have the flexibility to fit the brand and technology level that best suits the patient.  Also, the overall practice benefits because the fitting fees are generally higher than most carriers.

As the Director of Audiology, I am always looking for a program that will be easy to use.  With 1st Choice, there are no contracts or minimum commitments of units.  You simply get login credentials to the portal and can begin using the program immediately.  Training is available online if necessary. 

1st Choice also offers insurance verification so you and the patient can fully understand their benefits and has great flexibility in the forms of payments that the patient can use. 

1st Choice has fixed our third-party problems and I believe they can solve yours as well. 

If your interested in learning more – check out this short video or email info@1stchoicehearingbenefits.com for more information or to schedule training and enrollment.

Dr. Patricia Ramos is the Director of Audiology and Rehabilitative Services at ENT and Allergy Associates of Florida, and the President & Co-Founder of the Network of Medical Audiology Professionals.

Second of three articles.   Following the implementation of a successful virtual patient management pilot, QM2 moved forward with lessons learned and developed patient engagement strategies focusing on the right patient, the right intervention, at the right time, through the RIGHT channel.

“When something really great happens, what do you do?  You share it,”  said James Benson, President and Founder of QM2 Solutions as he reviewed the results of its early virtual visit programs.  “In the spring of 2020, we had virtual visit pilot programs at ENT Hearing Associates of Florida, Colorado ENT and Allergy of Colorado Springs, and South Carolina ENT in Columbia South Carolina.  Each group had different needs and patient types, but the volume and value of the patient engagement was clear.  How could QM2 easily adapt and share the successful programs with others in the hearing industry?

First, the basics.  QM2’s approach to virtual care focuses on asynchronous ‘e-visit’ and ‘check-in’ technology for patients to complete virtual visits, then driving other patient engagement through in person visits, telemedicine, remote programing and testing.  QM2’s technology includes patient outreach using text or email providing notifications and encrypted links for patients to connect to their clinicians.  The ability for patients to simply connect with their provider when they have an issue, and the ability for the professional clinician to triage responses based on the patient’s relative need, satisfied two seeming incongruent objectives: 1) Increase the number of quality patient engagements; and 2) Save time through a focus on triage and automatic connections.

Next, QM2 created targeted hearing outreach programs around three patient types, 1) Acute- Connecting to hearing aid patients with current technology or care needs; 2) Chronic follow-up: Directing on-going engagements to diagnosed, but untreated hearing loss, and on-going conditions like dizziness and imbalance issues with fall risk; And 3) patients who are seeking answers or help with non-diagnosis hearing issues or concerns.

In the start of the fourth quarter of 2020 QM2 launched the hearing aid virtual patient management program at groups in Alabama, California, Florida, Texas, and Wisconsin.  The results of these implementations drove significant patient interactions and ongoing care.

On average, 50% of hearing aid patients open and read virtual visit messages from the practices (emails or texts announcing the program and providing a link into the SEngage portal), while 20% of patients completed hearing aid virtual visits when provided the connection.  That means, for every 2000 SEngage patient engagements, over 400 patients completed virtual visits.

The data is instructive.  43% of hearing aid patients completing virtual visits report a change (or suspected change) in their hearing and a declining ability to communicate.  50% of hearing aid patients have identified features and functions they wish worked better (or were included in their hearing aids.)

As QM2 began to help clinicians prioritize responses, we found that “somewhat happy” patients report a 49% change in hearing, and that 76% of “somewhat unhappy” patients report changes in their ability to hear and communicate.  Working with clinicians we found that “somewhat” patients often not been seen for years, not attending clean and fit appointments, been re-tested or attended product “events”.  Yet, re-engaging these patients through virtual channels, making it easy for them to communicate their needs, drives impact.  These two-way engagements pointed to additional testing, adjustments, and sometimes, new technology or treatments.  Audiologists are surprised when they note the number of patients re-engaging the patient and the impact, they are having by re-connecting to these patients.

To determine the impact of this type of care on the business of audiology, QM2 looked at its customers’ ratio of experienced hearing aid patients beyond three years of use to the number of units sold to experienced users.  What have they discovered?  Most selling hearing aids to less than 5% of the eligible patients in their database per year and that implementing a virtual patient management program can increase the number of units sold by 30% year over year.

The final article in this series will speak to clinician techniques, what is next for virtual patient management to drive better care and increased business.

Don’t want to wait for the final article? Learn more today!

Things to know when you are a provider in a multispecialty practice.

As we know the risks associated with audiology are pretty low compared with physicians’ and surgeons’ risks.  Accordingly, the premiums for coverage are also very low and the coverage usually broad and comprehensive for the most part from the insurers that do offer this specialty coverage.  However, there still are important considerations in purchasing coverage that every audiologist working with a medical practice needs to take into account. 

The first and most important detail in the coverage arrangement for audiologists working with physicians, most commonly with otolaryngologists, is how the coverage is set up. 

In many practices, we see audiologists included in the malpractice insurance covering the physicians and the practice’s corporate entity.   Most standard physician’s malpractice insurance does not exclude audiologists so they are automatically included without any separate listings or paperwork.  This coverage is always on a “shared limits” basis that automatically extends the same liability limits that the doctor and corporate entity carry.  Sometimes the physicians are covered with their own set of limits and the corporation and employees are on a separate limit, but in both cases the audiologists are covered. 

That is all easy and clean. However, we find that many audiologists then go out and purchase additional individual coverage from a different insurer, often with much higher liability limits than the practice and doctors purchase since the audiology coverage is so cheap.  This independent coverage unfortunately creates two problems.  The first is that if or when a claim arises involving the audiologist almost always the doctor and corporate entity are also sued, with the audiologist now involving their insurance company claims defense team of lawyers and company claims representatives while the physician and practice will be defended by a whole separate defense team.  Predictably in most any arrangements like this with different defendants in the same lawsuit being defended by different insurers, finger-pointing and casting of blame to the other defendants becomes the plaintiff attorneys’ dream because of the divided defense.  The vastly better defense strategy is to have a unified defense handled by one insurer. 

The second problem with separate coverage from different insurers for the audiologists and doctors is that at least in Florida where most doctors carry relatively low liability limits, the audiologists are purchasing much higher limits than the doctors because the cost is so cheap.  Higher limits can lead to being a “deep pocket” in a multi-defendant lawsuit, and that can become a big issue when different insurance companies are defending the doctors and audiologists. 

Ultimately, it is recommended that audiologists and physicians practicing together purchase insurance, when possible, from the same insurance company.  

For additional information, find details here.

What started as an approach helping an audiology practice stay in business last spring, has become a beacon for expanded patient engagement and growing sales.

It happened to almost everyone.   Patients stopped calling, aware that ‘non-essential’ services were shut down.  And, while patients were still suffering, practices were furloughing staff and struggling to get ahold of patients.

“We developed our application, SEngage, to engage patients on behalf of their healthcare providers,” said James Benson, President and Founder of QM2 Solutions. “Before COVID we were using our system to deliver patient experience surveys and build online reputation.  Then COVID hit and we needed to do more for our customers.”

QM2 Solutions reached out to Dr. Patricia Ramos to talk about how they could help. Patricia Ramos is the Director of Audiology and Rehabilitative Services at ENT and Allergy Associates of Florida and oversees their audiology division, ENT Hearing Associates of Florida.

ENTAAF and their ENTHAF Audiology division is a large ENT and audiology practice with greater than 25 offices throughout Florida.  They were seeing decreasing volumes and were managing locations with decreased in office staffing and providers.

“We came together with QM2 through online meetings on evenings and weekends and laid out a plan for engaging our audiology patients,” Dr. Ramos said.

It was important for ENTHAF to test how virtual visits would work with hearing aid patients.  “Would our older demographic respond?  I needed to review clinical approaches and measure results.  It was all new to our providers and patients,” She said.

ENTHAF launched with a small group of patients.  Within the first week, 146 patients-initiated HIPAA compliant asynchronous visits with the practice.

The patient responses were prioritized and fit into the following categories: (1) I’m fine, thanks for giving me a way to connect, (2) I need supplies or batteries, (3) My hearing aids seem broken, (4) I would like to buy new hearing aids, and (5) I have an illness/condition requiring a physician evaluation.

Within three weeks, the practice collected $18,000 through the newly created remote service delivery channels.  The provider team scheduled 256 additional follow-up visits between the audiologists and physicians at a direct value of $25,000.  Medium term follow-up revenue from the limited program generated $32,000.  Overall, ENT Hearing Associates of Florida E-visit program initiated $75,000.  And it was just the beginning.

“The results of E-visits were real. We proved that we could improve hearing aid patients’ lives while generating revenue through virtual delivery channels,” Ramos said.

“In that first six weeks we showed that by focusing on the right patient, at the right time, through the right communication channel, our customers would serve more patients and generate significant revenue,” Benson said.

The next two articles will focus on the growth of the program, lessons learned, and the impact of new, approaches to engaging patients.

During the Florida Combined Otolaryngology Meeting in November 2020, I presented an overview on trends in audiology virtual visits.  Check it out on the MedAudPro YouTube Channel HERE!

Love this article? Check out Virtual Visits by the same author.

Why new Virtual Visit channels are important?

• A well-planned virtual visit program eliminates visit barriers. No-show research and studies on patient visit patterns highlight that patients often do not call when they have a need.   Phone trees, visit anxiety, long wait times, hurried providers, uncertainty about the reasons for their visit, limit patient driven engagement.  Lack of action by patients who need it delay key treatments that impact health and the cost of care.
• COVID fears, rules, and corresponding changes in consumer choice are reducing patients calling or coming into the office.  While in-clinic volumes are increasing, they will not return to pre-covid rates for some time. Virtual visits give providers a simple and secure way to begin or continue care.
• New clinical channels for delivery with more effective methods for patient triage, allow practitioners to make the best use of clinic time and space.
• Virtual visits create connection for both billable and non-billable e-visits and check-ins increase patient access to your practice.

What are the key ingredients to a virtual visit program?

• Build virtual channels by evaluating visit types and technology, then mapping patient type and services to each channel(s).
• Create a wide virtual funnel by reaching out to many patients.
• Utilize emails and/or texts to create virtual connections.  Secure patient messaging educates patients about virtual visit options and open the door to direct interaction.
• Develop diagnosis, visit-type content to streamline a patient’s virtual visit.  By helping patients efficiently communicate their needs, symptoms, and concerns, providers identify specific care opportunities.
• Cultivate virtual visit, clinical pathways around specific diagnoses.   Focus on chronic conditions and develop internal clinical guidelines to make sure you are quickly addressing patient needs.

Now Act!

Virtual visit programs are dependent on a clinic’s most valuable resource, the clinician, and their professional judgement, expertise, and clinic management.  New virtual approaches that open the door to thousands of patients highlight a clinic’s workflow and ability to respond to patient needs.   Asynchronous visit technology, not requiring real time response, allows for greater reach, but underscores the need to act fast on a patient’s needs.  The good news is that technology, supplemented with internal expertise, allows for more efficient triage.  These approaches, along with consideration to use the most efficient delivery channel, magnify a clinic’s capacity.

What a virtual visit program is NOT.

A Virtual visit program is not telemedicine software.  It is not emailing or texting patients. It is not having a portal. 

It is a comprehensive approach that focuses on the right patient, at the right time, with the right care, through the right channel.

Groups who have implemented virtual approaches create an impressive magnitude of “other” service opportunities realized through virtual visits.  Increased clinic site visits, surgeries, increased curbside services, and home-based services.  In the hearing aid industry, there is a significant increase in remote programming of hearing aids, and hearing aid purchases as a direct result of patient requests.

Maybe the most important way to describe the impact of virtual visits program is to talk about real life examples and the real-life results.   Today we highlight the journey of an hearing aid practice, ENT Hearing Associates of Florida.  On April 6, 2020 they identified the desire to develop a virtual visit program with established hearing aid patients.  The group started small, identifying care pathways.  They contracted with QM2 Solutions to implement an asynchronous portal and messaging system.

The group then began announcing the program and connecting remotely to patients.  As patients responded, they were brought to a customized, patient virtual visit where they answered four questions about their hearing needs.   Patients completed their visit on their smartphone, their computer screen, iPad, or tablet.  

It didn’t take long for ENT Hearing Associates of Florida to realize an impact. Within a week a hundred and forty-six different patients completed audiology E-visits. The patient response ranged from everything from, “thanks for giving me a way to connect,” to, “my hearing aids are broken.” Some stated they would like to purchase supplies and others requested to buy new hearing aids!

While engagement of a hundred and forty-six different patients is impressive, the 256 additional patient engagements within three weeks of the initial virtual visit are maybe more important to share.  Additional engagements included: curbside pickups, telephone calls, and more than 90 face-to-face audiology appointments.  The practice then focused on using telemed software to assist in both hearing aid sales and hearing aid adjustments.   Finally, triaging audiology virtual visits led to face-to-face ENT and Telemed visits.  The impact to the number of visits was real.

ENT Hearing Associates of Florida expanded their clinical reach and deepened patient engagement.  They took time to develop a well-organized virtual visit program and found it deepened connection with patients.  As the program matures and outcomes are measured, they are seeing better outcomes and greater patient satisfaction.  Ultimately, this approach had a significant revenue impact for the practice and has been expanded to address the needs of other patient groups.

Find out if a virtual patient management program is right for your practice. Click here for a Free Strategic Virtual Patient Management Assessment.

About James Benson

QM2 Solutions, CEO & Founder

James Benson is the President and Founder of QM2 Solution. QM2 Solutions, with headquarters in Elkhart Lake, Wisconsin, provides solutions that generate practice growth and clinical improvement through patient feedback.

Before QM2 solutions, James worked as a practice administrator and management consultant to surgical subspecialty groups including 12 years working with Otolaryngologists. James served executive leadership roles within the Association of Otolaryngology Administrators (currently known as ASCENT), as consultant to the AAO-HNS Board of Governors and is a co-founder of the Large Group Executive Forum for Otolaryngology Practices.

James speaks nationally on areas of healthcare quality, outcomes, experience, benchmarking, and business development. James has a BS from the University of Wisconsin-Madison (1994) and a Master of Science from the University of Wisconsin-Green Bay (Quality and Systems Design (2000).

Connect with Jamie on LinkedIn

As you know by now, there are seven new Current Procedural Terminology (CPT ®) codes for auditory-evoked potentials (AEP) and vestibular-evoked myogenic potential (VEMP) services. These codes were approved by the American Medical Association (AMA) CPT Editorial Panel for implementation on January 1, 2021.

Highlights:

The two AEP testing codes were replaced with four new codes to better define these services.

• CPT codes 92585 and 92586 are deleted effective December 31, 2020.
• The four new AEP CPT codes are 92650, 92651, 92652 and 92653.

Three new codes were released to simplify reporting of VEMP testing.

• The new VEMP CPT codes are 92517, 92518, 92519

What we’ve learned so far in 2021:

Check out the NEW CPT Codes for Ocular and Cervical VEMP in 2021 article in this newsletter edition authored by Dr. Richard Gans, Ph.D., the Founder & CEO of the American Institute of Balance.  He shares a historical perspective of the utilization of VEMP in clinical practice, along with clinical utility and application.

At-a-glance: New Audiology Codes

92650
Auditory-evoked potentials; screening of auditory potential with broadband stimuli, automated analysis

92651
For hearing status determination, broadband stimuli, with interpretation and report

92652
For threshold estimation at multiple frequencies, with interpretation and report
(Do not report in conjunction with 92651)

92653
Neurodiagnostic, with interpretation and report

92517
Vestibular-evoked myogenic potential testing, with interpretation and report; cervical (cVEMP)
(Do not report in conjunction with 92270, 92518, 92519)

92518
Ocular (oVEMP)
(Do not report in conjunction with 92270, 92517, 92519)

92519
Cervical and ocular
(Do not report in conjunction with 92270, 92517, 92518)

Effective January 1st, 2021, there are three (3) new CPT codes for Ocular and Cervical VEMP. Reimbursement amounts have been determined. The codes and reimbursement amounts were due to the collaboration between AAO-HNS, ASHA, AAN and the AAA. The codes and corresponding reimbursements in Florida are as follows:

Historical Perspective

Cervical and ocular VEMP (c/o VEMP) testing is not new and has been well-established as highly sensitive tests with excellent diagnostic efficiency in hundreds of scientific research articles and publications for more than 30 years. In much of the world, the use of the c/o VEMP have replaced the use of caloric testing. They are simple, fast, non-invasive with well-established norms for amplitude and latency. An example of normal v. abnormal cVEMP is seen in Figure 1. More importantly, they are unaffected by sensorineural hearing loss, even profound cochlear loss.

Although the instrumentation is the same, unlike Auditory Evoked Potential (ABR), VEMPs are myogenic responses, so they are large, strong and fairly resistant to background noise or electrical interreference. The ocular VEMP’s origin is the utricle, is an ascending pathway and is considered an “on” response measured from the output of the contralateral ocular muscles. The cervical VEMP’s genesis is the saccule, is an “off” response with a descending neural pathway, measured at the ipsilateral sternocleidomastoid muscle. Because they are not being pulled out of an EEG as with ABR, they need less than 200 samples, and at 5 tone bursts per second, a test can be run in only 30-45 seconds. Research and clinical use have demonstrated that these diagnostic tools are unique in their application to better identification of a wide range of both otologic and neurologic conditions as outlined in Table 2.

Clinical Utility & Application

The benefit of the c/o VEMP assessment cannot be over-stated based on their application for a wide range of otologic and neurologic conditions. More importantly, they are objective tests with established norms, requires little patient compliance, are unaffected by SNHL (will be affected by conductive loss), are comfortable and well-tolerated, and may be conducted on infants as young as 3-months of age. It is the sole objective assessment of vestibular function available in neonates. More importantly, The VEMPs provide information regarding the Saccule, Utricle, and particularly for the cVEMP’s utility to evaluate the inferior branch of the vestibular nerve and lower brainstem which are not available with any other neurodiagnostic vestibular tests.

Summary

The c/o VEMP have a well-established scientific and clinical history. They are easily and quickly obtained on infants to adults using standard ABR equipment (need to reset parameters), are non-invasive and unaffected by sensorineural hearing loss. Based on the newly published codes and rates, they now are also reimbursable.

About Richard E. Gans, PhD

Founder and Executive Director of The American Institute of Balance, one of the largest balance centers in the USA Dr. Gans received his PhD from The Ohio State University in Auditory-Vestibular Physiology. For over 20 years has been a leader in the development of vestibular evaluation and rehabilitation techniques, including tests of oscillopsia and postural stability as well as BPPV treatment. He has presented or published over 150 programs and papers worldwide in the area of equilibrium disorders. He is the author of 8 textbook chapters and texts ranging from diagnostic vestibular testing, vestibular rehabilitation, BPPV treatments and pediatric vestibular evaluation. Thieme Medical Publishers will publish his upcoming textbook, Evaluation and Management of Balance Disorders in Children and Adults. His most current research is in the areas of pediatrics, migraine and psychiatric aspects of dizziness. Dr. Gans served as the President of the American Academy of Audiology (2004-2005) and continues to be active in professional and governmental issues. He is an adjunct professor at Nova Southeastern University and the University of South Florida.

Read Richard Gans‘s Bio