ASHA Special Interest Group (SIG) 18, Telepractice, is a testament to the growing interest in delivering speech-language pathology and audiology services remotely. Telepractice already involves professionals in such diverse settings as rural schools with staffing shortages, civilian and military hospitals, universities, private practices, and home health agencies. But as telepractice continues to evolve, practitioners face challenges in the areas of reimbursement, licensure portability, and privacy—challenges about which practitioners can learn more through SIG 18 affiliation.
On the reimbursement front, the original federal legislation enabling Medicare reimbursement for telemedicine did not name SLPs and audiologists among the eligible providers. New legislation needs to be passed to allow Medicare reimbursement for telepractice. ASHA continues to work independently and with other stakeholder groups to introduce and support this new legislation. Although Medicaid has more state-to-state variability in its response to telemedicine, there are few examples of Medicaid reimbursement for speech-language or audiology services. Through the SIG 18 online community, affiliates can tap a valuable network for sharing breakthroughs in reimbursement at the state level.
In the portability arena, state licensure boards increasingly acknowledge telepractice when updating their laws or regulations, but typically require providers to be licensed in the state where the client is located. This requirement limits the potential growth and benefit of telepractice to underserved areas. ASHA is in discussions with the National Council of State Boards of Examiners, other professional boards, and the American Telemedicine Association to remove these limitations.
The issue of client privacy in telepractice is addressed in the ASHA Code of Ethics, as well as in federal regulations such as the Health Insurance Portability and Accountability Act (HIPAA) for covered health care entities and the Family Education Right to Privacy Act (FERPA) for schools. It is often difficult for SLPs and audiologists to judge whether they are compliant with privacy and security rules, given the lack of official interpretations or legal precedents about the acceptability of certain web-based services. SIG 18's inaugural issue of Perspectives provided an in-depth examination of these issues and a checklist to conduct a HIPAA risk assessment.
New SIG on the Block
SIG 18 was established in 2011 to share knowledge and resources about the emerging area of telepractice. Via a petition signed by more than 100 ASHA members and ultimately approved by the Board of Directors, the group began with 125 members. By the end of January 2012, membership had expanded almost threefold to 339 affiliates. Such significant growth highlights the fast-growing interest in this area of service delivery by SLPs and audiologists. The SIG's inaugural Coordinating Committee consisted of the telepractice supporters who helped establish the group, including Ellen Cohn (coordinator), Karen Golding-Kushner (associate coordinator), Michael Campbell, Diana Christiana, and Mark Krumm. In 2012, Lyn Tindall joined the committee as Perspectives editor, along with Janet Brown as the ASHA staff ex officio. Two coordinating committee members will be elected in 2012.
SIG 18's first issue of Perspectives, published in September 2011,addresses the evolution of telepractice in the professions, reviews evidence supporting telepractice in speech-language pathology, and describes current practices. The SIG 18 online community provides opportunities to discuss telepractice challenges and to share information about technology, research, and practice. SIG affiliates receive a discount on registration fees for short courses at convention and other ASHA continuing education activities.
The SIG sponsored a 2011 ASHA Convention short course by telepractice expert Deborah Theodoros (University of Queensland, Australia). Theodoros and her doctoral students have been prolific publishers of research comparing telepractice services with those delivered in person. The short course drew more than 100 participants. The SIG also sponsored a similarly well-attended panel presentation chaired by Lyn Tindal on "Telepractice and Veterans Health Administration: Past, Present, and Future Directions."
SIG 18, Present and Future
For 2012, the SIG Coordinating Committee already has plans for its issue of Perspectives—which will expand to two issues per year in 2013—and another Theodoros short course at the convention. SIG affiliates are posting in the online community, sharing their experiences with technology, and debating privacy issues. The SIG committee has made recommendations for professional development programs, and at its March meeting began strategic planning to envision the SIG's future. Other SIGs recognize the relevance of telepractice to their areas of focus and are seeking collaboration in the form of Perspectives articles and convention sessions.
For more information about SIG 18 and ASHA's other special interest groups, visit ASHA's SIG webpage. To propose a new SIG, visit ASHA's SIG Suggestion webpage.