Telepractice: A New Option for Private Speech Therapy

In December of 2010, I moved from Boston to my hometown of New Orleans, Louisiana. One of the toughest parts of moving was leaving my private speech therapy patients.

I gave each of my private patients about three months notice of my move. I offered the following options to each patient:

1. I could refer you to a trusted colleague/university clinic for continued therapy.
    
2. You could be discharged/ take a break from therapy and see how it goes.
    
3. We could use telepractice to continue treating via Skype.

Interestingly, each of the three private patients I had right before I left chose a different option and one chose two options!

One person decided that they weren't very computer savvy and wanted to continue to have speech therapy services in their home. I gave them the number for a colleague and expect that they will call when they are ready. Another decided that he would try to take a break from therapy and see how he did.

The third person, who I'll call Mike, decided to continue once with a colleague of mine and do teletherapy via Skype once a week with me. Before I moved, I had been seeing Mike twice a week and he wanted to make sure he got two individual sessions per week in addition to group therapies at university clinics.

While I don't think that telepractice works with everyone, I think that this option is perfect for Mike. First of all, he is tech savvy. He already had Skype on his computer and had heard of other people using it but hadn't tried it yet. He has mild aphasia and wants to continue to work on writing, which lends itself well to computer therapy.

The Tools I Use for Telepractice

First of all, there are many, many tools you can use. I'll share with you what I use and then you can decide what might work for you.

Obviously you must have a webcam. In order to use Skype, or any video conferencing program, you will need to have either a built in or external webcam. Because you’ll want to be able to see each other, both you and your patient will need to have webcams. FYI - you can purchase a good webcam for about $40 or less.

You need to be able to see each other.  It's pretty hard to do speech therapy if you can't see each other! For this, Mike and I use Skype. I really like Skype for several reasons:

1. The major one is that it's FREE and really easy to use.
    
2. The video quality is excellent.
    
3. They also have an iPhone or iPad app (just in case either of our webcams is acting up).

You may want to be able to see their screen. Depending on the patient and what you're working on with them, it may be important to see their computer screen. If I was doing just verbal expression or motor speech with Mike, Skype alone would work. Since we're working on writing (and seeing what he writes on paper won't work) we have tried a program that lets me see his computer screen and control his computer virtually.

LogMeIn is a program that is used by IT professionals to control people’s computers remotely. By using this program, I can actually see Mike's computer screen and we can save our work on his computer. I can pull up any website or Microsoft Word on his computer and can watch him typing, correct his mistakes, etc.

You may be thinking, Mike lets you take over his computer from Louisiana? Yes. This is because we have a very solid relationship and he trusts me. I am only allowed to control his computer for a predetermined amount of time and I can only view his computer once he sends me an email invitation to a secure site. I can see how a new telepractice only patient might be concerned about this, but it works well for people with whom you have already built trust.

**As soon as the free trial period is over, we might switch to a feature on Skype that lets you "view screen" so that I can see his screen. The only difference is that I cannot control his screen and will have to tell him what I want him to do.

How do I Bill / What Do I Charge?

Easy: my same rate. Because I'm continuing to provide individual therapy and both of us feel that there is no loss in quality, I will be billing Mike the same amount. I will continue to bill him monthly using Freshbooks.

Remember: According to the current ASHA rules and regulations, you can only do telepractice if you're licensed in the state where the patient lives. Although I moved to Louisiana, I decided to keep up my Massachusetts license so that I could continue to see patients via telepractice.

The rules, regulations, laws, procedures, preferred practice, etc. regarding telepractice is still being worked out. It's an emerging form of therapy and the rules are still being defined.

Also, this is an out of pocket private pay patient. I would not recommend trying to use telepractice with insurance patients unless you make sure that your services will be reimbursed!

So far, Mike and I have been using telepractice for six months and both of us feel that it's going very well!

Action Steps to Start a Speech Therapy Telepractice

Step 1: Read up on ASHA's website about telepractice and decide if it's right for you and your patient population

Step 2: Get a Webcam

Step 3: Sign Up for Skype

Step 4: Sign up for LogMeIn (optional)

I hope that you find that telepractice opens up some new options for your private speech therapy business. I'm thrilled with how telepractice has allowed me to continue to treat one of my favorite private patients from Boston and I hope that I'm able to treat more people using telepractice.

P.S. I did not mean to exclude my PT and OT colleagues from this post, but it seems that of the three disciplines, Speech might be the easiest to use telepractice.

Can any PT and OT colleagues chime in on how they might use telepractice?

Click here to read more about Jena Casbon, MS-CCC-SLP

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