Cochlear Implants Services & Support
by Cochlear Guest Author

Aural rehabilitation in practice with Dr. Pratesi

December 14, 2021
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Laura Pratesi, AuD, discusses the importance of aural rehabilitation and how she puts it into practice.

What is the value of aural rehabilitation for your adult patients?

Aural rehabilitation is immensely valuable. I recommend it to patients at just about every stage in their hearing wellness journey. I explain that aural rehab is like “physical therapy for the brain.” Whichever skills the patient wants to strengthen or develop, we create a treatment plan and a goal to work towards. I use certain speech in noise tests (such as the QuickSIN or AzBio), as well as questionnaires such as COSI, APHAB, HHIA, HHIE, as benchmarks, to track their progress. 

Data shows that aural rehab is important for adult patients – how do you implement into practice?

Pre-COVID, we were working on developing a weekly in-person group therapy session. I think that patients can learn so much from each other, knowing there are others in the same boat. Group therapy would also give patients the opportunity to listen to lots of different voices (male and female, accent variations, loud and softer talkers, etc.). COVID-19 certainly changed our plans and brought an additional level of complexity as masks hamper lipreading and distort speech signals while quality degrades over distance. We were not sure how to overcome this. So during this time, I have focused on working with patients individually, and having them complete homework by themselves or with family members. 

At what point in the treatment process do you bring up rehab? For whom?

I bring up aural rehab from just about day one. In private practice, if patients are at my office, it is because they notice they are struggling. They have acknowledged that there is an issue, and they want to get to the bottom of it. I listen carefully to their symptoms and concerns. Even patients whose test results fall into the “normal” range may not be performing as optimally as they would like. For some patients, their challenge may have more to do with auditory processing than anatomy and physiology, but that does not mean that their struggles are not real, and do not need to be addressed. If a patient is in front of me with a complaint, then I will work with them to find a solution to their problem!

How does an aural rehab program impact your practice?

I believe focusing on aural rehabilitation means that our clinic is working to treat the whole person. We cannot just fit a set hearing aids or a cochlear implant and call it a day. When the brain has been deprived of certain sounds (sometimes for decades), it’s going to take time to learn how to hear and process again. I was born with hearing loss myself, and I did not hear much in my left ear for the first 20+ years of my life, until I got a hearing aid. I remember the time it took to get adjusted to hearing my refrigerator humming and my clock ticking. I was about two years into wearing my own hearing aids until I could tolerate them at the full volume recommended for my hearing loss.

Even now, if I switch between old and new technology, or change between hearing aid brands, it takes about 2-3 weeks for my brain to adjust to the differences. It only makes sense that it will take time for others to adjust as well. Factors to consider include the patient’s duration of deafness, pre- or post-lingual on-set of hearing loss (i.e. before or after speech development) and interventions used to date. As a provider, and as someone with hearing loss, I think it’s important we address the person as a whole. Many are seeking better access to sound and greater ease with communication. Why would we not want to try to address those concerns?

How has Cochlear™ CoPilot been integrated into your program?

Cochlear CoPilot has been an effective addition to my aural rehab tool box. It has previously been a challenge to find quality, affordable solutions for my patients. There have been programs that have been discontinued, others that are not cost effective, some that are cumbersome or not intuitive. I love how the lessons build off of each other, and the tasks gradually become more complex. If the beginning tasks are too easy, you can jump ahead. If the exercise is too hard, you can go back and work on the skill set that builds up to it. You can focus on names or numbers or street addresses or whatever. I found the exercises to be applicable to real conversations and real interactions.

How have your patients used and benefited from Cochlear CoPilot?

I think that any kind of listening exercise can be beneficial, but I love that patients can stream directly to their processor/hearing aid, or can turn one side off and work an individual ear at a time. It’s been very easy to get the app downloaded and installed for my patients. I set aside a few minutes of their appointment time to go over and practice some of the first lessons. Everyone has found it very simple and easy to use, and not intimidating at all. My patients like the streaming aspect the most – and that they can do the exercises anywhere at any time. I try to get patients to commit to at least one hour a day of dedicated aural rehab time. Snagging 10-15 minutes here or there, they can accomplish that easily! 

Download Cochlear CoPilot for free from the Apple® App Store®.

About the author:

Laura Pratesi, Au.D. is owner of Citrus Hearing Clinic LLC in Clermont, Florida. Dr. Laura received her Bachelor of Science in Communication and Sciences Disorders with a concentration in Human Development from Auburn University in 2008, and her Doctor of Audiology degree from Auburn University in 2012. During her time at Auburn, she had the opportunity to work in a variety of clinical settings including in a school system, hospital system, VA facility, ENT practice, private practice, and assisted living facilities. She has extensive experience in working with both pediatric and geriatric populations, as well as veterans.

Audiology is not just a profession for Dr. Laura, but also a calling. Diagnosed with a progressive hearing loss at age 5 years, she was first fit with amplification by her classmates while at Auburn University. Having struggled with untreated hearing loss for years while falling into care gaps, Dr. Laura is passionate about proper identification, diagnosis and intervention of hearing and balance disorders for patients of all ages. 

Dr. Laura has been featured as a Woman of the Year for 2020 by Orlando Magazine, a HearStrong Champion, was a part of the Docs with Disabilities campaign by the University of Michigan, and was featured on multiple podcasts, including Orlando Lady Boss. She is a Fellow of the American Academy of Audiology, has her CCC-A from ASHA, is a member of the Academy of Doctors of Audiology, and is a member of the Florida Academy of Audiology. Since April 2021, she has been a member of a FLAA Task Force charged with updating Audiology Statutes in the state of Florida. At her practice, she does contract work for the Veteran’s Administration, the Department of Vocational Rehabilitation, the Lake County School System, and the Social Security Administration. She resides in Central Florida with her husband, their five year old son, four cats, and two hermit crabs. In her free time, she is a volunteer at Clermont First United Methodist Church, and the former Publicity Chair board member of the Moonlight Players community theater (on hiatus due to Covid-19).

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In an effort to keep our content fresh and reflective of a diverse industry, Cochlear Americas features a mix of employees and professional partners to contribute to Cochlear ProNews as Guest Authors.

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COVID-19 Public Health Emergency – Expiration date May 11, 2023

May 15, 2023

The Department of Health and Human Services (HHS) has announced the expiration of the Public Health Emergency (PHE) declaration for COVID-19 effective May 11, 2023.  With this expiration, many waivers allowing for changes and flexibility in health care delivery during the pandemic would have ended, unless Congressional action changed or extended the rules and flexibility, as was the case with the Consolidated Appropriations Act which extended certain flexibilities.   The Centers for Medicare and Medicaid services (CMS) issued specific guidance for providers on the various waivers, flexibilities, and transition through the PHE expiration, which can be accessed here.

Although HIPPA rules remained applicable during the PHE, HHS also allowed relaxed enforcement within certain contexts to support provider delivery of patient care. With the end of the PHE, the Office of Civil Rights at the HHS announced a 90-day transition period beginning May 12, 2023, for all providers to resume compliance under HIPAA rules when providing telehealth services.  CMS also announced extended coverage of specific telehealth services across specific specialty providers through the end of 2024. While providers are encouraged to review the guidance on overall healthcare delivery in its entirety, Cochlear Americas is pleased to share an update on the related telehealth services extension beyond the PHE expiration.

 HIPAA compliance and telehealth services:

The Office of Civil Rights (OCR) at the HHS has announced a 90-day transition period between May 12, 2023, and August 9, 2023, for covered health care providers to come into compliance with the HIPAA Rules with respect to their provision of telehealth.   During this time, OCR will continue to exercise its enforcement discretion and will not impose penalties on covered health care providers for noncompliance with the HIPAA Rules that occurs in connection with the good faith provision of telehealth during the 90-calendar day transition period.

Please read Office of Civil Rights Confirms Resumption of HIPAA Enforcement published by ASHA for additional information and resources. 

Medicare

The Consolidated Appropriations Act, 2023, extended many telehealth flexibilities through December 31, 2024, such as: 

  • People with Medicare can access telehealth services in any geographic area in the United States, rather than only those in rural areas.
  • People with Medicare can stay in their homes for telehealth visits that Medicare pays for rather than traveling to a health care facility.
  • Certain telehealth visits can be delivered audio-only (such as a telephone) if someone is unable to use both audio and video, such as a smartphone or computer. 3

A complete list of covered telehealth services may be found here. 

Cochlear implant programming services, reported with CPT® Codes 92601-92604, are included within the audiology code set under the CMS extension. 

Medicaid

Each state determines coverage and administers benefits under the Medicaid program.  With policies and guidelines determined by local government, some Medicaid programs allowed telehealth services prior to the emergency declaration.  Since telehealth flexibilities under Medicaid programs are not tied to the end of the PHE, each state will then determine the potential adoption, continuation, or expansion of telehealth coverage for its members. 

Private Health Insurance

While many commercial insurance plans adopted the flexibilities CMS allowed with telehealth services during the PHE, each individual plan will determine guidelines and policies for continuation of coverage moving forward.  The plans establish coverage and may impose cost-sharing, prior authorization, restricted provider specialties, or other forms of management across remote care services.  Providers and members are encouraged to contact payers directly to obtain specific information on the covered benefits available under an individual beneficiary’s plan. 

Audiology and Speech-Language Pathology Interstate Compact (ASLP-IC)

ASLP-IC is an interstate compact, a contractual, legislatively enacted agreement between states to facilitate the interstate practice of audiology and speech-language pathology.   As of August 2022, the ASLP-IC has been enacted into law in 23 states and is expected to be operational this year.  Once the compact is fully operational, licensed audiologists and speech-language pathologists will be able to apply for a privilege to practice in-person and through telehealth in ASLP-IC states.  Communication, including license verification, will occur among participating states, though practice regulation will remain within the purview of each state. When operational, the compact will support providers seeking to offer audiology and speech-language pathology services to an increased number of patients needing care.   Additional benefits of the compact include improved continuity of care, simplified pathways to navigate care, portability during travel, and options when travel for in-person case at a provider’s location may be prohibitive to care.

Please visit the ASLP-IC Commission website for more information and updates.  Providers may also view an interactive state map listing the current ASLP-IC member states.

For more information on Advocacy and Policy, please contact your local Cochlear Americas Regional Reimbursement Manager.  Access contact information and additional resources on the Reimbursement Resource HUB.

¹ US Department of Health and Human Services: https://www.hhs.gov/hipaa/for-professionals/faq/490/when-may-a-covered-health care-provider-disclose-protected-health-information-without-authorization/index.html

³ US Department of Health and Human Services: https://www.hhs.gov/hipaa/for-professionals/faq/490/when-may-a-covered-health-care-provider-disclose-protected-health-information-without-authorization/index.html#:~:text=would%20not%20apply.)-,A%20covered%20provider%20may%20share%20protected%20health%20information%20with%20a,subject%20to%20minimum%20necessary%20standards

³ Centers for Medicare and Medicaid Services: https://www.cms.gov/newsroom/fact-sheets/cms-waivers-flexibilities-and-transition-forward-covid-19-public-health-emergency  

This material is intended for health professionals. If you are a consumer, please seek advice from your health professional about treatments for hearing loss. Outcomes may vary, and your health professional will advise you about the factors which could affect your outcome. Always read the instructions for use. Not all products are available in all countries. Please contact your local Cochlear representative for product information.

CPT and CPT material are copyrights of American Medical Association (AMA): CPT copyright 2023 American Medical Association, all rights reserved. CPT is a registered trademark of the American Medical Association. The information provided in this document is provided as guidelines only to address the unique nature of implantable hearing solutions technology. This information does not constitute reimbursement or legal advice. Cochlear Americas makes no representation or warranty regarding this information or its completeness, accuracy, fitness for any purpose, timeliness, or that following these guidelines will result in any form of coverage or reimbursement from any insurance company or federal health care program payer. The information presented herein is subject to change at any time. This information cannot and does not contemplate all situations that a health care professional may encounter.

To be sure that you have the most current and applicable information available for your unique circumstances, please consult your own experts and seek your own legal advice regarding your reimbursement and coding needs and the proper implementation of these guidelines. All products should be used according to their labeling. In all cases, services billed must be medically necessary, actually performed, and appropriately documented in the medical record.

The purpose of this document is to provide coding options for Cochlear Implants however, you should always check your payer for specific coding policies to ensure compliance.

Science Spotlight: Efficiency and Safety of the Cochlear™ Nucleus® SmartNav System

December 2, 2024

Ensuring proper electrode placement is crucial for achieving optimal hearing outcomes following cochlear implantation. As intraoperative diagnostics advance, their benefits across various aspects of the procedure become increasingly evident. This Science Spotlight focuses on Cooper et al.’s study, “Utilization of [the] SmartNav [System] technology in cochlear implantation: optimizing efficiency in assessment of electrode placement,” which compares the Cochlear™ Nucleus® SmartNav system to the current standard, intraoperative x-ray.

Key Highlights:

  1. X-ray: The current gold standard for confirming electrode placement, though it is time-consuming, costly, exposes patients and staff to radiation, and extends anesthesia duration.
  2. SmartNav System: A reliable and user-friendly method for determining electrode positioning, with the potential to improve patient outcomes.
  3. Anesthesia Sensitivity: Children under 4 and elderly patients are more sensitive to general anesthesia and at higher risk of postoperative complications.
  4. Efficiency: The SmartNav System’s Placement Check averages 2.12 minutes, significantly faster than x-ray’s average of 14.23 minutes, potentially reducing anesthesia time by up to 34 minutes.

This study highlights the considerations of using x-rays for electrode placement confirmation, including radiation exposure and increased operating room time, which prolongs anesthesia duration and poses additional risks, especially for young children and older adults. X-rays also require a dedicated technician, and image quality can vary based on their experience.

In contrast, the prospective clinical study found the SmartNav System to be an effective, rapid, and reliable method for ensuring proper electrode placement during surgery. The SmartNav System eliminates radiation exposure while maintaining accuracy and reliability. The study concludes that the Nucleus SmartNav System significantly outperforms traditional x-ray imaging, offering a faster and more straightforward approach to assessing electrode positioning, thereby enhancing surgical efficiency and patient safety.

For more information on how the Nucleus SmartNav System is enhancing current gold standard techniques, please contact your local Cochlear representative or refer to the full article.

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This material is intended for health professionals. If you are a consumer, please seek advice from your health professional about treatments for hearing loss. Outcomes may vary, and your health professional will advise you about the factors which could affect your outcome. Always read the instructions for use. Not all products are available in all countries. Please contact your local Cochlear representative for product information.

 

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