The broadcast is now starting. All attendees are in listen-only mode. Good morning, everyone. We're going to give everyone a few more minutes to sign on, and then we will start. Good afternoon, everyone, and welcome to the webinar on Telehealth, Expanding Access to Hearing Care. We're so glad you could be here today to learn more about the current status of telehealth and how this method of service is impacting healthcare today. Your moderators today are me, Courtney Pitts, Marketing Specialist, and Esther Waldman, Membership Specialist. Our expert presenter today is Suzanne Yonker, AUD, DCA, FAA, and Director of Telehealth. She is a hearing healthcare provider with a vast array of experiences in providing direct care and fostering quality care for colleagues. Specifically, Suzanne has coordinated hearing instrument training programs while educating and mentoring trainees, provided skill oversight for quality assurance and compliance in corporate settings, managed and resolved consumer service issues, performed operational duties for company functionality, and in the past few years, coordinated and managed telehealth implementation services. Currently, Suzanne is Director of Telehealth at Your Hearing Network. We're very excited to have Suzanne as our presenter today, but before we get started, just a few housekeeping items. Please note that we are recording today's presentation so that we may offer it on demand through the IHS website in the future. This webinar is available for one continuing education credit through the International Hearing Society. We've uploaded the CE quiz to the handout section of the webinar dashboard, and you may download it at any time. You can also find the quiz and more information about receiving continuing education credit at our website at IHSinfo.org. Click on the webinar banner on the homepage or choose webinars from the navigation menu. You will find the CE quiz along with information on how to submit your quiz to the IHS for credit. If you'd like a copy of the slideshow from today's presentation, you can download it from the handout section of the webinar dashboard, or you can access it from the webinar page on the IHS website. Feel free to download the slideshow now. Tomorrow, you will receive an email with a link to a survey on this webinar. It is brief, and your feedback will help us create valuable content for you moving forward. Today's presentation is sponsored by Your Hearing Network and represents their view on telehealth. The content of this webinar has been developed especially for you by Your Hearing Network and may not necessarily reflect IHS's policy and stand on telehealth. Today, we will be covering the following topics, a general background and definitions used with telehealth, awareness of telehealth regulations, laws, and reimbursements, the current status of hearing care, the challenges of meeting expectations, modern solutions to these challenges, financial planning, and clinical data around telehealth. At the end, we'll move to a Q&A session. You can send us questions for Suzanne at any time by entering your question in the question box on your webinar dashboard, usually located to the right or top of your webinar screen. We'll take as many questions as we can in the time we have available. Now, I'm going to turn it over to Suzanne, who will guide you through today's presentation. Suzanne? Well, thank you very much for that wonderful introduction. Hello, everyone. I also thank IHS for hosting this wonderful webinar. I hope you'll be as excited as I am regarding telehealth. It is the future, and we're certainly going to talk about a lot of different things. We have some objectives here to define the components and terms, have a general idea of what the current rules and laws are, just sort of an overview of telehealth in general, and how do we use this to fill a void in patient care that's existing, and describe again how as a practice owner, how could this fit into your practice? We're definitely going to talk about some of those scenarios where you will discover how this is something that can be very beneficial, certainly moving forward. So basic terminology when it comes to telehealth, there's a lot of different words you might hear, telehealth, telemedicine, telepractice. So telehealth is more of a general term. Telemedicine is used typically with physicians in that really medical arena, whereas telehealth is more of a broad general scoping word to encompass allied professions such as ourselves. Two main differences in telehealth really is how they're delivered. How is this service delivered? There's two nice terms called synchronous and asynchronous. So synchronous is primarily really the real-time, kind of like what we're doing now. This is a real-time live conferencing with audio and video components, versus a store-and-forward, which is asynchronous, and that's more like you're faxing, you're emailing, where something's recorded and then reviewed at a later time. And I bet that we do that now. If you've ever faxed or emailed a physician an audiogram or something along those lines, that is a form of asynchronous telehealth. Of course, video conferencing has to be a two or more location, right from one place to another, and does include both the video and audio. So when telehealth is mentioned in rules and laws, some states are very specific in that they want a two-way video and audio, and some will accept one way, such as a telephone. So those are just things to understand as a basic terminology in what we're doing now. Also, in some of the literature and rules and laws, you'll see terms such as presenting site and receiving site. So the presenting site is where the patient is physically located for their telehealth treatment, whereas the receiving site is where the provider is physically located. Because typically, where the patient is, the technician with the patient is the one sort of commanding the video conferencing, so they're inviting a provider to join in to the appointment. So that's why those terms are as such. And why this is coming about and really gaining a lot of popularity today, particularly in our field, as well as medicine in general. But regarding hearing health care, there's a lot of government entities, groups, such as this one, National Academies of Science, Engineering, and Medicine, that are getting together to solve a problem. And they recognize that hearing care is very important for all persons, but especially because of our growth in that baby boomer population. Getting better access to care, this is going to be our buzzword for the day. Access to care has been defined as the timely use of personal information to get the best possible outcome. So something timely, increasing that access to care is certainly a recommendation of this group as well as others. So this is what government entities are looking at, and this is why it's so important that we stay in the forefront. Now, of course, medicine in general has a very positive opportunity to expand this access of care. But not only is it expanding, it certainly is very cost efficient. If you think about a physician, or as us, physically driving to a location versus being able to consult with a patient from a video conferencing standpoint. I mean, there's just a whole array of how it is cost saving. Does it increase patient satisfaction? Absolutely. And I'm going to talk to you and show you some outcomes that we have from some of our studies. And does it preserve the quality of care? Absolutely. All of those things are true, at least in the program where these are set up appropriately, that those things are preserved, and that's important. So we know that in our field of hearing care, the VA really has been the innovator and done the initial legwork and studies, and really they've had such success that they wanted to expand their programs. So they're expanding from 10 sites to 71 sites, and now 132 sites have telehealth carts containing equipment because they find that this, again, is meeting that need for access to care. And with veterans, they don't want them driving long distances because that's a hindrance, right? Transportation for a patient can be an obstacle for them seeking care. And so this answers that need. And what they are also discovering is that their teleaudiology outcomes are as good as or better than traditional face-to-face. So it's something that we have discovered that, and I'll show you some outcomes that it really is something that people just enjoy so much. Now, when we talk about rules and laws in general, particular for Medicare reimbursement, right, everybody is curious, particularly as audiologists, you know, we can bill a 92557, you know, the hearing test, let's say. And the question is, will Medicare, you know, reimburse for that? Well, right now, straight Medicare is really limited to fee-for-service reimbursement to just a handful of providers and services that they do. But these providers are being very dynamic in how they're organizing, and what they're doing now is some interstate medical licensure compacts because they want to be able to be able to service several states, even if they're licensed in one state. And so the nurses are coming together, physical therapists, psychology, and so there is this huge movement of telemedicine in general. So where does that, you know, leave us? Well, I'm going to answer that at the next slide, but just to give you an idea that that's just Medicare straight billing. A lot of us work with other entities, right, such as Medicaid. Medicaid reimbursement is determined by each state. Some states are very, just in their language, they're very specific about who they reimburse. They definitely include, again, it's very individual states. Some are very specific about audiology or hearing care in general, and some sort of vague. So navigating that language is something that certainly we want to do, and we do do that with some careful consideration. But the interesting thing is that there are 37 proposed bills in the House and Senate right now on how to expand telehealth Medicare reimbursement. So this is not an end-all. This is just the beginning, and you can kind of get a snapshot for what each, you know, how many states are really getting on line here with even Medicaid reimbursement. And then we talk about third-party reimbursement. So those would be, let's say, your Blue Cross Blue Shield, your Humana, your Aetna, and so forth. And that's determined, again, by each contracted provider between the provider and the payer. So some may allow it, and some may not. So there is some flexibility there. It's just that everything is very individualized, and there's no just general broad sort of, you know, whip of the pen that, as audiologists, if, you know, we're billing, that that could be reimbursed. But it could be reimbursed through these other entities, depending on the state. And, you know, there are a lot of states really embracing telehealth. Texas, you know, at the top of the chart, and so forth. Iowa, California, and so forth. And if a state's not listed here, they are participating, but they just didn't meet the top 10, right? But you can see how a percentage of total telehealth services are being rendered in these states, which is enormous. And these are fee-for-service. So this is, they're tracking this by how much they're billing. So it's a tremendous impact, and it's only growing. I mean, this was from 2016. So telehealth is here to stay. It's working its way into every facet of healthcare. And, you know, we need to be at the forefront and be on the bandwagon, because this is, it's exciting, and this is the future. But you say, well, how can I use it if I can't get reimbursed? Well, certainly, there's a lot of other opportunities in our field, in particular, because we work with a retail balance, right, between retail, obviously, and healthcare. We don't do a lot of billing for hearing aids. Obviously, Medicare doesn't pay for them. So our revenue stream is primarily by private funds, right, private payers, and not relied upon Medicare or Medicaid, I mean, in general. I'm sure there's some exceptions. But we can do, with telehealth, direct hearing aid sale to patient very easily, and that's done frequently. Direct ancillary, you know, sales, just like you would in the office with a patient. Anything that you're doing and selling with, as far as a hearing aid, assistive listening devices, warranties, repairs, that all can be done through telehealth. One of the, another exciting thing is indirect sales through schedule efficiency. I'm going to show you some examples of how schedules can be made to be where sort of those, quote, non-revenue service appointments that we do do for our patients, because they require our expertise, some more than others. But we know that if they're all on our schedule, you know, how far out is a new patient, or an existing patient who wants to upgrade, you know, how far out do they have to wait if we could see them sooner? And we'll give you some of those demonstrations of how telehealth works in that to make that an efficient schedule opportunity. But what is the push? Why this big access to care? And I briefly mentioned it, but these are the facts. You know, the oldest baby boomers have already begun turning 65. But in addition to that, which is the baby boomers, the largest population, as we know right now, the typical lifespan has increased over the past 30 years, with life expectancy beyond 65, going another almost 20 years. So not only do we have this large growth in the age group that is typically our population in hearing health care, but they're living longer. And not only that, if they reach the age of 85, the trend is that they could live another six and a half years. So this is a long time for somebody to need good quality lifestyle, their working life, their social life, their family life. You know, this is an increased need for optimum communication skills so that they do have a satisfactory long life. So, yes, this is critical. And this is why attention is being made through government agencies, through advocate agencies, and to recognize this and to come up with solutions. And even in MarketTrack, if they predicted in 2005 this growth, they definitely did the right prediction because we are there. And you can see how it's just absolutely increasing, which is a great thing for our field. You know, I mean, certainly we want to be able to help as many people as we can. But our challenge is also how many providers are going to be available to provide the care that these folks will need. And as you can see, Windmill and Freeman have a nice chart here from their 2014 presentation, but the growth in the profession of both audiologists and hearing instrument specialists is not going to meet the need. There are fewer that are available because more are retiring or leaving the field than entering the field. So, hence, large population, living longer, fewer providers to meet the need. What happens? Well, somebody's got to have some answers, right? And this is just a schematic that allows us to show where the heavy populated areas now This is for audiology, and I'll show one about hearing instrument specialists. But what's nice about this is you can see the states where there's very densely populated providers. Now, the blank states, as indicated here, just means that data is not available. Maybe at the time of the survey, they didn't meet the time frame, the time limit to submit information. So it doesn't mean that nobody's there, obviously. But you can see how in certain areas, there are very few, therefore, hence, how is that access to care going to be met? And similarly, again, the blank states don't mean that there are no hearing aid specialists in the states. But just to give you an idea, again, where the density is and where it's not. And these are all important factors when a community or a country, such as the United States, is looking at how to care for these individuals. So again, some more attention has been paid by the Federal Trade Commission. I think we're all aware of this, and that they held these workshops to look at, again, how are we going to meet these needs? And they came up with some real key findings. They want to develop and promote measures to assess and improve quality of hearing care. So hearing care is on their radar, which is nice. I think we've all tried to get it there over the past years and get the recognition that it's critical and it's important for not only just social life, but physical health, as we know from other studies, and reducing the effects of dementia and so forth. So they're recognizing that, and they're coming up with some great innovations. Sometimes we might not be comfortable with that, but this is our reality. So they also, again, use improved access to hearing care for the underserved and vulnerable, and evaluate and implement innovative models of hearing health care to improve access. So this is where all of this is coming, and this momentum to find answers out-of-the-box answers, and that may be something that we're comfortable with or not comfortable with. Certainly there is competition available to meet this need. I mean, this is a viable need. Certainly we have our own realms of where we work and our work environments, but what about other people entering into our hearing profession? The drugstore chains or direct-to-consumer items that are just, were inundated. I mean, if you type in, you know, hearing aid into Google search, you're going to get a lot of other sort of products, you know, the hearables and wearables, because everybody recognizes, and they want to jump in and be able to provide this access. But don't you think that we are the experts for this? We're the ones with the training. We're the ones with the experience. We're the ones that should keep this in our home, you know, with us, and how are we going to combat that? And again, just more, you know, more people coming to the table to address this need. You might have been familiar with PCAST, the President's Council of Advisors back in 2015. You know, they're the ones that are talking about, quote, FDA should approve this class of hearing aids for over-the-counter without the requirement for consultation with a credential dispenser. FDA should also approve, this is their recommendations, right? FDA should also approve the OTC sale, both in stores and online, tests appropriate to self-fitting and adjustments of these OTC devices by the end user. Such hearing treatments and tests meet the FDA requirements for over-the-counter products. So they're looking to self-treat, self-monitor. And, you know, that's important for us to recognize. That's not going to go away. That certainly is a reality. But what can we do? We need to do something to meet the need where we're keeping that with ourselves. We're the experts in this. Well, technology, you know, tele-audiology, tele-health, sometimes those are interchanged as well in hearing health care. But as technology continues to improve, tele-audiology and remote fittings will be a major player in the market, right? And we already see that. There is opportunity to do remote fittings or adjustments through some apps on our phones and the patient's phone. It's difficult to answer if the current model is still working. But the market appears to be dictating a more on-demand style of service where remote fittings may even eventually become remote evaluations and more as 3D printing. So that's an interesting concept. You know, 3D printing, you can print a hearing aid. Can you print it in your home? You know, why not? I mean, the possibility is there. So certainly technology is answering some of this. But let's keep the answers, again, in how we can maybe, again, address these issues. You know, again, this is a modern solution to these challenges that we can have and keep our skills, our expertise, and our experiences within our realm. But it does mean adapting to a new way to think, how we think about providing services, how we deliver those services and treat the patients. I mean, it's a very different approach. But telehealth is a benefit to hearing care. It's very convenient. It's efficient. And it gives quality care. Again, if done appropriately, I'm sure there's opportunities where that may not happen. But if done under the appropriate guidance of a skilled team with appropriate recommendations and training, you know, you're preserving that quality care that we all want to do. There, you know, we have staffing issues. That's just another. And I'll show elaborate on that a little bit later. But separation from competition, you know, if technology is it, we need to get on the bandwagon with that as well. Again, providing more access to care and concierge care. You know, this is a sometimes as a clinician, we're in the office and we're bombarded with maybe a lot of service appointments, but we know we have maybe a hearing test coming up in a few minutes. And you know how patients, some are chatters, right? And they want to chat and we want to give them that time and care. But sometimes it's just not possible. Well, with telehealth, you can schedule that. You can schedule the services, the troubleshooting, all of those hand-holding elements that we enjoy, but we just don't have time sometimes to do it or it may overrun our schedule and not allow us to see a new or existing patient who requires us to fit them with hearing aids because they have the hearing loss. So this is all the very wow experience and patients do have a wow experience. So this is just one model of how telehealth is used. I'm going to show you a video later on. You'll get a very good perspective about that. But so, you know, how else can this be done? Not only is it a video conferencing where you see somebody on the big screen, but you can really perform every test and service that you would in the, quote, knee-to-knee environment with that patient. Video autoscopy, tympanometry, acoustic reflexes if you wanted, inserts, using inserts or circumoral headphones for the test, bone conduction, calibrated speech testing, hearing aid fittings. Here's a speech mapping example, all done remotely, meaning the provider is in a remote location or away from where the patient is. The only things that you cannot do, which makes sense, right, is obviously at this point, we're not removing cerumen from a remote location, but I wouldn't put it past technology to address that. And ear impressions. Again, we can't do impressions ourselves remotely, but with 3D printing coming, don't you envision a scanner that can scan the ear and impressions will no longer be needed? And I believe that's not too far in the distant future. So those questions, those small challenges are definitely going to be answered with technology. And what some of the equipment that we have used, you know, we, you can really tailor make a beautiful report. Again, very professional with, this can be customized to whatever you would like, whatever you want to display on your report. We choose to put the pictures of the video autoscopy on there, because when it's done with telehealth, you want that evidence that we've done our due diligence to be assured that that patient's ears, whatever condition that they're in, whatever we are reporting on, that it's visible, right? We show it. We have the proof that these were the outcomes. Test, retest, reliability. Absolutely. So in this particular scenario, and this is a real patient getting really tested by one of our team members, our remote providers, Dr. Lydia Gladwin. And she, so this was last year's test of this patient. Yep, about a year ago. And then this is this year's test. So you can see, very nicely matched. Of course, the right ear went down a little bit. I don't see bone over here. You know, I don't really know, but that's not unusual, right? From year to year. So certainly the quality of the test environment, the quality of that patient responding, everything is the same as if the provider was physically doing, testing that patient in the same office. So I did mention that we would have some scenarios that this might work out and be a solution for you. These are just a few, but we know that, you know, as a profession, you know, maybe we own clinics and we are looking forward to retirement. So, you know, this would be a way where you don't have to back out of being involved in the clinic for so long, or you don't have to back out like abruptly. You can actually work from home and still see your patients and maybe gradually back out. Or you want to grow the practice and there are provider shortages or perhaps schedules. Some are part-time providers. You know, how can I grow my practice? The resolution, absolutely telehealth. What about if you're going to get new equipment? I do mention, I'm a firm believer that if you are looking to invest in equipment, either to replace or to start anew, please look and make sure that they're going to meet a future need of telehealth. Maybe you're not going to do that today, but you will definitely be doing that in the not too distant future. And you don't want to be sort of financially constrained with equipment that may not work in that environment. So, and so just a lot of different good uses here. So, let's talk about some business smarts for those that might travel and have satellite offices. I know plenty of scenarios where there's a main office and maybe a couple of satellite offices. You know, how much is that taking out of your time, out of your productivity, whether it's yours or your staff? Well, we can certainly do the math. And if you've got a provider, depending on salary status, and you calculate, you know, how many eight hours, you know, how many miles they have to drive and how many hours is that going to take? And it comes out to about $34 an hour lost as they're traveling. And then the mileage that has to be reimbursed. And then what about just even when they get there, do they jump in and start to see patients? No, I'm sure there's some adjustment period. Then, of course, there's a lunch hour and then the driving back. So you're looking at how much of a day is spent on sort of that, you know, just that time that could, instead of losing, you know, some lost revenue, even just for an hour, can be gained because there is no travel. You don't have to do that. You have a technician on site with the patient. And that does vary from state to state. Again, it's very state specific on who can be with that patient. What are the qualifications for someone to be with the patient? But the remote provider is not having to be there. And so you just jump right on and start your day and start your schedule. And so the efficiency and the increased ROI is obvious. Now, we spend a lot of time, again, as mentioned before, providing services, right? Or just seeing walk-ins. And what is that doing to our schedule? So just a couple of sort of examples here. In one scenario where we have telehealth implemented, over here on the right hand side is the telehealth schedule. And the telehealth provider, we're remoting in, okay, she's not on site, happens to see all of the services. So they, not maybe all, but a lot of them. Maybe your annual checkups, maybe your, you know, just routines or your troubleshootings or your hearing instrument fittings and those sort of things. So that you want to be sure that if you are, in this particular case, let me back up a little bit. Sorry, went a little farther. Here we go. So in this particular case, the providers on site want to see these, the new patients, right? So in this example, these color-coded appointments are the new patients while the telehealth provider is seeing sort of the non-revenue. And certainly when you compare side-by-side how much revenue is being generated at the same time, there certainly is a dollar value that makes that very viable to make an efficient schedule. So now what I'm going to do is treat you to a wonderful video. This is about the provider's perspective. And I just have to do some stopping of my screen and showing of the video. I hope you'll enjoy it as a provider and patient perspective. Okay. Excellent. So, I'm hoping that you're back to seeing my screen. And we're going to continue. And I apologize if you are listening to this on a telephone, you might not have heard that audio. That's just something that happens with video conferencing. So, just wanted to apologize for that. But the link will be up in the website at IHS. And that'll be up for you to view it, actually, if you wanted to review that at some other point and you'll get the full audio and video. But just some, again, some comments, very positive outcomes that people really do like it. Have we had somebody say no? Yes. And certainly patients have that opportunity to not participate. But very positive, they think it's high-tech and they're really glad that their provider is doing something high-tech. They find it very fascinating and comforting that somebody's cutting edge. So, definitely some positive outcomes, for sure. Just a few, a couple of more slides and then we'll have some questions and answers. But the Center for Telehealth can be anything, customized to any need, any room, in a booth, out of a booth, quiet room, rolling cart, just depending on what need there is and how the expansion or revision of a site wants to accommodate this, the possibilities are endless. We certainly advise and counsel on how that should be the best for you and for your patient to assure that quality care. The support team and I, what we do is we definitely develop procedures and protocols. We assure that regulatory requirements are met, site requirements, other things, such as even how the staff interacts. We do teach that. There is a skill. How do you engage a patient on the big screen? Our stage presence, as we say. And then minor troubleshooting strategies. What happens if something happens? What do you do? And, you know, it's just a lot, it's all encompassing that we do and we provide as a team with YHN to assure that this is a success for everyone. And so, just winding up, we certainly can do some business planning. We will take, I mean, this is just an example of some average hearing aid costs and warranties and how, you know, what kind of revenue can be generated, I mean, just as a sample. And you can see how really the ROI is very cost efficient in a quick amount of time. So we can do that individually for you just by taking some data from you. And, you know, this is the future. And if we're going to be competitive, if we're going to be a player in helping to see these patients that are going to be expanding in their base and need, we have to come up with some great and quality and reliable methods that can resolve that challenge. And this definitely is an answer. So right now, I thank you all. And here are some references. And I believe we are going to have some time for some questions and answers. And I appreciate having this opportunity to discuss this wonderful modern method of service delivery. So I'm going to... Yes. Great. There we go. Thank you. Thank you, Suzanne. We're so excited that 150 of your fellow colleagues have joined us today on the webinar. We do have some time for questions. So if you have a question for Suzanne, please enter it in the question box on your webinar dashboard. Our first question is from Jessica. And Jessica wants to know, do patients have to agree to be seen through telehealth ahead of time? Great question. Yes. So there are a lot of states, many states, I'm not going to say all of them, but many states require a consent, right, from the patient. And we have developed what that language is. It's really a simple paragraph to be added onto a patient information form. It's like they would sign everything else and they understand confidentiality and compliance and all of those things. This is another paragraph that is added that when they sign, they are giving consent to participate in telehealth. They certainly can opt out. And certainly if a patient does not want to participate, we're not going to force them to do that, right. But there is an opportunity for them to consent to this method of service and... or to opt out. So thank you. Great question. Great. So another question we have is, how does, Carol wants to know, how does licensing work if you are seeing a patient in another state? Okay. Yes. So licensing is still the same as if, again, knee to knee. So the provider can be anywhere, but they must be licensed in the state where the patient resides. Myself, I have a license in Florida and Ohio. So I can be at my Florida office and help see patients in Ohio. And so we do that where you have multiple licenses in different states. And for now, that is a requirement. As I had mentioned before, other entities are getting interstate sort of licenses or being able to do that in the other professions. And there's like a co-op kind of a thing. And I envision that that will happen with audiology or hearing instrument specialists as well. So that's going to come down the pike. But for now, you must be licensed in the state where the patient physically will be. Thank you. Great. Thanks, Suzanne. We have another question from Christine who wants to know about the setup and the equipment and where you can get it and what kind of training is available for that. Awesome. Great. So right now, we, YHN, we have a tele-hearing care department. And myself and my team, we provide all of that. We provide the counseling or the guidance, doing a site review, really customizing what your plans are, what you would like to achieve, doing a financial plan, and then really discussing what you would need as far as equipment. It can be, it's very different. Right now, we work with two manufacturers of equipment. We work with InterAcoustics and MedRx. So we have some nice selections there. And we also provide the training. We provide the training of the staff. We have that all laid out. So everything can be taken care of through us. Great. Okay. And we have another question from Andrea. And she wants to know, is this also available for hearing instrument specialists or just audiologists? So it is, again, state by state. So it just depends on the state's writing of their rules. But definitely, there are states where both professions can provide this service. So I can't just say yes or no. And that's something that we do, again, upon consultation. You know, we would go through that and really look at the rules and regs of your state. Perfect. We have another question from Kevin. And he wants to know, what happens if the Internet goes down during telehealth or the power goes out? How do you continue with the appointment? Okay, yes. Well, that's, you know, I guess that could be a concern. I mean, fortunately, with today's Internet, it doesn't happen too often. But I guess if you were in an area where it might not be as reliable, that could be a concern. Again, I say, what would you do in your own office when you're with a patient and the electricity goes out or your Internet goes out? Sometimes, you have to reschedule that patient. So it's no different. We try to do what we can do, giving those challenges. And maybe we're unable to complete the whole appointment, but we reschedule the patient. And again, not any different than if it would have happened in your own office, you know, with a patient. So pretty much treating it the same way. Thank you. Great. Okay. We have quite a few more questions, so we'll keep going for a little bit. Can you explain briefly the laws and rules as far as the licensing and how many licenses you can hold? Well, to my knowledge, there's no maximum amount of licenses. I do know of some people that are licensed in all 50 states. So that is a possibility. I would say there are certain things that makes that a little easier, because many states have what's called reciprocity. So if you're licensed in one state, it's fairly just about paperwork and documentation to get licensed in another state. But things that do help you with that is if you are, for instance, BCHIS, so board-certified, I think all states would recognize that in reciprocity. And on the audiology side, if you have your AUD, that helps. Again, most states require an AUD now, right? So it just depends, again, state to state, but it's quite easy for the majority of states. It's just a question of documentation, getting things transferred from one state to another. So, yep, not really a big challenge. Great. So we have a question from Deb, and Deb wants to know, what training is needed and required for the telehealth audiology assistant? Okay, great. Yes. So, again, it's state by state, right? So each state may have or may not have some rules and regulations regarding audiology assistants, or sometimes they call them audiology aides or hearing care aides, or they don't address it at all. And from a telehealth standpoint, they just require a facilitator. So there's all these options on where that person might fit in. And so, again, we would advise on what the state needs, and it would just be whatever their state would allow and dictate for that. For instance, in Florida, we have a situation where supervision isn't an issue because our provider that is a supervisor is still able to supervise that assistant, but the telehealth person can work with that assistant as well. And so there's ways to really accommodate any state's scenario. So, very good question. Great. And we'll do one more, and Rob wants to know, in the examples you showed for providing remote services, it appears the patient went to a specific location where testing equipment was, but not the provider was present. How does this scenario change or limit the scope of services when the patient is at home? Yes. So the at-home testing, at least in our model, because of all this, you know, you think about the equipment and bone conduction, we don't do an at-home model. But what we do do is we have a mobile cart, right? So theoretically, you could take the equipment, because that's really sort of that challenge, right, is having all the necessary equipment with you. And doing that and having the assistant bring a mobile cart to, for instance, we have some clients doing this in sort of assistive living or independent living communities where the assistant is the one bringing the cart and the remote provider can be at their main office and provide that, you know, the actual services, the actual testing and the counseling or the fitting or whatever it is. But our answer to reaching more and providing that access if there's mobility needed would be a mobile cart version. Perfect. Thank you so much, Suzanne, for an excellent presentation and all the questions and answers. And thank you, everyone, for joining us today for the IHS webinar, Telehealth, Expanding Access to Hearing Care. If you'd like to get in contact with Suzanne, you may email her at suyo at yourhearingnetwork.com. For more information about receiving continuing education for this webinar through IHS, visit the IHS website at ihsinfo.org. Click on the webinar banner or find more information on the webinar tab on the navigation menu. IHS members receive a substantial discount on CE credits. So if you're not already an IHS member, you will find more information at ihsinfo.org. Please keep an eye out for the feedback survey you'll receive tomorrow via email. We ask that you take just a few moments to answer a few brief questions about the quality of today's presentation. Thank you again for being with us today, and we'll see you at the next IHS webinar. Thank you.

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