JCPSLP Vol 21 No 2 2019 DIGITAL Edition

Ethical conversations

Mobile service delivery and ethical issues Susan Block, Tristan Nickless and Richard Saker

W ith changes to practice of service delivery now including increased private services and with many of these services being mobile services in a range of settings, it is timely to alert members to some of the issues arising. It is also important as more new graduates move into this mode of delivery that they are aware of the range of ethical considerations before they provide mobile services. In this ethics alert, we are discussing the ethical considerations most pertinent to speech pathologists offering mobile services, or services not always provided from one treatment centre. It should be confirmed from the outset that all matters relevant to providing services to any speech pathologist’s client/patient will of course apply to speech pathologists providing mobile services. In general, we suggest the main issues for consideration fall under the following areas: legal, insurance, taxation, data storage, terms of trade, other. Part of an ethical and professional speech pathology service is to include some or all of the following in a practice’s policy and procedures manual. Legal It is necessary to check and confirm in writing with Medicare and/or private health funds, etc., that such “mobile” services as proposed are lawfully billable (i.e., if delivered from a mobile location such as a clinic, vehicle/ mobile consulting room or client’s home or nursing home site, etc.). Provider number status may not always be straightforward. Both entities like to have different provider numbers for each location where service is provided. However, this may be difficult with mobile service providers as location may vary from day to day. Written permission and authority (i.e., a memorandum of understanding) from third party, e.g., schools, to use facilities for such purposes as professional speech pathology services is strongly recommended. There may be some situations or locations where service may be provided but may not comply with local or state planning by-laws or regulations regarding safety, zoning regulations (i.e., home- based businesses exceeding the number of practitioners permitted; use of industrial zones that do not support health services etc.). It is strongly recommended that service providers contact local government authorities to confirm allowable use as per the planning scheme. Required safety checks, such as Working with Children (WWC) checks, usually require the confirmation of the location/s where the service provision is provided. Care

needs to be taken to ensure all the locations are included (e.g., education; early intervention; disability services, etc.). Insurance Public liability must be considered carefully. There are many scenarios where professional speech pathology services use consulting rooms from third parties. Ensuring that there is adequate insurance and that insurers are notified of the “mobile” nature of the service is important. There may also be legal issues around subletting facilities from other tenants. Legal advice is highly recommended. Other insurance considerations include car insurance – i.e., notification to the car insurer that the car is used primarily for business services as opposed for personal use. Professional indemnity insurance usually also requires the specifics of the location of service provision. It is important to ensure that the practice locations are all covered by the appropriate insurances. Communication with insurers including honesty of service provision locations will ensure that if any claim or action is taken, the policy contains current and contains truthful information. Taxation Taxation considerations include evaluating legitimate claims of travel costs – e.g.,”Where do travel claims start and end?” – are vital to operating an ethical, mobile practice. Claims for transportation costs can include such factors as fuel, servicing of vehicle, wear and tear, keeping a logbook etc. and parking costs. Accurate records are essential. Data storage Storage and transportation of files requires careful consideration. Moving between sites where there is no secure file storage is problematic. Where speech pathologists use electronic storage of information/data/ – i.e., if using server-based storage – consideration needs to be given to issues such as where the servers are located – overseas or in Australia? This has implications around transborder flow of information as per the Australian Privacy Principles. Communication to clients via a privacy statement that explains how their sensitive health information is stored is a legal requirement under the Privacy Act 1998. Care also needs to be taken with the security of local electronic data storage – is it on a dedicated computer, is it password protected, where is the backup?

Susan Block (top), Tristan Nickless (centre) and Richard Saker

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JCPSLP Volume 21, Number 2 2019

www.speechpathologyaustralia.org.au