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TELEHEALTH, Physical Therapy  Not The Mismatch That Was Once Imagined

Feb 9, 2021 3:42:02 PM

Is it even remotely possible that a hands-on profession like physical therapy can be effectively administered via telehealth? Contrary to previous long-held beliefs, the answer in many instances is yes.

BIGGEST BARRIER: LACK OF TECHNOLOGY 

Until the COVID-19 pandemic began wreaking havoc on practices nationwide, “teletherapy” was barely a blip on the physical therapy radar screen. Prior to 2020, arguably no other healthcare specialty offered fewer telehealth solutions to their patients than those in physical therapy. 

Consider two 2020 surveys conducted by the American Physical Therapy Association, which found that only 2% of all pre-pandemic practices were providing any kind of video consults. 

The major barrier? Surveys say Inadequate technology. That includes 29% for patients and clients who lacked the technology to access telehealth. However, it also includes 16% of providers unequipped with telehealth software. At a combined 45%, the next biggest barrier was the catch-all “other” category at 31%.

What about payer reimbursement? Isn't that a bigger barrier than technology? Until the CMS relaxed regulations in response to the pandemic, 17% of survey respondents identified that as their biggest obstacle. 

But again, until the pandemic, these numbers would have raised few eyebrows. Under what circumstance would physical therapy providers ever need telehealth? And even if offered, would patients ever go for it?

These were legitimate questions. Little could anyone have imagined what was to come.

TRANSITIONING TO TELEHEALTH For Physical Therapy? HERE'S A CHECKLIST

“Physical therapy initially wasn’t identified as a profession that was allowed to provide telehealth,” says Marissa Muccio, a New Jersey-based physical therapist who specializes in adolescent idiopathic scoliosis. But as patients canceled, practices closed (temporarily or permanently), and revenue dropped, that perspective changed virtually overnight.

The pandemic crushed a lot of practices and forced a lot of hands. Was telehealth the answer?

Between the time of APTA’s initial April-May survey and its second survey in July, the number of physical therapy practices implementing telehealth solutions spiked from 2% to 47%. Though pandemic-inspired, this swift 45% spike didn’t happen without some fortuitous preparation.

“It has been in the works on a national level for quite some time,” says Muccio. “The Federal State Board of Physical Therapy actually had telehealth policy recommendations in place for quite a few years. This virus just catapulted that.”

But before jumping into telehealth, consider these APTA recommendations:

  • Know the physical therapy licensure law and corresponding state licensure board rules and regulations for your state.

  • Contact your state licensure board to ensure no limitations or restrictions for telehealth practice exist.

  • Review telecommunication modalities.

  • Consider federal and state legislation and regulations pertaining to your practice.

  • Be aware of billing and coding issues.

  • Know hardware and software requirements.

opportunities and limitations exist

Telehealth inherently enables the reach of your practice to expand not just within your community but to extend well beyond state borders.

“Historically, PT licensure was state by state, and if you wanted to practice in multiple states, you needed to hold that PT license in each of those states,” says Muccio. The FSBPT interstate licensure compact for physical therapists “was a response to the need for PT services to be more flexible – to be able to cross state lines in a collaborative type of way (while) still maintaining the foundations of licensure and insurance and consumer safety.”

The compact currently includes 29 states. Five others have pending legislation in 2021.

“It’s been a really interesting professional evolution – the logistics of it – and it’s definitely got its pros and cons in our field,” says Muccio. “There certainly are limitations. Obviously, anything that definitively requires hands-on, you either have to assume some type of modification, or in some very specific cases, those patients either need to be moved back to a single direct-treat or that component is left out of the plan of care.”

Even within those limitations, however, the introduction of telehealth has proved to be a welcome reprieve for struggling and desperate practices and the patients who were able to benefit from their virtual therapy sessions. With it, providers are still able to:

  • Analyze patients’ movement, range of motion, and limitations to determine at-home exercise routines and therapy programs.

  • Use Zoom or Facetime cameras to instruct, review, and correct patients as they practice their exercises.

  • Share videos to aid in the instruction of exercises.

BETTER FOR YOUR PRACTICE AND PATIENTS

For recovering COVID-19 patients, telehealth isn't just about convenience. Often bedridden, isolated, and/or quarantined, it's become their best solution for getting them back on their feet.

Meanwhile, a largely unexpected benefit of telehealth sessions is the active, physical engagement of patients who'd previously been so reliant on manual therapy for their rehabilitation.

"Many of us can attest to the fact that too much manual therapy makes our patients dependent upon us, when what they really need is to be up and moving," advises a post in The Non-Clinical PT, a career resource website. "As patient education and pain science are increasingly influencing our treatment choices—and ineffective treatment modalities are falling out of favor—we PTs are finding that our role as movement experts relies less and less on patients being physically in the clinic for treatments."

Other benefits include:

  • Patients are less likely to miss follow-up appointments, more likely to complete treatment plans because of time flexibility and convenience.

  • Less delay for appointments, especially when simple guidance or exercise prescription is all that’s required.

  • Less travel is required for post-hospitalization care.

  • More and quicker virtual visits, along with fewer missed appointments, means more revenue.

IF YOU DON'T HAVE A PLAN, MAKE ONE

Unfortunately, of the 5,400 PTs and 1,100 PTAs who responded to the APTA survey, only 30% had emergency preparedness plans in place before the pandemic. Telehealth technology, the APTA notes, enabled the treatment and advice to patients "who might otherwise might have gone without care during the public health emergency."

The APTA has since recommended that providers develop long-term telehealth strategies that entail a full understanding of evolving regulations and best practices to ensure patient safety, privacy, and quality of care. 

"Some patients — especially those who live in rural and remote areas and those with underlying health conditions — will rely on physical therapy services delivered via telehealth," the APTA says. "Patient access to physical therapy via telehealth must continue beyond the public health emergency.

Shopping for telehealth for physical therapy? Other features to consider

If you're in the market for a physical therapy software system with telehealth functionality, here's a checklist of other features it should include:

Exercise flowsheets:

These are prescribed exercises that are specific to the patient and their type of injury. Instantly accessed in a click, they provide tracking, charting, and documenting workflow efficiencies that include:

  • Listing the number of reps and minutes for each exercise, and whether they were performed independently or with assistance.

  • Automatically attaching CPT and procedure codes to exercises that carry over from one appointment to the next.

  • Documents progress on charting sequences which can help identify the best and least effective exercises.

  • Track long- and short-term goals over time.

  • Carryover patient history and records, and provider notes to each new encounter.

Patient portal:

A huge time-saver for front-office staff. A dedicated patient portal enables patients to access, complete and electronically sign pre-appointment forms and documents online, thus eliminating the need for paper-to-digital data re-entry. Also enables staff to send appointment reminders, referrals, and fill e-prescriptions while serving as a line of communication between provider and patient.

Billing:

Let's say you have 25 appointments tomorrow. How great would it be if each patient's insurance eligibility could be automatically verified before you arrive at the office in the morning? It can be that fast and simple on software with HCFA 1500 and UB04 billing integration. Meanwhile, patients can access and make payments through the portal. 

At InSync Healthcare Solutions, all of these features - telehealth, exercise flowsheets, patient portals, and billing - are part of a fully integrated, interoperable Physical Therapy EHR system that can keep your practice up and running through COVID-19 or any future public health crisis. Pandemics aside, its growing acceptance and popularity among patients can help increase your bottom line.

To learn more, schedule a demonstration today and a specialist will prepare a custom presentation for your physical therapy practice.

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To learn more without scheduling a demo click the button below to take a brief video tour through the InSync Physical Therapy software.

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Andy Smith

Written by Andy Smith

Andy brings his passion for writing and editing, along with decades of experience, to research and compose stories that keep healthcare InSync. His articles take a deep dive into the trending and relevant issues of mental health, interoperability, physical therapy, speech therapy, substance abuse treatment, and CCBHC's - bringing clarity to the effects of emerging technology and Electronic Health Records on today's top healthcare stories.

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