When it comes to telehealth physical therapy and outpatient rehab, Alaska’s nickname “The Last Frontier” should more aptly read “The First Frontier”.
A few weeks ago, Alaska Governor Bill Walker expanded the use of telehealth for licensed audiologists, speech language pathologists, physical therapists and occupational therapists. This reform unfortunately did not require insurance companies to actually pay Alaskan PTs, OTs and Speech Therapists for delivering treatment remotely. But hey, progress is progress and compared to other states, Alaska just took one tundra sized step towards embracing the remote delivery of therapy.
Alaska’s healthcare reform could not have come soon enough. If widely adopted, telehealth could help solve the most challenging problems of our current healthcare system: access to care, cost effective delivery and distribution of limited providers.
Why Telehealth Matters to Your Clinic
According to the American Telemedicine Association, telehealth, sometimes called telemedicine, is the remote delivery of healthcare services and clinical information using smartphone apps, video conferencing, traditional telephone audio, remote device monitoring and other media.
What some see as a clever use of two smartphones, many see as the future of healthcare.
The utilization of telehealth services will increase from 250,000 patients in 2013 to an estimated 3.2 million patients in 2018. The Veterans Health Administration delivered over 300,000 remote consultations using telemedicine in 2011- and that was five years ago.
Evidence of the clinical value of telehealth in physical therapy is emerging. A 2011 study published in the Journal of Bone and Joint Surgery reported that the outcomes achieved via telehealth at six weeks following total knee arthroplasty were comparable with those after conventional rehabilitation.
Telehealth is not only of clinical value for outpatient rehab therapists, but also a means to remain financially independent in a changing healthcare environment. The Medicare Shared Savings Program will reward accountable care organizations (ACOs) that lower health care costs while meeting performance standards on quality of care. If properly constructed, a full-service telehealth network would provide the foundation for a successful ACO.
As goes Medicare, so goes Telehealth
In the past, telehealth’s promise to expand care delivery was limited because of low reimbursement and physician support. Some would add poor implementation to that list as well.
But Medicare’s tentativeness about telehealth is inarguably a primary factor impacting its market adoption. For starters, Medicare does not cover telehealth for PT, OT, Audiology or Speech Therapy.
In certain situations, Medicare reimburses for telehealth services for covered treatments. But patients must reside in a Health Professional Shortage Area or far from any area with high population density and present at “a clinical originating site.” In other words, they must still drive to receive care.
Medicaid patients who could benefit from telehealth are not that much better off. Almost every state’s Medicaid plan specifically covers at least some telehealth services, however states vary greatly in their coverage. State-specific information is available on www.atawiki.org and the 50 State Telemedicine Gaps Analysis: Coverage and Reimbursement.
Where does that leave patients? Outpatient rehab therapists say it leaves them grossly under served.
More Obstacles: Licensing
The majority of occupational therapy and physical therapy boards are silent on telehealth- therefore stymieing attempts for PTs to seek reimbursement. A handful of physical therapy laws and regulations address “consultation by means of telecommunication,” but do not provide any guidance for practitioners seeking to provide direct telehealth-delivered services to patients.
States that do have applicable laws or regulations vary widely in their approaches. For example, a small number of state occupational and physical therapy telehealth laws and regulations hold OTs and PTs to the same standard of care whether services are provided in-person or via telehealth, thereby maintaining patient safety.
- Illinois incorporated telehealth into the definition of occupational therapy.
- Similarly, Mississippi’s physical therapy administrative code includes telehealth under the definition of “practice of physical therapy”.
Other states limit telehealth-related regulations to the provision of consultative services, like Washington. A few states have more restrictive telehealth laws or regulations, requiring OTs and/or PTs to comply with standards above and beyond the normal standard of care. This approach often acts as a barrier to telehealth utilization.
Early Telehealth Use in Outpatient Rehab
Due to the multitude of reimbursement and state licensure issues detailed above, adoption of telehealth by PTs, OTs and speech pathologists has been sporadic. Examples of special circumstances in which physical therapy is being delivered via telehealth technology are few:
- Indian Health Services in Alaska uses telehealth to provide PT to very remote patients.
- Michael Billings, PT, MS, CEEAA, of Infinity Rehab, a Clinicient client, uses telehealth to supervise remote patients in the state of Washington that receive care from physical therapy assistants. Physical therapists, which there is a shortage of in remote areas of the state, are required to supervise every 5th visit. Infinity Rehab successfully lobbied the state PT board for permission to use video for this supervisory visit.
- Archbold Medical Center in Thomasville, Georgia, uses telehealth to reach patients in very remote parts of the state.
This rigid and fragmented telehealth regulation is the reason why the US is far behind other countries in telehealth. Therapists in Canada, New Zealand and Australia aren’t bogged down in fragmented licensure restricting the use of telehealth.
As telehealth becomes more critical to meeting the needs of those newly insured as a result of the Affordable Care Act, state physical therapy and occupational therapy boards must ease licensure requirements for the delivery of telehealth – and payers must follow suit as well. After all, no one wants to be the last frontier of telehealth.