"What is Telehealth?" is a question that echoes throughout physical therapy clinics across the country. The truth is that telemedicine has been around for decades. Still, in the last five years, it has grown exponentially, and in many cases, is the first line of contact with a medical professional for patients seeking health care. The benefits of telehealth are copious; streamlined reimbursement, practice efficiency, reduced no-shows and cancellations – but the question remains, how does this form of patient visit fit into a physical therapy practice model?
The general attitude among DPTs and PTAs is usually, "I use my hands; how do I do this through a virtual experience?" Physicians are feeling pushback from their current caseloads as well. Hands-on healing is the expertise of a physical therapist and converting this model to a telehealth visit can seem impossible. If you're a solo physical therapist right now, and you're trying to navigate telehealth for the first time, it's overwhelming.
To begin implementing telemedicine in your clinic, the first thing you will need to do is sit down and talk with your team. Ensure that everyone is on board, answer their questions, and decide on messaging; how to tell both patients and referral sources that you are implementing this type of therapy.
One tip from Tim Richardson, PT, and Franchise Regional Consultant, "Don't call it telehealth, instead say 'Throughout our therapy, we may do a video call, a phone call, or an office visit. Your patient care plan could comprise many different elements. Informing the patient and shaping that message is key to adoption of telehealth by your patient population." Next, evaluate your existing patients and determine who telehealth is appropriate for and who it is not. Have a plan to discuss why telemedicine is suitable for that patient's care plan and show them the value of this method.
Telehealth visits will be most appropriate for patients who will improve when the focus is on the exercises and posture. The therapeutic and rehabilitative care strategies are taking center stage. At the same time, the more hands-on modalities such as laser, massage, and ultrasound cannot be replicated in a telehealth setting. Peer-reviewed research and evidence prove that telehealth visits for physical therapy are as effective as office visits. There are definitive functional and pain improvement outcomes. Clinicians at FYZICAL clinics say they see improved outcomes, patients are happier because they are still getting better, there is no drive time, and they are seen from the comfort of their own homes.
You may be wondering, as clinics bring more patients back to the physical facility, does having telehealth opportunities still make sense? Telehealth is here to stay; regulatory billing codes, rules, regulations, and statutes have passed. PTs will continue to perform telehealth visits; commercial providers will continue to reimburse for them. Long term, there are considerable advantages to telehealth. Patients are already realizing how convenient it is, and it will become a new line of business. For instance, the initial triage visit could become a phone consult that lays the groundwork for a varying care plan that encompasses a combination of in-person office visits and telehealth visits. A filtering process will develop over time to determine who is seen in person and who can be helped from home for which appointments.
Telehealth also increases accessibility to people who may not otherwise have time, transportation, or the ability to access services face-to-face.
The legislation adjustments made because of COVID-19 helped cut through much of the red tape around telehealth by adding PTs to the list of providers whom insurance will compensate. Private practice owner Mike Teater of Camas, WA, helped lead the charge to adopt telehealth as a private practice Telehealth Taskforce member. He shared several vital insights for PTs who are considering adopting telehealth into their clinics.
Mike: If someone is sick and can't come into the clinic but can access our services from home – they can stay on track with their care plan. If a patient is traveling or vacationing [in-state], has a sick child, or needs to cancel because they can't make it to the facility – these are all ideal scenarios to convert to a virtual visit. There are many applications to improve accessibility to patients and improve clinic metrics. It also helps reduce cancellations and no-shows in the clinic because travel time is no longer a factor for those who "just forgot" or would love to fill a spot-on short notice.
Mike: To be effective, you'll need digital consent and release forms, digital intake forms, a HIPPA compliant email account, and a laptop. Then, you'll need to select a telehealth platform. I piloted five different telehealth platforms to see which worked the best. Some didn't perform smoothly, some were difficult to navigate, or had lots of bugs and glitches in the software because it is a newer offering. Many available programs are still in the alpha or beta testing stages. My research pointed me to two platforms. I favored: Doxy.me and Medbridgeeducation.com. However, FYZICAL reviewed many additional platforms and has provided insight into the pros and cons to consider when selecting the right option for you. If you don't have the input of an organization like mine to fall back on, start by checking out virtual therapy platforms within your existing EMR solutions compatibility.
Mike: Many providers notify clients via email only. If you feel your patient base can operate in this methodology, you will have no problem. I found that my patient base's level of IT knowledge had varied widely, so SMS Text was a feature I needed to be successful. Make sure you have a program that is effective for the initial visit and the follow-ups. For example, I love the convenience of Doxy.me, and its text capability. Still, it did not store patient information in the program, which meant I was constantly performing manual lookups. It also did not integrate with the exercise program.
Before you settle on your platform of choice, make sure the time you save on the front end isn't lost on the follow-up visits. And… You've Got to Know How to Implement! Know your regulations, codes, and modifiers. Set up your EMR to apply these codes and modifiers. Know what is eligible for reimbursement and be aware of any restrictions for each insurance company. Get that infrastructure in place!
Telehealth is here to stay, so make sure you're prepared. Here is a cheat sheet to make sure that you are ready to implement telehealth into your practice:
1. Know the Benefits: Be sure you can articulate the benefits of telehealth to your team, your referral sources, and your patients. If you don't honestly believe in the program – your constituents will not accept it either, or participation will suffer.
2. Acquire the Necessary Tools: To be effective, you'll need digital consent and release forms, digital intake forms, a HIPPA compliant email account, and a laptop.
3. Select a Platform: Consider the EMR compatibility, ease of use, cost, and if available, rely on organizations that have tested multiple platforms to determine which is best for your practice.
4. Determine the Messaging for Introducing Telehealth: You must be able to tell both patients and referral sources that you are implementing this type of therapy. "Don't call it telehealth, instead say, 'Throughout our therapy, we may do a video call, a phone call, or an office visit. Your patient care plan could be comprised of many elements'. Shaping the proper understanding and expectation is key to the adoption of telehealth.
5. Train Your Team: Start by allowing them to practice on each other and then move to current patients that have already built trust and rapport.
6. Have a Discussion Plan prepared for patients that helps them understand why telemedicine is appropriate for their treatment plan. You'll need to gain the agreement of value for participation.
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