This article about using telehealth in physical therapy practices was written by Marla Ranieri, PT, DPT, OCS, Chief Development Officer at BetterPT
The pandemic changed how and where individuals connect. From celebrating birthdays via Zoom to using QR codes to access restaurant menus, people increasingly adopted new technology.
During the earliest stages of the COVID-19 pandemic, telehealth became a vital resource for medical professionals to continue caring for their patients, particularly when they couldn’t meet in person.
Adoption of telehealth exploded as a result of social distancing and public health restrictions. Half of all physical therapy sessions this year were conducted virtually!
Now, several months into the pandemic, there is still much uncertainty about the future of telehealth in physical therapy.
Many clinics were forced to quickly implement telehealth when the pandemic restricted in-person appointments. What worked initially, though, might not be the right choice for long-term use.
As we approach 2021, it’s important to review the state of telehealth for physical therapy practices, including the current regulations and reimbursements, as well as the best practices for providing telehealth services.
The Current State of Telehealth for Physical Therapists
Telehealth access expanded into physical therapy practices as a result of the public health emergency. By and large, we continue to operate under these temporary regulations.
In March, the CARES Act provided legal authority for the Department of Health Human Services to temporarily waive restrictions to add physical therapy to the list of temporary authorized providers of telehealth for Medicare.
The CARES Act also allowed the Centers for Medicare & Medicaid Services (CMS) to temporarily add physical therapists, occupational therapists, and speech language pathologists to the list of providers eligible to offer telehealth services.
It’s important to remember, these changes in telehealth policy are largely temporary. The public health emergency declaration was most recently renewed for 90 days effective October 23, 2020.
Best Practices for Providing Physical Therapy via Telehealth
Telehealth is a valuable tool for physical therapists, particularly while many of the areas of the country maintain strict social distancing and indoor capacity restrictions.
Before you begin providing virtual sessions, consider the following.
- Safety and security of telehealth technology
- Informed patient consent
- Protecting patient privacy
- Abiding by HIPAA regulations
- State and local laws and regulations
Currently, the CARES Act exempts Telehealth providers from HIPAA compliance. However, when the public health emergency expires, HIPAA enforcement as it relates to remote communication technology will resume.
It’s important your practice implements a safe, secure, and HIPAA compliant telehealth platform.
As a physical therapy provider, it is always essential to know exactly what you can and cannot do when it comes to treating patients.
Is Telehealth Physical Therapy legal?
The answer is yes. Whether your clinic adopts a hybrid model or you’re considering going virtual full-time, physical therapy professionals must be careful and competent when working with patients.
This means keeping clients and their information safe, as well as following other guidelines for care. These guidelines are outlined in the APTA Code of Ethics and The Federation of State Boards of Physical Therapy.
The safest way to ensure compliance and protect yourself and your practice is to stay up to date on changes in HIPAA laws and regulations and any alterations to the Codes of Ethics.
- Look into insurance requirements, like limits on the frequency, duration, and types of visits that can be conducted via telehealth.
- Implement an up-to-date HIPAA compliance privacy policies and procedures manual.
- Check state legislation regarding direct access considerations.
- Understand state requirements. Many states have an in-person requirement for telehealth-based provider-patient relationships, meaning it may not be possible to operate a fully telehealth-based practice.
- Confirm location of your patient during your telehealth session to stay consistent with practice guidelines (treating within your license state) and to prepare an action plan in case a situation arises during the call where your patient needs supporting medical help sent to their home.
The laws surrounding telehealth often lack technology, patient demands, and provider capabilities. This makes it critical to be proactive. Sign a Business Associate Agreement (BAA) with your telehealth service provider and ensure that you and your team are covered by a reputable and comprehensive insurance policy.
Remember: Everything a physical therapist does needs to be HIPAA compliant.
This is true for both services and platforms used, as well as the methods chosen for treatment.
Considerations When Choosing a Telehealth Platform
Implementing telehealth services into your practice helps you grow your clinic and provide care to previously unreachable patients. From online scheduling, EMR integration, and the ability to have more than two participants, it matters which telehealth platform you choose.
There are many different and important features that a practice should consider. Three of the most important considerations are simplicity, security, and safety.
Simplicity and platform ease of use will help both patient and therapist get the most out of each session. A non-complex system can make people feel confident each time they log in.
Security ensures that patient information is securely stored on the platform and that the platform itself is secure. Some sessions may require additional participants aside from the patient and therapist, but unauthorized users should never be able to access sessions or patient health information.
Safety for patients and therapists must be carefully considered during each telehealth session. This means having patients sign a Telehealth Consent to Treat prior to their session. It also means being able to easily see and hear each other. It also includes being confident when asking questions or demonstrating exercises or techniques. Finally, it’s critical to know where patients are physically located during sessions in case of an emergency.
The following are other key features you should consider when choosing a telehealth platform.
- Ease of access for patient and provider on any device they choose
- Reminder system
- Personalized consent to treat form automatically sent to patient and sign off automatically requested from patient prior to every call
- Ability for the patient to request an appointment from website or email
- Flexibility to allow more than two people to join the visit
- EMR integration
- Pay-per-call pricing model
- HIPAA compliance, including signed BAA
If you’re unsure if your chosen platform offers these features, consider a better option for telehealth.
What worked at the height of the pandemic might not be the right choice for long-term use. Now it’s time to choose a telehealth platform that grows with your practice.
Choose a Telehealth platform that will grow with your practice, not a short-term Band-Aid.
BetterTelehealth is designed for both patients and physical therapists. The easy-to-use, HIPAA compliant platform provides one-tap access to safe and secure video sessions. These sessions allow patients and providers to openly discuss treatment options and course of care with ease. BetterTelehealth’s seamless user experiences keeps the focus on what matters most: Getting BETTER.
Reasons to Make Telehealth Part of Your Practice Long Term
Telehealth may have helped your clinic maintain the status quo during the initial outbreak of COVID-19. That’s not a reason to limit the possibility of future growth, though. Many PTs turned to telehealth when the pandemic forced clinics doors shut. Now that the clinic is open, don’t abandon Telehealth — use it to grow your business.
Telehealth services can be used in the following ways to grow your business.
- Increase patient volumes
- Attract new patients who wouldn’t travel for care
- Reduce appointment cancellations
- Offer more in-depth functional analyses
Telehealth should account for 20% of your caseload.
That’s 20% additional volume you may miss out on if you’re not utilizing telehealth sessions.
With a safe and simple telehealth platform, you can advance and grow your practice. Do this by capitalizing on opportunities that didn’t exist before.
Increase Your Clinic Volume
Everyone is busy and in a rush. People with nagging injuries may be deterred from seeking care because it will take too much time or effort. Not only do they have the session itself to consider, but also the drive to the clinic (maybe in traffic) and time in the waiting room. When all is said and done, this is a hard sell for someone who may only be able to carve out an hour for treatment. A patient’s time is valuable to them, and it should be to you, too.
By utilizing telehealth, you just made physical therapy a lot more accessible for this patient.
Other scenarios where you can use telehealth to expand your practice include the following.
- Niche practices
- Follow-up visits with physicians
- Opportunity to schedule new patients when in-clinic evaluations are booked
- Lead generation tool to capture new patients from your website via complimentary video screenings
Reduce Cancellations and Missed Appointments
Cancellations are frustrating. They result in missed opportunities and scheduling inefficiencies.
Stuck at work? Unreliable transportation? Weather not safe for travel? These excuses don’t have to result in cancellations!
From inclement weather to sickness, telehealth offers a solution for your clinic to keep more patients on the books and reduce cancellations. The next time a big storm is in the forecast, rather than have your staff call to confirm appointments or even cancel outright, schedule those sessions virtually.
You’ll reduce cancellations while maintaining continuity of care and ensuring patients are able to receive care, no matter the circumstance. This is especially useful for those that rely on others or public transportation to get to and from your clinic. Eliminate this worry, and you’ll likely eliminate a lot of the uncertainty.
Conduct Assessments in the Patient’s Environment
Ever wanted to take a tour of a patient’s home to see exactly what safety risks they face during recovery? Would seeing how they sleep, or their office setup help you instruct them?
There are some things you can actually do better with a virtual visit. It’s incredibly valuable to see the patient’s home and provide an exercise program that’s customized to both the patient’s recovery and their home environment.
From evaluating workstations to sleeping positions, telehealth sessions allow patients to show their therapist the exact home setup.
Patients using the platform show therapists stairs, entryways, bathrooms, and furniture. After seeing the inside of the home, a physical therapist makes recommendations for home behaviors and modifications. This is also the perfect opportunity to discuss in-home patient safety and the transition back to home life.
What’s Next for Telehealth?
The pandemic has made it clear that the use of telehealth by physical therapy professionals is not only appropriate, but effective in delivering care and expanding patient access to physical therapy services.
Telehealth physical therapy sessions shouldn’t be for emergencies only.
The public health emergency was most recently renewed for 90 days effective October 23, 2020. This means physical therapists are able to continue providing sessions via telehealth, but it’s still a temporary policy.
Significant changes to both state and federal legislation as well as commercial payer policies are required to expand telehealth services on a more permanent basis.
Most importantly, congressional action is needed to outline specific, explicit authorization in the federal statute for physical therapists, occupational therapists, and speech language pathologists to provide services via telehealth after the public health emergency expires.
There are several bills that would expand the list of eligible telehealth providers to include physical therapists. The American Physical Therapy Association (APTA) and their members are engaged in advocacy efforts to expand telehealth services to the list of resources readily available for physical therapists.
These bills need to be passed by the end of December, before the new Congress begins in January. If they are not passed by the end of the year, telehealth expansion legislation will need to be reintroduced to the new congress.
The APTA believes there is broad support among patients, providers, and policymakers to expand telehealth services for physical therapists. If not this year, certainly in the new congressional session.
Telehealth Remains a Key Component for Physical Therapists
Physical therapy itself is all about adapting, and BetterPT’s telehealth platform allows you to do just that. It’s not just a video conferencing app. This solution offers your team a seamless integration of telehealth services into your EMR, scheduling, and billing platforms. With automatic reminders, pre-programmed consent to treat forms, and clickable confirmation links via text and email, BetterTelehealth offers your staff the increased efficiency they need.
And it’s easy to use for patients. They only need a device with a stable internet connection. The rest of the visit is managed on your end in the clinic.
Telehealth services are still being covered by CMS and major insurance carriers under the public health emergency. While temporary applications, such as FaceTime and Google Meet may have been your go-to in the spring, find a telehealth solution that will protect your business and provide an efficient workflow for your staff. It will be worth the investment.
Why wait? Learn more about BetterTelehealth and how it is designed to help you accurately and completely treat all of your patients.
Dr. Marla Ranieri graduated from Stanford University with her bachelor’s degree in Human Biology in 2005. She went on to receive her Doctorate in Physical Therapy from Columbia University College of Physicians and Surgeons in 2009. Dr. Ranieri has worked with all types of individuals, including professional athletes as part of the USA Gymnastics Medical Staff. She continues to treat patients with evidence-based medicine and the best quality of care.