In the not-too-distant past, telehealth was unexplored and unfamiliar territory for rehab therapists—long-time advocates of the in-person visit. Yet practically overnight, therapists were forced to dive head-first into the telehealth pool and start providing care via hybrid or fully remote treatment models. And now that many major payers are covering therapy services delivered via telehealth, clinic leaders are realizing that it might be one of the few ways they can keep their businesses financially viable during the coming months. Luckily, you don’t have to fly blind if you want to take the leap and provide telehealth—at least, not if you start your preparations with this list.
1. Make sure telehealth falls under your scope of practice.
Not all state laws are made equal, so before you do anything else, confirm that your state allows you to provide telehealth services in the first place. Some states are loosening up their telehealth restrictions for rehab therapists, but others are not—and at the end of the day, you cannot administer telehealth if your state practice act forbids it. So, be sure to review your practice act and check in with your state licensing board to determine where you stand.
2. Decide which kinds of virtual services you’d like to provide.
After you confirm that your state will allow you to administer telehealth, it’s time to decide on the type of remote services you want to provide your patients. Now that Medicare is covering telehealth services provided by PTs, OTs, and SLPs, we would strongly encourage therapy providers to consider offering true telehealth (i.e., services typically billed using regular CPT codes, including 97000-series codes). Other service options include e-visits, virtual check-ins, and telephone visits. In some cases, communicating with patients through a patient portal (i.e., providing an e-visit) or talking to them on the phone (i.e., providing a telephone visit) may actually be preferable for older, less tech-savvy patients.
Contact your in-network payers.
Prior to the pandemic, many payers did not cover telehealth services delivered by rehab therapists—but that isn’t necessarily true anymore. Like Medicare, many commercial insurers are now covering telehealth, e-visits, virtual check-ins, and telephone visits (or some combination of these services) that are provided by a PT, OT, or SLP. It’s up to you to contact your in-network payers and figure out which services they cover, as it’ll affect which services you choose to provide.
And finally, keep in mind that standard telehealth (e.g., providing gait training through a live video stream) typically pays better than the more consultative e-visits, virtual check-ins, and telephone visits.
3. Make sure your liability insurance covers telehealth.
You should already have a liability insurance policy—but it’s possible that your policy doesn’t actually cover telehealth. That’s why you need to check in with your liability provider and figure out if your insurance policy—including its malpractice, cyber liability, and general liability provisions—extends to services provided outside of your clinic. If it doesn’t, then you may need to ask for a rider in order to practice safely.
4. Pick a platform.
Once you know which services you’re going to provide—and you have your liability coverage squared away—it’s time to pick a platform that will meet all of your requirements. If you’re going to provide e-visits or virtual check-ins, then you need a secure patient portal (like WebPT HEP). If you’re going to provide standard telehealth, however, then you need to pick a software that is:
- able to enter a business associate agreement (BAA) with your clinic, and
- capable of passing a comprehensive risk assessment.
It’s important to note that while the federal government has temporarily relaxed its HIPAA requirements, those rules will eventually return to normal. So, if you want to continue providing telehealth services after the COVID-19 pandemic, then it’s not in your best interest to rely on a platform designed for general consumers (e.g., Facetime or Skype). Instead, find—and sign a BAA with—a HIPAA-compliant software. Some vendors might even take care of the BAA for you; WebPT’s new Virtual Visits tool, for instance, comes with a BAA. That means our Members will be totally covered—even post pandemic.
5. Set it up.
At this point, it’s time to cement your telehealth service specs. Many telehealth programs are relatively easy to install (Zoom for Healthcare, for example, only requires one click). The brunt of the work in this step involves perfecting your telehealth setup. Not only do you have to find a quiet, clean, professional, spacious, and well-lit area to administer telehealth, but you also must ensure that your camera, microphone, and Internet can support your telehealth demands. (Learn more about perfecting your telehealth setup here.)
6. Get your policies down pat.
If you’re offering telehealth services for the first time, you must create a whole new set of policies and procedures to ensure a smooth, uniform patient experience. Think about it: if the patient isn’t coming into your clinic, how does the intake process work? What about insurance and payment verification? Are there any telehealth video etiquette rules that therapists need to follow (wearing a certain uniform, not eating on camera, etc.)? You get the idea.
How you handle these items will vary based on your clinic’s brand, your software’s capabilities, your state laws and regulations, and your payers’ telehealth requirements. So, no two clinics will necessarily have the same telehealth policy or process. That said, you can start by answering these questions:
- What’s our telehealth appointment cancellation and no-show policy?
- How should patients request a telehealth appointment?
- What telehealth intake forms do patients need to fill out—and how do they do this?
- Who collects patient insurance information—and when and how do they collect it?
- Who collects patient payment information—and when and how do they collect it?
- Who follows up with patients—and how and when do they do it?
- What should a therapist do if a patient suffers a serious injury (e.g., a heart attack) during an appointment?
- What are the biggest factors that will impact patients’ telehealth experience, and how will you train your therapists to address them?
7. Train your staff.
Speaking of training: After you create all those new telehealth policies and procedures, it’s crucial that you dedicate time to training your staff on them. They’re going to have to unlearn and relearn a whole heap of information, so be patient. Everyone is trying their best.
Plus, as I mentioned in the opening of this article, telehealth is largely foreign to rehab therapists—so you shouldn’t expect your PTs, OTs, or SLPs to be telehealth masters right out of the gate. It can be difficult to predict the things that might go wrong—especially if everything is new. So, once you feel confident in your telehealth setup and your staff’s training, try running some tests. Ask your therapists to team up with you or their coworkers (or even their family members) to complete mock telehealth appointments. Be sure they ask their helpful stand-in patients for honest feedback about the experience.
8. If you’re offering cash-pay services, determine your pricing structure.
Offering cash-pay telehealth services might not be the right choice for every clinic, but it could be an alternative if you don’t want to mess around with payers. (Note: Before providing cash-pay services, check your payer contracts and ensure that you’re not violating the fine print.) Also, keep in mind that because Medicare now covers telehealth services delivered by rehab therapists, therapy providers cannot provide those services to Medicare patients on a cash-pay basis.
When creating your cash-pay pricing structure, you can lean one of two ways:
- You can use the same pricing you currently use for in-clinic services (because you’re still providing the same caliber of care and medical expertise to your patients); or
- You can discount your telehealth services (because appointments typically run a little shorter than standard appointments, and you aren’t incurring the same costs you would when providing in-clinic services).
9. Market your services.
Implementing a whole new telehealth program in your clinic won’t do you any good if no one knows about it. That’s why it’s so critical that you market your new telehealth services. Start by notifying your current and recent patients that telehealth is an option if they need or want to continue their care; then, educate the heck out of them. Teach them that telehealth is a viable substitute for in-person care (especially on a temporary basis) and that your guidance and expertise are still critical to their ability to heal. This step is especially crucial when it comes to your Medicare population, because until late April, many patients—and their therapy providers—were under the impression that Medicare would not cover telehealth services administered by a PT, OT, or SLP. So, if you have not done so already, be sure to reach out to your Medicare population to inform them of this newly available option.
Once you’ve educated your patients, get in touch with your referral sources and do the same thing. Let physicians, nurse practitioners, and anyone else who refers patients to your clinic know that you’re still available to treat patients—and that your telehealth format makes treatment safe for everyone. Give physicians the same educational run-down that you give your patients, and if possible, supply evidence-based proof that you can still help their patients.
Finally, be sure to update your public-facing clinic information. Add all COVID-19-relevant info to your website, your Google My Business page, and your clinic’s social media accounts. Include everything from changes to your business hours and your telehealth availability, to educational content about the benefits of telehealth therapy.
10. Get feedback from your patients.
After you roll out your telehealth services to patients, your work is not done; you must track how your patients are responding. First impressions mean a lot, so you want to understand if or when anything is going wrong on the patient’s end. We are big fans of measuring patient loyalty through Net Promoter Score® (NPS®) tracking, and NPS surveys offer a great way for you to gauge your patients’ telehealth experience. Check out this article to learn more.
Rolling out a completely new telehealth program is an enormous undertaking, and it’s a little unfair that circumstances have thrown rehab therapists into such an unforgiving “sink or swim” scenario. But rehab therapists are resilient, and if anyone can adapt to these tumultuous waters, it’ll be you.