If you’ve been to Ascend—or any business-related rehab therapy event—you’ve certainly heard this common complaint: “There are so many patients who would benefit from OT, PT, and SLP—but they aren't making it into our clinics.”
To make matters worse, we therapy professionals aren't very good at retaining the patients who do come to see us.
And, of the few patients who complete an entire course of therapy, many don’t comply with their home exercise programs (HEPs)—which means they’re not integrating what they’re doing in the clinic with what they’re doing at home.
This is not because we are bad therapists.
It simply means that we’re not set up for success. The tools we use are often outdated, and the business models and regulations under which we operate are often unnecessarily complex and bureaucratic.
Luckily, hope is on the horizon: we can see the signs of new technologies and business models bridging the gaps in our current systems.
We hope you find inspiration in these exciting new developments in the rehab space (particularly in OT):
1. Technology for Remote Monitoring of Patient Progress
Almost everything is cloud-based these days, and nobody can dispute the fact that we live in an extremely connected world.
Mobile health tools and other technologies are starting to emerge as solutions for connecting with patients (and their data) outside the clinic.
The Consumer Electronics Show—a mecca for tech junkies—has even added a Digital Health Summit to showcase health-specific technologies. (Check out this overview of some of the most exciting connected health devices out there.)
The development of mobile health (often shortened to “mhealth”) and connected health tools spells a bright future for the marriage of technology and rehabilitation.
Instead of sending a patient home with an archaic handout of rehab exercises, we can now remotely track patients’ compliance with their HEPs—and even deliver real-time feedback to help them stay on track to reach their goals.
Examples of Therapy-Related Connected Technology
There’s no shortage of tech tools that allow therapists to better engage patients in their care. Here are few examples:
- Neofect’s Rapael Smart Glove enables cloud-based data collection that tracks information like range of motion changes of the forearm, wrist, and digits. Therapists can track patient HEP compliance and progress, making adjustments to the care plan in real time and ensuring they can make the most of the face-to-face time they have with patients in the clinic.
- Reflexion Health’s VERA (Virtual Exercise Rehabilitation Assistant) instructs and records exercise performance, all while measuring 26 joints and limbs in motion—30 times per second—to provide real-time feedback to patients. VERA also enables telehealth visits with clinicians.
Reimbursement for Remote Monitoring
When it comes to reimbursements, we therapists are often used to being left out in the cold.
Luckily, that’s not the case with remote monitoring!
In 2018, CMS unbundled the remote monitoring code CPT 99091, which allows service providers to bill for patient monitoring on a remote basis. This means eligible practitioners (including therapy providers!) can bill to receive separate reimbursement for time spent on collection and interpretation of health data that was generated by a patient remotely, and then digitally stored and transmitted to the provider.
There’s a lot to unpack in that single statement––not to mention a few caveats to the code’s use––but here are a few key highlights:
1. You can only use the code once per month.
The remote monitoring code can be billed once a month for a patient who is using a device that remotely monitors progress. For example, you can bill CPT 99091 a single time for data collected during a patient’s month-long use of the Rapael Smart Glove.
2. You must amass 30 minutes of monitoring time in order to bill the code.
This total includes monitoring performed inside or outside of direct patient care time. For example, the code can apply to time you spend reviewing data in preparation for a patient visit as well as time you spend tweaking a patient’s home therapy program by adjusting his or her remote monitoring tool while the patient is in your office.
3. Things should loosen up more in the future.
As Medicare gains a better sense of how the code is used, the rules will likely become less restrictive. Now that remote monitoring is on Medicare’s radar—and the initial data is being gathered—we anticipate wider adoption of remote monitoring technologies among rehab therapists.
To read more about remote monitoring, check out the CMS Remote Patient Monitoring 2019 Physician Fee Schedule.
Keep in mind that remote patient monitoring is technically considered a form of telerehabilitation. In fact, remote patient monitoring is classified as one of the four types of telehealth physical therapy (and telehealth OT, too)—an emerging practice niche that has been widely discussed at recent PT conferences and conventions.
And that brings us to the second emerging rehab trend of 2019.
2. Telerehabilitation as a Viable Model for Service Delivery
Remote patient monitoring aside, the broader idea of teletherapy as a practice model is becoming more accepted in the rehab world.
I (Lauren Sheehan) have used telerehabilitation while working for a technology company in an OT role, and I’ve seen, firsthand, the exciting opportunities that this practice model can deliver.
Therapists can leverage teletherapy in a number of ways, including:
- Providing education on HEPs;
- Guiding practitioners and patients on the setup and use of assistive technologies;
- Providing home safety evaluations and recommendations;
- Supporting the use of pediatric sensory integration therapies in schools; and
- Remotely monitoring patients’ rehabilitation progress (as mentioned above).
There are several emerging platforms for telehealth. One that I have personally used (and enjoyed) is Doxy.me. The setup is easy, the format mirrors a traditional therapy environment (for example, patients check in to a “waiting room”), and the professional version of the software even offers options for payment processing.
The Logistics of Telerehab
Navigating reimbursement for teletherapy—not to mention the state-by-state guidelines governing its delivery and its inclusion (or exclusion) in state practice acts—can be complicated. Furthermore, the rules and guidelines governing its use are changing rapidly.
Thus, if you’re looking to introduce telerehab services in your clinic, it might be a good idea to start with a cash-based program. You can then gradually transition to incorporating these services into your standard therapy programs as private insurers increase their coverage.
Adding standard check-ups with discharged outpatients, offering wellness-based programs, or providing sports clinics are all ways that practices can dabble in teletherapy offerings. These services can support patients’ well-being after they finish therapy, while simultaneously boosting clinic revenue.
New Applications for Virtual Care Tools
While we typically hear about therapists using telehealth technology to supplement traditional care delivery, companies like TheraNow are taking a different approach.
This company operates as a central hub where patients can get matched with a therapist licensed in their specific state. By providing all of the tech and making it easy for patients and therapists alike to sign up and connect, TheraNow is eliminating tech barriers and creating a viable solution for:
- patients who may otherwise be unable to access rehab therapy, and
- clinicians who want a more flexible, less physically intense care delivery setting.
3. Technology for Patient Engagement and Retention in Rehab Gyms
So far, we’ve focused largely on technology’s role in care delivery outside of the clinic, but our final rehab trend of 2019 is very much rooted in the brick-and-mortar model.
More and more rehab gyms are opening across the nation, enabling patients to remain engaged and healthy after they’re officially discharged from therapy. But the exciting part is the integration of technology into this model.
By partnering with a local gym or allowing clients to use existing outpatient facility equipment outside of clinic hours, savvy therapists can provide follow-up services to discharged patients. This keeps patients motivated to maintain their function—and enables therapists to keep tabs on their patients’ future rehab needs.
Some examples of gyms operating within therapy facilities include Recharge—which is a mash-up of CrossFit and rehabilitation—and Madonna ProActive, a community gym run and managed by a rehabilitation hospital. The latter provides in-house therapy services along with adaptive sports and other rehab offerings. Patients can often join these facilities on a subscription or concierge basis, or they can simply pay a drop-in fee if they don’t plan to come in regularly.
Rehab gyms provide structured opportunities for patients to stay injury-free following the completion of their regular therapy programs. And in addition to providing access to equipment, these gyms foster the same sense of camaraderie found in community-based rehab programs. Some facilities—like Burke’s Neuro Recovery Center—allow patients to leverage rehabilitation technology under staff supervision (or even independently in some cases).
The wonderful thing about these rehab gyms is that they integrate well with the aforementioned technology. As more and more patients use tech to access our services, we can add wellness services and maintenance programs to promote patient engagement and loyalty. Not only can technology make patients and clients aware of these offerings in the first place, but tech additions can also enhance the facilities themselves. A single patient might not be able to afford the latest technology, but rehab gyms can house such equipment and make it accessible to many patients. A therapist can train patients to safely use the devices during rehab sessions, and then allow wellness-based clients to continue using the devices (when appropriate) following discharge.
Even if your outpatient clinic has fewer rehab technology options, allowing patients access to a few key pieces of equipment may be worthwhile. This gives patients the ability to pay a drop-in or monthly fee for access after their formal therapy has been completed.
It can be difficult to wrap our minds around all the ways that technology is going to transform health care over the next decade.
And yet, forward-thinking therapists will keep their eyes on the horizon, remaining agile and open to new opportunities for delivering care. After all, it seems inevitable that new care delivery models will take hold––and these developments will almost certainly benefit our patients.
Here’s to staying adaptable and optimistic—and leading the way for thinking outside of the box in order to provide our patients the best possible experience.
Lauren Sheehan, OTD, OTR/L, has been an occupational therapist for 10-plus years in a neuro-rehabilitation clinical setting, working with individuals with neurologic injuries and illnesses. She also spent a handful of years in clinic administration and director of rehab roles for small community hospitals as well as facilities in large, urban areas. She has spent the last two years of her career working for rehabilitation technology companies to assist with product and process development for products that serve stroke patients. She’s currently the Field Clinical Manager for NeuroLutions, a device company committed to developing quality products for patients through innovation such as BCI (Brain Computer Interface) stroke rehabilitation technology. She has a passion for supporting individuals with neurologic injury and illness through greater accessibility to technologies that can be used at home to increase function and improve quality of life. Outside of work, Lauren enjoys singing, cycling, and traveling.
Sarah Lyon, OTR/L, is the founder of OT Potential. She recently launched the OT Potential Club, which assists therapists in keeping up with new OT evidence. When she’s not thinking about OT, Sarah can be found enjoying small-town life or frantically finishing her next book club book.