The US Senate recently introduced the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act 2017 (S.1016). If passed, the CONNECT for Health Act would remove several barriers to utilizing telehealth with Medicare patients—which would present a valuable opportunity to the physical therapy profession. Here’s why PTs should strongly consider supporting it:
It will allow PTs to deliver, and receive reimbursement for, physical therapy telehealth services.
As it stands, Medicare only provides telehealth reimbursement to certain healthcare providers, not including physical therapists. However, under the new bill, the HHS secretary would be granted authority to issue demonstration waivers that would:
- Remove limitations on provider type, which in turn could allow physical therapists to provide telehealth services.
- Remove limitations on telehealth-specific codes, which could allow providers to bill for telehealth services that would normally be furnished in person (provided that the telehealth service is appropriate for the patient and his or her treatment plan).
- Remove restrictions on originating sites, thus allowing telehealth services to be provided in any location—including the patient’s home.
- Allow providers to receive reimbursement for telehealth services delivered using store and forward technology when patients are not physically present.
- Provide coverage for remote monitoring of patients under chronic care or transitional care management.
The CONNECT bill would enable physical therapists to provide a reimbursable service that has already been available to other providers for quite some time. As a result, physical therapists could potentially extend their reach to more patients who would otherwise not be able to receive physical therapy care due to barriers associated with location and geography.
It aligns with bundled payment and managed care programs.
Although the bill places stipulations on which providers would be eligible for demonstration waivers that would exempt them from certain telehealth requirements—including originating site restrictions and geographic limitations—the language seems to indicate that the trend toward alternative payment models (like bundled payments or ACOs) will continue to drive telehealth adoption, as providers who participate in such models would have greater telehealth flexibility under the new act. These payment models, which are gaining popularity among health systems and payers around the country, are being adopted as part of an effort to reduce healthcare costs while promoting better clinical outcomes. The net effect, however, is a fundamental shift in clinical practice, whereby providers are encouraged to apply a more streamlined and coordinated approach that will—as these programs mature—increasingly rely on telehealth and other intelligence-based technologies that can help providers treat patients in a more cost-effective way.
For PTs who happen to participate in these programs, the demonstration waiver could allow them to further align with value-based payment model incentives by supplementing their practice with alternative care delivery options. And as telehealth continues to play a vital role in the provision of value-based care, PTs could potentially gain more visibility within the broader healthcare community as it moves toward a more data-driven and collaborative form of medicine.
The technology already exists.
The good news for physical therapists is the technology already exists. Several digital healthcare companies already provide telehealth services such as live video conferencing. And due to the rather unique nature of physical therapy—a discipline that is highly contingent on hands-on treatment and customized home exercise programs—other companies have gone further to develop even more robust platforms.
As a matter of fact, new telehealth technologies have emerged specifically to help PTs gain new and valuable insight into a patient's rehab progress—while the patient is recovering at home. For example, some telehealth tools now come equipped with motion-tracking cameras and intelligence-based applications that can record video of patients performing their home exercises and capture a multitude of real-time data, such as exercise repetitions, pain levels, and overall exercise performance. Treating therapists can also use this technology to remotely administer and review range-of-motion and functional tests—all with the patient participating in the comfort of his or her home. As a result, PTs can quickly identify and manage patients in most need of hands-on care while driving greater patient participation and home exercise adherence—both of which, as studies show, lead to optimal long-term outcomes.
So instead of relying on a limited number of in-person clinic visits and a few home exercise paper handouts to treat their patients, PTs can use these tools to assist with their clinical decision-making and enhance their patients’ rehab experience. And with the passage of the CONNECT bill, these new services and features would become reimbursable and could serve as attractive solutions for hospitals in managed care programs.
It would drive the establishment of updated standards of practice.
Admittedly, while telehealth studies are being conducted within the physical therapy profession, it remains a relatively novel concept. However, at a period when disruption caused by the emergence of episode-based payment models is requiring hospitals and providers to make significant changes to their infrastructure, now is the ideal time for the physical therapy profession to leverage the CONNECT bill to establish new guidelines and standards of practice for the proper use of telehealth. It’s becoming increasingly clear that the traditional fee-for-service structure that supports physical therapy in the post-acute setting will steadily change and make way for a more streamlined and standardized system that rewards patient satisfaction and cost savings while penalizing service overutilization and poor outcomes.
And this is perhaps why telehealth technology is becoming such a major healthcare player: it can allow providers to (1) increase their access and impact to patients beyond the four walls of a traditional brick-and-mortar clinic and (2) be less limited by distance and geography. Still, because this technology is so new, physical therapists must push themselves to use and engage with it in order to determine its advantages, identify its limitations, and ultimately, establish guidelines for using it to efficiently and effectively treat patients within this new environment. The CONNECT bill would afford PTs the opportunity to do all of this.
And the CONNECT bill isn’t the only piece of legislation that would help government regulations catch up with available healthcare technology. There are several other proposals at the state and federal level aimed at either granting parity for, or improving access to, telehealth—as well as some aimed at ensuring PTs can receive reimbursement for these services. This includes the physical therapy licensure compact recently enacted by 10 states.
In the face of ongoing changes in clinical practice, telehealth technology—along with passage of pro-telehealth legislation—could help the physical therapy profession attain a level of stability and predictability as the healthcare landscape continues to evolve.
Ben Torres is a senior account manager and clinical specialist at Reflexion Health, a digital healthcare company based in San Diego, California. Ben works directly with clinicians and physical therapists to integrate virtual health technology into their current workflows in order to advance patient recovery.