Technology continues to play a key role in furthering health care’s reach—and remote, virtual care delivery is the latest trend in the overarching push to improve patients’ access to care. In fact, as we’ve previously reported, an estimated 1.8 million health consumers are expected to take part in some form of telehealth—or telemedicine—by year’s end, with the biggest market share coming from post-acute care patients. That’s great news for patients looking for alternate ways to access health services—especially those who are homebound or who reside in more rural, underserved areas.
However, although there are some state-specific telehealth laws on the books, arguably one of the biggest issues rehab therapists face on the telehealth front is the lack of a standardized route to receiving payment for telehealth services. Efforts to potentially bolster provider reimbursement are already underway (more on that later), but many of those initiatives are still in their infancy. As new telehealth legislation moves forward, though, the rehab therapy community will want a seat at the table to help open the door for greater telehealth opportunity in the rehab space.
Expanding Billing Options for Telehealth Services
Today, as en vogue as telehealth is among patients, not all providers are fully on board—at least not yet. That’s partially due to a lack of clarity—and consistency—around payer coverage of telehealth services. For example, Medicare currently reimburses providers in other specialties for certain telehealth CPT codes. However, many physical therapists continue to sit on the sidelines, as there’s no formal policy regarding reimbursement for telehealth therapy services. Fortunately, there are some initiatives in the works to address this issue.
In October 2015, the American Medical Association (AMA) formed a working group of more than 50 healthcare experts tasked with creating new telehealth CPT codes. More than 14 months have passed since the formation of the Telehealth Services Workgroup—and the verdict is still out about whether full-scale virtual health care will be a reality in the near future. But we may have more answers after the workgroup reconvenes on February 9, 2017, during the CPT/HCPAC Advisors’ annual meeting in New Orleans. According to the presentation materials, the workgroup is expected to make two proposals to the CPT Editorial Panel, which will hold its own meeting February 10-11, 2017, in The Big Easy. These proposals include:
- Introducing a telehealth services modifier (i.e., a modifier providers could append to existing CPT codes in order to receive reimbursement for services rendered via telehealth); and
- Creating a telehealth services appendix (i.e., a resource that would include a listing of codes currently covered by payers for telehealth services).
Enhancing Patient Care
Telehealth improves patient outcomes.
Now, make no bones about it, the two proposals being floated by the Telehealth Services Workgroup may not go anywhere or lead to anything of significance. Plus, the results of any previous closed-door workgroup discussions may not receive endorsement from the CPT Editorial Panel. Still, the growing demand for greater healthcare efficiency and convenience cannot be ignored—especially considering the continued push toward achieving the triple aim. After all, if providers are able to leverage telehealth to its full potential, they will expand access to care, improve health outcomes, and reduce costs associated with chronic medical conditions. This is particularly important when it comes to improving the health of those populations of patients who are homebound or who live in rural areas. So clearly, telehealth isn’t going away—which is exactly why the rehab therapy community must continue to push for greater opportunity in the telehealth realm.
It also provides a new medium for patient engagement.
The good news: Technology is already advancing to meet the needs of therapists who elect to provide telehealth services in the future. VERA™, a pilot program rolled out in November 2015 by Reflexion Health, allows high-functioning physical therapy patients the ability to receive care from the comfort of their own homes—virtually. The digital treatment platform “includes a suite of prescription rehabilitation exercises, an animated avatar coach, a 3D imaging system for measuring movement and form, functional assessments, an intuitive dashboard for off-line clinical review, automatic report generation, and telemedicine capability.” According to HomeCareDaily.com, in early use, VERA “increases patient engagement, improves adherence to prescribed exercises, [and] delights patients, all while increasing the reach of physical therapists into the home while saving steps, time, and money.” Pretty neat and far-reaching, huh? Well, we may see more programs like VERA sprouting up in the near future, particularly as CMS introduces more pro-telehealth policies, including one included in a recently introduced bundled payment model.
Telehealth is possible in CJR episodes.
In April 2016, CMS officially rolled out a new payment model that, in large part, opened the door for the increased availability of telehealth therapy. The Comprehensive Care for Joint Replacement (CJR) model created a bundled payment program for knee and hip replacements. This makes the hospital in which the procedure—including post-surgery rehab—takes place accountable for the quality and costs of the full care episode. This includes services rendered up to 90 days after discharge. So, how does telehealth therapy fall into this picture? Well, the introduction of CJR also relaxed the rules regarding originating site requirements, meaning providers are now given carte blanche to perform post-operative care via telehealth from any location, including the patient’s home. “Any service on the list of Medicare-approved telehealth services could be furnished to a (patient), regardless of (his or her) geographic location,” states this CMS final rule. That’s a pretty important development. As this mHealthIntelligence article explains, it’s also “the first step in establishing telehealth as the standard of care for all post-discharge programs, not just those focused on knee and hip replacements.” And while CJR helped pave the way for telehealth therapy, some pending legislation could potentially widen its scope even more.
Keeping the Ball Rolling on Telehealth Legislation
The Telemedicine Parity Act of 2015
Rehab therapy leaders are no doubt keeping a watchful eye on this piece of legislation, which would open the door for more providers (including PTs, OTs, and SLPs) to perform telehealth therapy. Additionally, this bill, if passed, would expand the coverage area for telehealth to include both rural and urban settings.
The TELE-MED Act of 2015
If passed, this bill would allow specific licensed Medicare providers to offer telehealth therapy services to Medicare patients who live in different states, even if a provider isn’t licensed in the state that a particular patient calls home. However, those services must be performed by participating physicians or practitioners (more on that here).
It’s safe to say that telehealth is the future of rehab therapy care delivery—and that its demand and scope will only continue to grow. That’s exactly why the rehab therapy industry must be ardent in its push for the enactment of pro-rehab telehealth policy; otherwise, therapists risk losing out on a huge potential revenue source. Let’s face it: technology is the new frontier in health care—and, in a value-based system, providers should be looking to empower patients with more choices to reach their treatment goals.