Three months ago, if you had asked me, “What is the application for telehealth in physical therapy?” I would have answered, “Very limited.” Up until then, I believed that for patients with no other options—like those in the remotest parts of the country—telehealth might be useful. But otherwise, not so much. Physical therapy is by definition physical. For it to be effective, the provider must be physically with the patient. Or so I thought.
Then, COVID-19 happened.
Beginning in March, easy and safe access to our practices—which my patients and I had always taken for granted—was no longer a given. While most businesses were put on hold, the conditions that required physical therapy weren’t. My patients still needed help treating their pain and injuries, but for many of them, coming into the clinic was no longer an option.
That’s when I began to reconsider telehealth. Within a week of the shutdown, all our physical therapists were trained on how to use our newly launched telehealth app. In under three months, we went from having delivered zero telehealth visits, to 20,000.
In those three months, my views on telehealth have flipped 180 degrees. I went from being a telehealth skeptic who thought this mode of service delivery belonged on the fringe of care, to a true believer who thinks that telehealth should be a treatment option available to all patients, regardless of where they live.
My views about telehealth have been transformed by not only the outcomes I’ve seen in our practices, but also the results of the first-of-its-kind patient survey we conducted with our telehealth patients in partnership with Northeastern University. You can see more detailed analysis of the study in this report, but here are the main takeaways:
1. Patients like the experience.
When we started using telehealth, I feared that our Net Promoter Score (NPS) would take a big hit. It didn’t. It actually went up significantly. From the time we started tracking NPS until March 21, 2020, our average score was 86.85. From March 23, 2020, through June 9, 2020, our average score was 91.25. Our joint survey with Northeastern echoed this trend: telehealth patient satisfaction (95%) is nearly as high as in-clinic patient satisfaction (98%).
2. All patients are satisfied with the experience, regardless of age.
Although older patients are sometimes considered less tech savvy, our survey shows that they are just as satisfied with telehealth as their younger peers.
3. No-shows have decreased.
Prior to COVID, our no-show rate was 13%. With telehealth, that rate has dropped to 8%. Clearly, telehealth is a far more convenient option than driving to a clinic.
4. The cost of care has decreased.
Compared to last year, our average visits at discharge—or what some call “length of stay for care”—went down by one visit. In other words, with telehealth, patients completed their care plans sooner, suggesting that telehealth helps patients better adhere to their plans—thus lowering the overall cost of care.
The Way Forward
Fortunately, at the outset of the COVID crisis, Medicare and most payers—like me—overcame their longstanding skepticism of telehealth. For the first time ever, they started covering telehealth physical therapy services. This has given tens of thousands of patients access to high-quality care that they otherwise would not have received. As the country slowly begins to re-open, there are some signs that Medicare and other payers might stop covering telehealth. That would be a big mistake for many reasons.
First and foremost, as our survey revealed, many patients (39%) are still uncomfortable returning to clinics—even if they get reassurances from their providers that all safety guidelines are being followed. By not covering telehealth, Medicare and other payers will be denying this sizable population convenient access to care. But there are many other people who could benefit from telehealth as well, including:
- frequent travelers,
- anyone with a fever or the flu,
- older patients with mobility issues, and
- patients with compromised immune systems.
Yes, most of my patients will likely come back to the clinic—especially those who benefit from hands-on treatment or services requiring sophisticated equipment. Telehealth, though, must remain an option for all others.
Although COVID has brought many unforeseen hardships, it’s also brought with it a few bright lights. One of those is telehealth. I hope private payers and Medicare see the light as I have, and resolve to cover telehealth moving forward. If they have any skepticism, then I implore them to dig into the data. With so many lives lost during the pandemic, it would be a shame to lose this opportunity to improve access and lower the overall cost of care.
Steven Windwer, DC, PT, is the president and CEO of Bay State Physical Therapy, a therapist-founded, owned, and operated provider of comprehensive outpatient physical therapy services offering more than 60 clinic locations in Massachusetts, New Hampshire, and Rhode Island. Learn more about Bay State’s mission and its innovative partner model.
