Physical Therapy and e-Health – Benefits and Barriers

In 1995 a study was published in The American Journal of Cardiology that sought to quantify the benefits of remote monitoring of cardiac activity during physical therapy. It was one of the first efforts to codify the benefit of e-health applications in physical rehabilitation settings in the United States.

But the PT community was just getting started. Since then, there have been dozens of studies and more than 117 peer-reviewed articles published showing the positive effects of coordinating rehabilitative physical care with a telehealth device to facilitate remote monitoring.

This article will look at the various clinical applications for physical therapists to use e-health models. While these models are clearly beneficial, what are the barriers to adoption?

Kaiser Permanente published the results of their first e-health applications in 2000. The study showed that e-health models used with home care patients had the same levels of patient satisfaction and care quality metrics as in-office visits. However, these remote patient visits had a lower average cost. As a result, Kaiser continues even today to expand their e-health models.

In 2001, the U.S. Department of Veterans Affairs published their study on early e-health models that later were applied in a variety of settings nationally. One of their programs included the Low Activities of Daily Living Monitoring Program (LAMP). LAMP used a text messaging device for physical and occupational therapists to monitor the daily activities and physical functions of remote elderly patients. The study determined, “These programs have consistently demonstrated high patient and provider satisfaction, as well as improved clinical outcomes.”

An article in Physical Therapy reviewed many of the studies to date to determine the applications for e-health in physical therapy, citing, “cardiovascular, integumentary, neuromuscular, and musculoskeletal,” use cases. The article highlighted a number of studies including:

• The use of telemedicine to provide PT to post-operative patients after total knee arthroplasty. The study, published in The Journal of Bone & Joint Surgery pointed out the benefits of remote monitoring for incision care; chiefly, the patients did not have to travel to visit their doctor. In this application, e-health technology was also used to provide physical therapy for these patients. The end results were that the outcomes for flexion and extension range of motion, as well as limb girth, pain, and other clinical measurements were at least on par if not higher then the control group that received in-office treatment.
• On April 25, 2017, the Physical Therapy Licensure Compact was passed. This was an initiative facilitated by the Federation of State Boards of Physical Therapy to reduce regulatory barriers to interstate licensures. As of May 2018 more than 17 states had enacted laws that increase consumer access to PT services. Prior to this important shift in policy, physical therapists and their assistants could not cross state borders to provide care. Now, service providers can expand services in any of the states that have passed these rules with e-health applications to provide treatment to patients in remote regions and across state borders.
• The Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2017 was introduced and has been referred to a Congressional subcommittee. The bill would expand Medicare coverage for PTs providing e-health services by stripping away current reimbursement restrictions. It would potentially allow physical therapists to be added to the list of approved providers that can provide treatment via a telemedicine application and generally expand care for patients.
• The Medicare Telehealth Parity Act of 2017 was also introduced and sent to a subcommittee. Like the CONNECT legislation, it would potentially allow PTs to seek Medicare reimbursement for e-health treatment. Occupational therapists are also currently covered under the bill. The bill is parsed out in three phases, first, expanding reimbursement for e-health treatment to rural health clinics and federally qualified health centers (FQHCs). The second phase would expand reimbursement to e-health provided in the home. Finally, the bill, as currently written, would expand reimbursement for e-health treatment even further, adding originating sites and more chronic conditions.

The authors of the Physical Therapy article reached the same conclusion that clinicians around the nation are now recognizing:

In light of these findings, we recommend that future clinical trials should investigate cost reduction and comparative effectiveness for consumers of telehealth services in physical therapy.

While the studies have shown widespread use of e-health could be beneficial in physical therapy treatment, there have traditionally been barriers to adoption including reimbursement and licensure.

The good news is that 2017 was an important year for e-health initiatives. Federal policies have begun to change, including three in the past year that holds real promise to expand PT access to care:

These bills would bring outdated Medicare reimbursement and regulatory policies in line with what we now know to be true: there are real benefits when physical therapists use e-health applications to treat remote patients.

Integrating e-health into ancillary services in the orthopedic practice has a strongly positive outcome for providers and patients. In the same way that physical therapy helps restore function and improve the quality of life for our patients, adding e-health applications to the orthopedic workflow can improve the quality of life for clinical teams.

That’s because telemedicine has proven to have a number of benefits for the orthopedic practice:

• The technology reduces costs.
• It can expand access to care for remote customers.
• It’s more convenient for patients, cutting the time spent just getting to your office.
• Patients spend less time waiting for treatment.
• It cuts no-shows, which cost your practice big money.
• It streamlines practice efficiencies, allowing for a higher volume of patients and a better bottom line.

OrthoLive has created a low-cost, reliable and effective e-health application that our clinical clients use to provide remote care to patients. We’ve eliminated the risk of purchasing expensive HIPAA-compliant technology and replaced it with a telemedicine subscription service that will expand your practice and improve patient satisfaction. If you’re considering the future of your practice, consider OrthoLive.

Contact us today for a complimentary consultation and a demo of our service.