I’m not sure if anyone other than Bill Gates saw 2020 coming.  The novel coronavirus Covid-19 has completely changed how we all live, work, and enjoy friends and family.  It has already had a profound impact on healthcare and by this point I think we all realize our lives will never be the same.  The rise of telehealth, also called telemedicine, is an inevitable consequence of this ever-changing dynamic as the public perception of safety in healthcare evolves.

This is the time to embrace telehealth as the next frontier of healthcare and how it will benefit your life going forward.  Telehealth brings with it many advantages over traditional healthcare and most vital is the ability to treat patients without exposing them or yourself to other contagions and adverse events.  In this article I’m going to answer some basic telehealth physical therapy questions and reasons why you should be performing telehealth physical therapy services.

  1. What is telehealth physical therapy?
    1. First the basics:  telehealth physical therapy also called online physical therapy or virtual physical therapy is the rehabilitation of disease or injury by means of education, physical modalities, and exercise via the use of telecommunications technology.
    2. There are four main ways PTs treat patients via telehealth:
      1. Synchronous or live video – using HIPAA compliant teleconference software to perform “real time” examinations and treatments.
      2. Asynchronous or store-and-forward video – using recordings of the PT and patient sent to the opposite party for instruction and review.  This can include HIPAA compliant text messaging.
      3. Remote Patient Monitoring – using therapeutic technology that tracks biomarkers to have 24/7 or daily reports of a patient’s condition and adherence to a protocol.
      4. Mobile Health – leveraging mobile application platforms with algorithms that recommend rehabilitation protocols and guide patients using premade plans.
  2. Is online physical therapy legal and ethical?
    1. Telehealth physical therapy is legal in most states.  The way it is conducted and the rules governing telehealth vary and it is important to keep up to date.  The Center for Connected Health Policy is an amazing resource for keeping up to date with legislative policy in each state.
    2. Telehealth physical therapy has a substantial amount of research prior to the Covid-19 validating the efficacy of its use.  The Duke University Clinical Research Institute published a 2018 study that showed online therapy outcomes that exceeded those of traditional in-person care.  As early as 2009, the paper “Overview of Telehealth and Its Application to Cardiopulmonary Physical Therapy” by Donald Shaw PT, PhD reported on the astounding innovations in Cardiopulmonary Physical Therapy via telehealth.
    3. Especially in the post-Covid era of care, we as physical therapists must engage our patients in the safest manner possible and consider that exposing them to contagions in our offices may not be the best method of care.  When weighing the risks, at home care via telehealth will be the most ethical method of physical therapy care for many patients.
  3. How do I begin performing telehealth physical therapy?
    1. First off, you need to embrace the medium of telehealth and educate yourself as well as practice performing online PT.  www.telehealthpt.com has a wide variety of courses including the “Everything You Need” free instructional video library.  Take the time to perform demo session and learn to setup your space.  You will also need to learn how to instruct the patient to setup their space.  One of the number one factors that influences a patient’s experience in telehealth regardless of technological proficiency is whether they receive education on how to setup and what to expect prior to your first session.
    2. Second, remove all barriers to online care by establishing a method of booking appointments online and choosing a telehealth software system.  We recommend PtEverywhere as they have one of the most complete HIPAA compliant systems available for performing online PT sessions.  Contact Jonathan at www.PtEverywhere.com.   Make sure the teleconference software you choose enables you to share your screen, chat, and perform virtual goniometry.  As a bonus, look for a platform with electronic medical records, home exercise program, and text messaging built in.
    3. Check your state legislation using the Center for Connected Healthcare Policy website.  Ensure you have the most up to date information by checking directly with your state board.
    4. Consider expanding your licenses to other states.  Especially if your state is part of the PT Compact.  Many states do not require you to be physically present in the state in order to perform telehealth physical therapy.
    5. Build a patient market base.  That’s where we come in here at www.GoTherex.com!  You can list your services for free and our community of PTs refer out when patients we cannot treat are in need of care.  GoTherex is the first place to get the word out that you offer telehealth physical therapy.  Join the GoTherex Facebook group to brainstorm with other GoTherex PTs about all issues related to growing in telehealth.
    6. Consider getting specialized certifications that are perfect for use via telehealth.  SFMA, McKenzie Method, and other movement screens are perfect for examinations when you cannot put hands on your patient.
  4. Keep up to date with payors.  Currently due to the coronavirus pandemic Medicare, Medicaid, Tricare, and many other government payors as well as private insurance companies have made changes to their policy in reimbursement of telehealth physical therapy.  Stay up to date on the private insurance rules, CPT and ICD codes.
    1. Know the correct terminology including originating site which is the patient’s location and distance site which is the PT’s location.
    2. Place of Service codes “02” for actual telehealth services, “11” for e-visits from an office, “12” for e-visits from home.  This includes phone consults.
    3. Modifiers: “95” if services were synchronous, “GQ” if services were asynchronous, “CR” if services were disaster related (this is currently mandate by Medicare for telehealth PT services).
    4. Codes, rules, and policy are subject to change.  Ensure you keep up to date by contacting all payors you accept.
    5. Consider “Cash Pay” for telehealth services and consider a rate that is competitive with insurance reimbursement, but not a barrier for patient’s care.  E.g. in many states $50 cash for a 30-minute session would be equal to or greater than the hourly rate of reimbursement from insurers, especially when you include the time and cost of documentation and proper filing for third party reimbursement.
  5. Find your niche.
    1. If you are a specialist in a certain area of PT, telehealth is an amazing way to expand your market base in your specialty.  By offering your specialist services to an entire state or multiple states, you can ensure you always have patients regardless of the economy or social distancing guidelines.
    2. Consider leveraging our advance specialty certifications.  You worked hard and went above and beyond to become an Orthopedic Clinical Specialist or Women’s Health Specialist.  Now leverage that on the open market and educate patients on why you can give better more specialized care than a generalist.
    3. Is your personal background in CrossFit or Powerlifting?  Why not niche down and serve the same group in which you participate.  Patients love to have a medical practitioner that truly understands the demands they face.  Leverage your current pursuits and prior athletic background.

The big question:  WHY?  Why perform telehealth physical therapy?

  1. Flexibility and Convenience – You can treat patients from anywhere at any time.  Want to sit on the Champs-Elysees and perform a quick treatment while on vacation.  No problem, if the state your patient resides in does not require your physical presence in the state and you are licensed in that state, you are good to go.  Want to treat only Wednesdays and Saturdays from 6:00am to 10:00am?  That’s not an issue either.  Maybe you are flexible to do 10-15 hours per week but don’t want to work 8-hour days.  That works as well.
  2. Predictably Hours and Income – You set your schedule and you can set your rate if you do cash pay.  Balancing the number of patients each week and the rate you charge; you can reach whatever financial goals you have.
  3. Work from Home – No commute, no dress code.  But really, do we need to say more?

Some cons to telehealth PT:

  1. It can be hard to get patients.  Patients views on telehealth and telehealth physical therapy are evolving rapidly.  But you are stepping into the unknown and a new field in performing online physical therapy.    That’s where www.GoTherex.com steps into the gap educating the public on telehealth physical therapy and leveraging the economies of scale of hundreds of physical therapists and our partners to bring patients interested in telehealth PT to you.
  2. Lots of sitting – A large majority of each session will be sitting while examining a patient’s movement and performing patient education.  That’s a change from our in-clinic routine and it can feel exhausting, especially at the outset.
  3. Confusing rules and rapidly changing reimbursement and legislative policies.
  4. Uncertainty and Change – being on the cusp of innovation means learning and adapting on the fly.  As a telehealth PT, you will need to learn to perform the same expert care via an online medium.  I believe our greatest asset as physical therapists is our knowledge and ability to educate and motivate patients.  We may not be able to be hands on during our telehealth sessions, but with practice and a change in approach we can achieve outcomes that rival and may exceed those of in-person therapy.  Many clinicians I speak with are nervous starting out, however, most all speak of your engaged patients seem to be in their session and that they see home exercise program compliance markedly increases with online PT.

It’s time for every physical therapy clinic to offer some form of telehealth.  If you are a solo practitioner, your practice is in jeopardy if you do not offer telehealth.  The lesson we should have all learned from the Covid-19 pandemic is that we need multiple streams of income for our practices and that in-person care alone cannot be our only source of revenue.  Just as with good financial planning, our clinics need diversity of income and telehealth has not become a vital source each clinic should embrace.

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