Let’s be honest. Our US healthcare system is under a large amount of stress. Whether it’s through additional charting requirements, productivity standards, or increased patient load, the physical therapy field is feeling it. With the aging baby-boomer generation, this is just going to increase. It’s estimated that there will be 83.7 million adults 65+ by 2050, almost two times the amount of senior citizens in 2012. It’s expected that the senior citizen population will be growing at a faster rate than the working age population.10 Waiting lists in local physical therapy clinics can be as long as two weeks. So, what can we do?
A great option is starting a telehealth side business.
Telehealth is the use of electronic communication to remotely provide health care information and services. While physical therapists have been using it in some cases to help with healthcare access in rural communities, the general health care world has been taking it even further.
Telehealth is projected to grow worldwide to a total of 1.8 millions users this year. Using telehealth is one way to increase cost efficiency when delivering care.(7)
In 2014, the global telehealth market was worth 17.8 billion, and it’s just expected to keep on growing.(9)
Why use a telehealth practice?
So, what does this mean for physical therapists?
First of all, telehealth is not a supplement or replacement for typical physical therapy care. It’s a resource that offers additional options for providers to use.(9) This allows healthcare to be more accessible for individuals and takes some burden off both the patient and provider. For example, patients in a clinical or hospital setting could have their care provided in their homes instead.
It is also great for post discharge communication and checkups.(9) Telehealth is a great option for quick screening, assessment, and the subjective portion of referrals. It also encourages more collaborative care towards the patient-centered medical home(11) because telehealth allows for consultation between providers or during clinical education.
Using telehealth for a more involved HEP process(9) is one of the best ways to optimize patient recovery, and the technological advances allow to a patient to in essence having a "PT in their pocket" for any questions about their treatment. Finally, a telehealth program can allow a physical therapist to expand into the wellness market and preventative medicine. It’s an efficient way to offer these ‘wellness visits.(11)
How do I get patients interested in telehealth?
As a general rule, people aren’t always excited for change. How do you encourage your clients to embrace including telehealth? Greg Todd, founder of Physical Therapy Builder, has the following suggestions. Talk with the patient about the ease that telehealth can provide; like mentioned previously, it’s like having a PT in your pocket.(5)
Similarly, certain telehealth programs, such as the BlueJay smartphone application, can be used by the physical therapist to check on whether a patient is being compliant with their HEP. This app also provides exercise videos and explanations of each item in a HEP; physical therapists can also upload their own videos.(5)
What technology should I use?
Let’s say that you have patients interested in what you can offer with telehealth. Now, you need to determine what telehealth platform you are going to use. Personally, I have the most exposure with BlueJay platform.
From a patient perspective, it is pretty easy to manage. They will receive a link to open their BlueJay account via email. After setting up their demographics and downloading the app, they can open the BlueJay portal. This portal allows for patients to attend virtual appointments, view videos of their HEP, and to message their provider with any questions they have about their POC.
As a physical therapist, this platform allows for communication that is HIPAA compliant, and it allows their personal email/mobile phone number to remain private.(5) There are other options for telehealth platforms, such as eVisit. What is great about the various platforms, is that they all tend to give a free demo! This allows you to pick which platform works best for your clinic and clients.
Update: PT Rob Vining has also reached out to us to share a new service, Telehealth Prime, where PTs can create their own virtual or hybrid telehealth practice! There's also PTLive, an online platform (and app!) that PTs can use to facilitate telehealth.
Are there legalities that I should be aware of?
But what about the legality and licensure of telehealth? It can be complicated, but the good news is that the Physical Therapy Licensure Compact comes into effect in 2018. This allows therapists licensed in one of the participating states to work in one of other 13 states in the agreement without applying for an official state license there. (These participating states are Arizona, Kentucky, Mississippi, Missouri, Montana, North Dakota, Oregon, Tennessee, Utah, Washington, North Carolina, New Hampshire, Texas, and Colorado.) Instead, therapists will apply to the Compact Commission who will determine if the compact privilege will be granted.(4)
How would I bill for telehealth?
The next big topic is billing. How can you bill? First of all, Medicare does not consider physical therapists as one of their approved telehealth providers. (Medicare-approved providers include: physicians, nurse practitioners, physician assistants, nurse midwives, clinical nurse specialists, clinical psychologists, clinical social workers, registered dietitians, and nutritional professionals.)(2)
Medicaid does cover some part of telehealth in 47 states and Washington, D.C.; however, the reimbursement standards vary among the states. The three states without a telehealth statement include: Massachusetts, Rhode Island, and Utah.
The reimbursed services are broken into three main categories(3):
- Live video - The most common approved telehealth form. However, the services covered vary among states. For instance, Connecticut only reimburses for behavioral health of minors while California covers a diverse amount of specialities.(3)
- Store-and-forward - This occurs when clinical information, (things like data, images, sounds, and videos), is first gathered and stored. The clinical information is then forwarded or retrieved by another site for clinical interpretation. There are 9 states that provide reimbursement of this type: Alaska, Arizona, California, Illinois, Minnesota, Mississippi, New Mexico, Virginia, and Washington. However, the services covered vary by state, so reviewing the your state Medicaid guidelines is a must!(3)
- Remote patient monitoring - There are sixteen states that offer these services, but there are special restrictions. The most common restrictions are: only reimbursing for home health, limiting the clinical conditions covered, and limiting the type of monitoring device and the data that can be gathered. The participating states include: Alabama, Alaska, Colorado, Illinois, Indiana, Kansas, Louisiana, Maine, Minnesota, Mississippi, New York, South Carolina, Texas, Utah, Vermont, and Washington.(3)
What if your patient has private insurance?
Again, this varies depending on the contract that the payer has made. Unfortunately, there isn't a list of third party insurances that reimbursement for physical therapy telehealth services. Usually, an addendum to the CPT code is required that states the service was provided through telehealth. Private payers sometimes want a written explanation, so always keep a record of why telehealth was used. Currently, there are no telehealth codes specific to physical therapy; since many traditional CPT codes require direct 1 on 1 patient contact, telehealth services may not be covered unless there is already an agreement with the payer.(2)
Another option clinics have is cash-based telehealth services. Providing cash based services might appear overwhelming, but there are several resources available for learning how to efficiently begin cash based services. One of the best resources that I know of is Aaron LeBauer. He had a free Facebook group with a weekly podcasts as well as courses that he had designed.
When should I charge the patient?
Finally, should you bill initially? Often, some clinics offer a short free telehealth screening for physical therapy or wellness. These can help bring clients into a physical location and encourages buy-in and compliance. In today's busy world, many potential clients want a quick and easy way to know how to address their health and wellness concerns. Direct marketing for a telehealth screening can increase the number of potential clients your clinic may see.
10 steps to getting started!
Lastly, if you are interested in starting a telehealth service, where do you start? You should follow the steps below and ask yourself these questions.
- Evaluate the need in your clinic. Are you in a rural area? Are road conditions difficult during the winter seasons? Are you interested in starting a wellness program? Are clients struggling to find rides to your physical location?
- Survey your current patients to gauge interest. It may not be worth the initial investment if your clients aren't comfortable with telehealth.
- Discuss telehealth with your staff. It's always good to involve staff when making changes to patient care. Some staff may be more interested than others and may be willing to help with the transition.
- Decide on your platform. Contact some of the software platforms mentioned above and all for demos. Find an interface that works best for your needs.
- Run the numbers to see if it’s worth the investment. It's a good idea to consult with your accountant, manager, and telehealth platform provider to get a realistic idea of the upfront and recurring costs.
- Start using the software. Try having a soft opening with your staff and close friends to try out the interface.
- Train your staff. It's a good idea to have an overview on how to use the platform, what your expectations are for your telehealth services, and to solve potential issues ahead of time.
- Get feedback from your staff and patients. Provide surveys and feedback opportunities throughout the patient's plan of care. This provides you will valuable information on how to improve your service. It's also a great way to see what is and isn't working for your patients and staff.
- Modify as needed. It's a good idea to routinely evaluate your telehealth services. What can be improved? How effective is your marketing strategy? What are the new services provided in the different platforms? What are patients asking for, but not getting?
I have collected sources from this article, as well as some for additional reading below. Don't be afraid of telehealth; it's not going anywhere!
Much of what I have learned about physical therapy and online health/wellness, I have learned from Greg Todd, the founder of Physical Therapy Builder. He is a fantastic physical therapist whose mission is to help physical therapy students and physical therapists provide patient focused care without becoming overwhelmed.
Greg Todd is also known as a “social media guru,” and I have a lot of thank him for. I highly suggest his courses, especially Smart Success PT. In May, I attended Smart Success PT Live, a business, marketing, and branding course by some of the top PT entrepreneurs in the field.
Update: Interested in telehealth, but still have some questions? Check out these groups on Facebook:
- TelehealthDPTs, a group for telehealth PTs
- Concierge Telehealth - PT, a group where telehealth PTs can ask questions and seek advice from their fellow practitioners
- Greg Todd Video - Telehealth Visit - Patient Standpoint