I n my previous article I discussed the significant challenges facing the field of physical therapy as it scales to meet the demands over the next decade. I broke down America’s aging society, complications of acute rehab sessions, as well as emerging tech solutions that will ultimately save our rehabilitation system.

On March 11th, 2020, the World Health Organization officially amended its designation of COVID-19, from an epidemic to a pandemic. As you might expect, this virus has triggered unprecedented reforms to the U.S. healthcare system to counteract the spread. These new policy revisions have propelled some of the tech solutions I discussed in my previous article, from early concepts to reality; practically overnight.

Prior to COVID-19 entering the picture, the issues of scalability, lack of modernization, and a rapidly aging society was already beginning to weigh on healthcare, especially physical therapy. Nevertheless, this pandemic has triggered meaningful progress and changes to healthcare definitions Nationwide, boosting the concept of digital health platforms and communications tools to new horizons.

Synopsis of U.S. Demographics:

Before diving into the changes to telemedicine and patient care, consider the current landscape:

  • One in four U.S. adults have two or more chronic conditions
  • More than 50% of older adults have three or more chronic conditions
  • 62 million adults are 65 and older or roughly 16% of the U.S. population
  • U.S. Census Bureau projects by 2050, 22% of the U.S. society will be 65 and older
  • 10,000 Americans turn 65 each day through the end of 2029

When examining patient care, the outlook is similarly disconcerting:

  • The average outpatient course of care is only seven to ten sessions in total
  • Reimbursement rates (as well as the number of payer-approved visits) have remained mostly stagnant – and in some cases, decreasing
  • Only 30% of patients who receive outpatient rehab attend all insurance covered visits

Ultimately the statistics above will be the catalyst for change, modernizing and revamping the way we treat patients in the US. Nevertheless, public opinion, technology, and stagnate policies evolve during extraordinary times.

New Policies:

On March 17th, as part of loosening requirements, the US Centers for Medicare and Medicaid Services’ (CMS) approved the expansion of telehealth and patient-initiated digital communication (5,6). This change was primarily motivated by guidance from the White House, CDC, American Medical Association, and other governing bodies to allow for remote and easier access to care while maintaining social distancing guidelines. These revisions ensure that the most vulnerable of our society are still able to receive the medical care they require while helping tame the spread of the virus.

CMS decided to immediately remove Medicare telehealth restrictions, allowing physical therapists to provide e-visits initiated by patients for the first time. Accordingly, e-visits are defined as “non face-to-face patient-initiated digital communications that require a clinical decision,” that otherwise would have been assessed in a doctor’s office (2,5). Under the new waiver guidelines, Medicare beneficiaries can now qualify for e-visits irrespective of their geographic location, receiving care from the comfort of their homes (5,6).

This announcement coincides with the Health and Human Services Department March 18th report, temporarily allowing healthcare providers to practice across state lines – a move that eliminates a key barrier towards the continued adoption of telemedicine and digital health platforms (1).

Additionally, the Centers for Disease Control and Prevention is calling on health care facilities to use telemedicine and “other remote methods of triaging, assessing, and caring for all patients to decrease the volume of persons seeking care in facilities.”

Nationally, we are seeing a rise in private rehab clinics switching to mostly telemedicine visits following social distancing guidelines and continued care (3). In fact, several states are waiving a host of regulatory requirements for healthcare professionals licensed in other jurisdictions to practice across state lines (4). With the federal government calling on states to relax telemedicine regulations, most experts agree this removes fundamental barriers previously blocking the growth of digital remote treatment and communication (1,7).

What this means for P.T.’s:

CMS had previously not recognized physical therapists among health professionals allowed to bill codes associated with e-visits, as P.T.’s had largely remained outside of “1135 waivers” related to telehealth. The new CMS code suggests the policies are intended to cover short-term assessments that are conducted online and include associated clinical decision-making (5,6).

CMS was already heading towards new and less restrictive guidelines for telemedicine before the virus, as it began covering ‘virtual check-ins’ and short patient-initiated communications under Medicare Part B. Nonetheless, these changes lifted the remaining blockades for patients seeking remote rehab care with a practitioner.

In Summary:

We’re undergoing changes to healthcare policies yet to be seen in 21st-century medicine. While many of these reforms will be temporary for the foreseeable future, the impact on tech advancements, digital health platforms, and prospective policies will last for decades to come. Given the current crisis, people will have to adopt remote medicine, but leading experts agree this movement will propel digital health systems to new horizons.

For more information on P.T. requirements for e-visit, please see below;

To qualify a P.T. session as an e-visit, three basic qualifications must be met:

  1. The billing practice must have an established relationship with the patient, meaning the provider must have an existing provider-patient relationship
  2. The patient must initiate the inquiry for an e-visit and verbally consent to check-in services
  3. The communication must be limited to seven days through an online patient portal.

Physical Therapists will be allowed to bill for e-visits under codes associated with online assessment and management services (codes G2061, G2062, and G2063). (5,6,7).

References:

https://mhealthintelligence.com/news/feds-ok-interstate-licensing-paving-way-for-telehealth-expansion

https://www.capemaycountyherald.com/lifestyle/health_and_wellness/article_1c923062-6aef-11ea-8fa2-4fc071f7690c.html

https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet

https://www.proactiveinvestors.com/companies/news/915348/ewellness-hails-cms-move-to-allow-digital-communication-e-visits-by-physical-therapists-915348.html

https://www.businessinsurance.com/article/20200318/NEWS08/912333584/Telemedicine-offerings-to-rise-with-coronavirus-quarantine-CDC-Ohio-Bureau-of-Wo

Colin Reno

Colin Reno

Board-Certified Exercise Physiologist; Sports Science & Technology Consultant. Follow on Instagram: @colin_reno

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