Treatment from afar

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As the COVID-19 virus continues to pause our lives and wreaks havoc on the health care system, telehealth is taking center stage with a leading role. This recent rise to prominence is due mostly to the nationwide call for social distancing, especially among those who have the virus or are at an increased risk of contracting it, and as the death toll climbs to over 140,000 people in the United States.

Telehealth, as defined by the American Physical Therapy Association, is the use of electronic communication and technology to remotely provide health care information and services. This form of health care, although recently brought into the spotlight, is not new to the medical space. Health care providers introduced this idea early in the 20th century through phone and radio and further traction was gained in the 1960s and 1970s through the rise of television and NASA funding and in the 1990s through the increased use of smart devices and the internet. Fast forward to current day, as we operate under a public health emergency, nearly half of physicians have reported that they are using some sort of telehealth, up from 18 percent in 2018.

Before the pandemic, health care professionals and patients alike were reluctant to welcome the remote practice of medical care due to the lack of human contact during an evaluation and the feeling that a virtual visit meant a lesser quality of care. Additionally, the most significant barriers to the adoption of telehealth have been the limited coverage and reimbursement by health insurance carriers and the different rules governing telehealth from state to state. In a matter of days, COVID-19 broke down these barriers and required much health care to go virtual. The largest health care payer in the country, The Centers for Medicare and Medicaid Services, temporarily set aside its strict guidelines and allowed for nearly 90 new services, ranging from physical therapy to emergency department visits. The agency also set aside the requirements that a patient and health care provider be in the same state and now allow reimbursement for virtual visits that take place across state borders.

Efficient and effective

Patients and health care providers have also embraced and welcomed the use of telehealth while we navigate our new normal. Telehealth is connecting patients, providers and health systems and practices while eliminating the crowded waiting room and in-person communication. Patients have reported that virtual visits have eliminated the stress of contracting or transmitting the virus by completing their appointment from home and health care providers are pleased with how telehealth minimizes the risk to health care workers and the public in general. The virtual visit has also reduced the workload and stress on the hospitals by allowing patients to be pre-screened, diagnosed and treated without ever setting foot in a facility.

There are also a few benefits of telemedicine that have been overlooked. The virtual visit allows patients access to routine care such as a well visit, annual check-up, prescription refill, injury evaluation, physical therapy or imaging discussion. These important visits were often placed on hold due to fears of leaving the house but are once again are on the rise. Second, telehealth can ensure that residents of areas located many miles from effective health care now can schedule an appointment with health care professionals to access the care that they need. Third, the virtual visit has provided access to health care professionals who would otherwise be inaccessible. Health care professionals and their staffs are at an increased risk for contracting the coronavirus due to their increased exposure to those who have tested positive. Once a provider or staff member becomes infected, they must also enter quarantine which would make them unavailable to assist at a time when they are most needed. Now, through telehealth, during quarantine these providers and their staff have the option to continue to provide care while remaining remote.

Physical and occupational therapy

In 2018 and 2019 only 2 percent and 3 percent, respectively, of physical or occupational therapists were utilizing teletherapy. As COVID-19 began to spread widely and people feared leaving their homes, physical and occupational therapy along with the rest of the medical field dove head first into the telehealth world as a means to provide essential care.

Physical and occupational therapy services were not approved services for reimbursement from insurance payors before the appearance of COVID-19 and social distancing. In March, officials decided that these services could be reimbursed but at significantly lower levels than those for in-person visits and would expire when the public health emergency is lifted. Additionally, the nature of these types of therapies requires a hands-on approach whether through stretching techniques, mobilizations, passive range of motion or assistance in the re-introduction to activities of daily living. Teletherapy as it stands today, with less than ideal or no reimbursement from insurance carriers and the inability to provide hands-on techniques, is not sustainable in the physical and occupational therapy space as a complete therapy program. Instead it should rather be considered as something that is utilized on an “as-needed” basis or a supplemental service.

Telehealth historically gained little traction even though the technology to support it has existed for years. Once thought of as a luxury, the institution of social distancing across the nation has forced health care professionals, whether they were ready or not, into providing a telehealth option if they wanted to continue to see their patients. Now that patients have had a taste of telehealth and with the ease of stay at home restrictions, the question looming over all our heads is whether the virtual visit is here to stay?

Now, telehealth is here to stay but the extent to which it is used will be largely dependent on government regulators and health insurers in regard to reimbursement and limitations in practice.

Studies that have been conducted have shown that telehealth has been received positively by patients albeit the rapid expansion and large learning curve for both the physician and patient, has helped to ease concerns on spread of COVID-19 and has helped to reduce the number of patients flooding the hospitals and urgent cares. Health care professionals have also reported positive experiences with the utilization of telehealth and are now more prepared than ever to continue to provide this service. Now, telehealth is here to stay but the extent to which it is used will be largely dependent on government regulators and health insurers in regard to reimbursement and limitations in practice.

John Gallucci Jr. is president and CEO of JAG-ONE Physical Therapy and the medical coordinator for Major League Soccer, coordinating the medical care of more than 500 professional soccer players. He is the former head trainer of the New York Red Bulls MLS team and is a sports medicine consultant for professional athletes in the NHL, NFL, NBA, MLB, and USA Wrestling.