Why Physical Therapy Should Embrace Telehealth
Telehealth offers unprecedented levels of access to care for the patient and a low-cost, mass-scaling opportunity for the practice.
By Darwin Fogt, PT, MPT, BS
Telehealth is rapidly gaining popularity on a global scale.
It’s estimated that some 7 million patients used telemedicine services in 2018.1 What is driving this monumental shift? Changes in patients’ behavior, the desire for convenience, and cost savings seem to be the main factors. It is reported that 74 percent of polled patients in the United States would use telehealth if it was offered.2 It has also been shown that U.S. employers could save up to $6 billion per year by providing telemedicine technologies to their employees.3 It is undeniable that this is the future of health care. The earliest adoption of telehealth services has come from behavioral health, dermatology, and primary care.
So, the question arises, what role will our profession play in this new landscape of care delivery? Will we continue to adapt, change, and grow our skill sets to better serve our patients? Or will we cede our patients to other online providers? Telehealth and physical therapy can no longer be considered a conceptual curiosity. Practice owners can no longer afford to devote just a passing interest to this new delivery approach. Rapidly changing insurance landscapes, new patient markets, and competition are all driving telehealth to the forefront. What was once thought to be a novel speculative idea has manifested its way to our profession. It has never been a more exciting time to be a physical therapist. We are on the cusp of innovation that will transform the profession and fundamentally change the way patients receive care. Physical therapy must play a role in musculoskeletal care via telehealth.
The list of challenges for physical therapy practices is long and growing. We continue to struggle to be accepted as primary care clinicians for musculoskeletal injuries. Patients opt instead for management at urgent care centers and emergency rooms, and with primary care physicians, which generally triggers unnecessary and costly interventions like imaging and prescription medication. Our increased cost of doing business coupled with ever-shrinking insurance reimbursements slice away at our margins. We continue to lose revenue from patient cancellations due to adverse weather, transportation issues, and work and family commitments. The newer generation of physical therapists has different expectations and motivations regarding work and are placing more value on flexible working conditions and establishing a better work/life balance. In traditional care models, it is difficult to remain connected with discharged patients to continue brand promotion and providing postdischarge services. By incorporating telehealth to traditional brick and mortar practices, many of these problems can be mitigated, and indeed other opportunities arise that will allow the forward-thinking practice owner to thrive in this emerging marketplace.
A telehealth component to a traditional model allows almost instant access for a patient to receive care from a physical therapist. Many times, patients who are experiencing musculoskeletal discomfort can be assessed through a video evaluation and prescribed exercises that will help resolve their issue. Other times, patients may just need a quick answer to a question regarding stretching or postural education. Due to the unparalleled access to care, patients who might have otherwise sought care for low back pain from an urgent care center, for example, won’t have to absorb those costly interventions, and they are saved the time and effort of getting themselves to a care center.
The benefit of this instant access to care gives us a distinct competitive advantage by being able to connect with our community both near and far. Now a clinic does not have to be confined to the four walls of a brick and mortar location. Historically, a clinic can draw patients from a defined radius around the location. However, a “virtual” clinic allows the practice to draw patients into a secure telehealth environment hundreds of miles away from the physical location. Rural communities that may not have a physical therapist within miles can now access a physical therapist’s expertise through a technology platform to get the help the patients need. With telehealth, the reach stretches to the borders of the physical therapist’s state of licensure (and into other states if the therapist has multiple state licenses). The momentum of the PT Licensure Compact (see ptcompact.org) makes this reach even more substantial, and the opportunity for scaling is unprecedented. Because of physical therapy’s more active approach to restoring a patient’s long-term functional status, we are able to make assessments regarding movement dysfunctions and prescribe therapeutic exercises remotely. Other clinicians who rely on more passive approaches to rehabilitation are not able to take advantage of telehealth the way that physical therapists can. And if we provide the most convenient, expedient care to the patient, if we are able to be one click away from seeing a patient in a virtual treatment room, we have the advantage. Additionally, the cost of delivering care via technology is a fraction of that of a physical location while using only minimal resources.
Patient cancellations and no-shows are a problem that all practice owners must contend with. Storm fronts and polar vortexes may force a practice to close its doors for days. Afternoon appointments can trickle off a physical therapist’s schedule as work and other commitments come up in our patients’ lives as the day goes on. Sick children, pets, traffic, and parking are all factors that may prevent a patient from coming into the clinic to get the care they need. With telehealth, if one of these events does arise, the patient may be suitable for a telehealth visit where the physical therapists can meet the patient online, assess progress, modify or create exercises for the patient, and then monitor the patient as they perform the assigned exercises. Patients would be able to get the care they need from their home or worksite, and the practice would not lose that appointment and revenue.
The Millennial physical therapists are here. There has been a lot of discussion and studies regarding characteristics of this generation. What seems to be commonly accepted is that these employees (born between 1981 and 1996) tend to value flexibility with regard to work, be more lifestyle oriented, are tech-savvy, and are entrepreneurial. In order to effectively recruit and retain talented physical therapists, these values and motivations must be considered. Indeed, offering a telehealth option to a practice would allow a PT to work from home, establish hours outside of traditional clinical hours including weekends, and allow them to treat patients using technology that they are familiar and comfortable with.
Practices that have no tool to connect with discharged patients are losing out on a critical source of additional revenue. How many times have patients “self-discharged” and been lost from the physical therapist’s schedule? With telerehab, the patients remain in the ecosystem of the “virtual” clinic. Retaining these patients who are only a click away from physical therapy care is invaluable. Cash-based, postdischarge maintenance programs can easily be delivered via telehealth. This accessible way for a discharged patient to get answers to any questions or discuss other injuries with your physical therapists keeps them invested in their health and committed to your practice. In addition, informative lectures and real-time online virtual group classes are now possible as a new revenue stream. Engaging patients through the continuum of care has never been easier, and it allows our profession to continue to establish ourselves as the experts in movement and exercise.
Of course, a telehealth approach will not be able to effectively treat 100 percent of patients requiring physical therapy. More complex patient presentations and comorbidities might make a patient unsafe in an exclusively online episode of care. And there are certainly benefits to manual therapy, passive modalities, and medications to address pain and to achieve short-term success. It’s important to assess each patient to ensure that online treatments are indicated. Sometimes a hybrid adoption of telehealth where a patient has in-clinic appointments as well as online treatments is the best approach.
There will undoubtedly be hesitation from some clinicians who favor more conventional physical therapy methodologies. However, technology is changing the world we live in—including the way we access medical care. We have an incredible opportunity in front of us to expand our reach. Telehealth achieves the Institute for Healthcare Improvement’s Triple Aim. The profession and the population stand to benefit substantially by optimizing telehealth services. Let’s make physical therapy the future of musculoskeletal management today.
3www.towerswatson.com/en/Press/2014/08/current-telemedicine-technology-could-mean-big-savings. Accessed April 2019.
Darwin Fogt, PT, MPT, BS, is a PPS member and the founder and chief executive officer of Phzio.com, an online telerehab platform. He can be reached at email@example.com.
*This author has a professional affiliation with this subject.