Telerehabilitation
Considerations for utilizing telehealth in physical therapy private practice.
By Paul J. Welk, PT, JD
February 2015
“Telehealth,” sometimes referred to in the physical therapy setting as “telerehabilitation,” is defined in the physical therapy context as “providing physical therapy via electronic communication where the physical therapist or physical therapist assistant and the patient are not in the same location.”1 Telehealth has become a frequent topic of discussion in physical therapy as providers seek to adapt and broaden the services provided to patients. In recognition of the importance of addressing telehealth issues, at its 2014 House of Delegates, the American Physical Therapy Association (APTA) passed RC 8-14, which provides in part that “it is the position of the APTA that telehealth is an appropriate model of service delivery for the profession of physical therapy when provided in a manner consistent with association positions, standards, guidelines, policies, procedures, Standards of Practice for Physical Therapy, Code of Ethics for the Physical Therapist, Standards of Ethical Conduct for the Physical Therapist Assistant, the Guide to Physical Therapist Practice, and APTA Telehealth Definitions and Guidelines; as well as federal, state, and local regulations.”2
Four key issues exist for private practices should they wish to explore implementing telehealth services.
1. State Law and Regulation. Only a limited number of states have telehealth legislation and regulation that specifically address physical therapy practice.3 These states include, among others, Alaska and Washington. By way of example as to how telehealth is regulated in the physical therapy context, Washington allows the use of telehealth in the practice of physical therapy by both physical therapists and physical therapy assistants. Among other requirements, the Washington regulations mandate that the physical therapist or physical therapy assistant identify in the record that physical therapy occurred via telehealth.4 Alaska allows for the provision of physical therapy via telehealth to patients who are located at distant sites in the state, which are not in close proximity to a physical therapist. The regulations further provide that the physical therapist must be present in the state while performing telehealth and provides that telehealth may be conducted for one-on-one consultations, including initial evaluations.5
The somewhat obvious conclusion drawn from the above information is that the majority of jurisdictions do not have specific laws or regulations governing telerehabilitation. Regardless of whether a jurisdiction has extensive regulation on telerehabilitation or none at all, providing telerehabilitation inconsistent with applicable statutes or regulations puts the licensed physical therapist at risk of regulatory action. For this reason, it is important for any practice that desires to start a telehealth program, to review applicable state laws and regulations, including applicable licensure laws, as well as any guidance available from the jurisdiction’s licensure board. In addition to understanding what qualifies as telehealth under state law and regulation, it is important to understand what may be permissible without falling within the regulatory realm of telehealth. For example, state law and regulation may expressly permit a non-face-to-face discussion between physical therapists regarding the care of one therapist’s patient.
2. HIPAA and Privacy Compliance. To provide telehealth services in compliance with applicable state and federal privacy standards, physical therapy practices will need to consider a number of issues related to technology, privacy and security.6 These considerations may include developing policies for the provision of telehealth services and engaging appropriate professionals to assure that the platform for providing such services complies with HIPAA and other legal requirements. Practices must also assure that there are secure communication channels through which to provide the telehealth services and that, where appropriate, confidentiality and/or business associate agreements are entered into with relevant service providers. Private practitioners need only to read the daily newspaper to see the risks associated with a breach of the privacy of patients’ and customers’ personal information.
3. Professional Liability and Insurance. Prior to providing any telehealth services, practices and their providers should assure that they have adequate professional liability insurance to cover such services. Failure to secure adequate professional liability insurance coverage puts the practice and the provider at risk. Given that telehealth is a somewhat emerging issue across the national landscape, professional liability insurance products may have not yet adapted to cover telerehabilitation services. In addition to professional liability issues, practices may also wish to consider whether securing cyber liability insurance or other similar coverage is appropriate. Cyber liability is the risk posed by conducting business over the internet, over other networks, or using electronic storage technology. By way of example, a private practice may be subject to a cyber liability claim asserted by a patient whose personal information has been breached.7
4. Reimbursement. Governmental payers have differing views on the reimbursement of telehealth services. Medicare does not pay for telehealth provided by physical therapists.8 However, in the Medicaid context, 44 states reimburse for live videos and 10 states reimburse for remote patient monitoring provided by certain health care providers. Specific to telerehabilitation, the Arizona, Minnesota, and New Mexico Medicaid programs reimburse physical therapists for telehealth.9 When seeking reimbursement from private insurance companies for telehealth services, it is important to review the practice’s payer contracts to determine if telehealth services provided by physical therapists are a covered benefit. It is also important to determine the appropriate coding required by private insurers to ensure that there is a mutual agreement on the codes that may be used for services. Failure to confirm that reimbursement is available or to properly submit appropriate billing codes for telerehabilitation may result in costly audits and other related issues.
In summary, telehealth provides both unique opportunities and unique challenges to private practice physical therapists. As physical therapy providers enter into this area of practice, they must be cognizant of the issues that need to be considered to maintain compliance.
REFERENCES
1. WAC 246-915-187 (2014).
2. See APTA 2014 House of Delegates Meeting Minutes available at www.apta.org/HOD. Accessed November 16, 2014.
3. www.apta.org/telehealth/legislationregulation Accessed November 3, 2014.
4. WAC 246-915-187 (Accessed November 3, 2014).
5. 12 Alaska Admin. Code 54.530 (Accessed November 3, 2014).
6. See www.hhs.gov/ocr/privacy/ Accessed November 20, 2014) for extensive resources related to HIPAA compliance.
7. www.filetransferglossary.com/cyber-liability Accessed November 15, 2014.
8. www.apta.org/telehealth/billingcoding. Accessed November 3, 2014.
9. www.fsbpt.org/Portals/0/Content%20Manager/PDFs/Forum/Forum-Spring2014-The_integration_of_Telehealth.pdf Accessed November 16, 2014.
Paul Welk, PT, JD, is a PPS member and an attorney with Tucker Arensberg, P.C., where he frequently advises physical therapy private practices in the areas of corporate and health care law. He can be reached at pwelk@tuckerlaw.com.