Telehealth Flashcards
Definition of telehealth
The provision of healthcare remotely by means of telecommunications technology to support long-distance clinical health care, professional health-related education, public health, and health administration.
Telehealth concerns from APTA
- Caution with increase in companies entering the digital space with products and services for Telehealth care delivery and monitoring
- Some offer technologies that are valuable adjuncts to PT care
- Others offer services without interventions of a licensed PT but are representing themselves as PTs to address MSK issues
- Technology is not a virtual skilled provider or service
- Technologies designed to gather data for analysis or to support patients in the effective performance of ex or activities that are not PT
Advantages of telehealth
- Increase patient access: rural places, transportation issues/decreased travel time/costs, accommodates varied schedules, access to patients in new geographies
- Control of infectious illness
- Continuity of care for traveling patients
- Family connections
Disadvantages of telehealth
- Not every type of visit is appropriate
- Technology: lack there of, issues/comfort with tech, lack of equipment, video fatigue
- Issues with developing relationships
- No hands-on care
- Security
- Emergency situations
Telehealth and medicare?
PTs do not have permanent telehealth privileges to see medicare patients
Congress extended current temporary ability of therapists to use telehealth under medicare until 12/31/2024
Telehealth billing/reimbursement
- Rapidly changing since mid-march 2020
- Currently being covered by most payers with the use of a modifier (95) to indicate telehealth services. Some codes, such as manual therapy, are not allowed.
Telehealth visits — all payer
- No telehealth CPT codes: use same codes as in person plus the 95 modifier
- Real time two way audio/video platform that meets HIPPA requirements
- Best judgement to determine which services and associated treatment and measure that can be realistically performed.
Modifiers for telehealth
- 95 — real time synchronous services
- 02 — place of service code, services provided other than in a patient’s home
- 10 — NEW PLACE OF SERVICE CODE, telehealth provided in patient’s home (effective 04/04/2022)
- CR — services were disaster related
How is telehealth impacted by location
The patient must be located in the state in which the PT is licensed during the telehealth session.
PT can be anywhere
What is the PT compact
An agreement between member states to improve access to PT services for the public by increasing the mobility of eligible physical therapy providers to work in multiple states
Applies to in person and telehealth therapy sessions
Illinois isn’t in it yet but working on it
Telehealth documentation?
Same as in person but add a few items like..
1. Record time and length of session
2. Tech used
3. Specific consent
Telehealth software
COVID put in “good faith” rule for telehealth
Secured HIPPA compliant platforms recommended that you enter into a business associate agreement
Ex: WebEx, eHAB, WEBPT
Best evidence if medicare works before pandemic?
VA had the research before the pandemic: signficant improvements in mobility, cognition, self care and QOL measures for rural dwelling veterans with MSK and Neuro disease
Some research in Medicaid and rural based settings prior to pandemic.
Goni on telehealth
Reliable and valid for a variety of diagnosis using internet based tool.
Mild-mod severe examples
Also appropriate in patients that have had a stroke — specifically looking at hemiplegia shoulder ROM
Total joint replacements and telehealth compared to normal services
Patients were satisfied with no significant difference between groups
PT’s satisfaction with regard to goal achievement, patient-therapist relationship, and overall session satisfaction and quality and performance of tech platform was HIGH
LBP
- High levels of agreement in identifying pain with specific lumbar movements, eliciting symptoms, and with discerning response to SLR
- Moderate agreement with detecting which the relationship of the direction of spine movements and pain, SLR range of motion, and active lumbar spine range of motion
- Poor agreement with postural analysis and identifying limitations to lumbar movements.
Stoke and telehealth
Moderate evidence that telerehab of all approaches has equal effects with conventional rehab in improving abilities of ADLs and motor function for stroke survivors
SCI and telehealth
Positive outcomes with virtual wheelchair fitting with high client satisfaction, goal attainment, improvement in time to access vs. Traditional in person clinic appointments
High-dose scapular stabilizer and rotator cuff strengthening program using telerehab for supervision holds promise for shoulder pain treatment in manual wheelchair users with SCI.
Pulmonary conditions and telehealth
Pulmonary rehab programs delivered by telehealth produce results comparable to those of traditional hospital-based programs and exceed the effectiveness of traditional programs in decreasing emergency room usage.
ALS and telehealth
Good esp for people with ALS that live in the middle of nowhere.
Facilitates interdisciplinary care.
Telehealth and collaboration
- Asynchronous, consultative, provider - to provider communications within a shared electronic health record or web based platform
- Timely access to specialty care and was well received by PCPs
- Telehealth may offer other avenues of providing specialty consultations and recommendations to PCP within a patient centered framework.
What’s different with the PT treatment via telehealth
- Primarily active treatment
- Focused on self-efficacy and self-management
- Far less reliant on passive therapies
Providers experience with older adults and telehealth
- Allowed older adults to receive care while aging in place
- Eliminates need for older adults to travel to and from appointments
- Reduces potentially harmful exposure
- Affords more connection between provider, patient, and family
- Reduces the stress on family/caregivers
- Enables easier/faster access to providers
- Reduces costs for patients
barriers to telehealth
- Payment
- Regulation
- Access to hardware/software
- Lack of familiarity with tech
- Therapist POV
- Patient POV
Telehealth blunders (what does this mean)
- Lack of clear communication
- Unfamiliar with tech
- Space to exercise
- Subpar audio
- Poor lighting
- Slow internet connection
- Lack of private space for practitioners - HIPPA
Telehealth - what have we learned?
- HEP resources — medbridge
- Therapeutic alliance
- Therapist attitudes regarding value and billing
- Special consideration during social distancing
- Evidence for telehealth - good
- Can be difficult sell
- Use guided palpation, precise instructions, and functional testing
- Consider set up and set expectations
- Determine when hybrid is necessary
- Develop emergency procured rules
Webside manner
- Recognize delay
- Slow down, leave room for thinking, discussion and questions
- Look directly into the camera
- Consider your enviornment
- Neutral clothing
- Space so you can move around to demonstrate action/activity
- Plan ahead
