Telehealth, by definition, is the provision of healthcare information and services at a distance, with the help of telecommunications technologies. This definition applies to a broad range of applications – from simple use cases such as a phone or video consultation with a provider, up-to advanced use cases where providers are able to deliver advanced care remotely, without the need for the patient to be present, but with all the benefits of an in-person visit. So, while the technical elements of telehealth have made huge strides in recent years, State and Federal legislative policies have not kept pace with the evolution of technology, and thus have slowed the adoption of telehealth by healthcare providers.
The changing landscape of healthcare policy
Providers like Physical Therapists face particular challenges with the delivery of physical therapy services due to restrictive policies related to cross-border practice & reimbursement of procedures coded as telehealth services. However, 2017 represents a pivotal year for progressive change in the policy landscape. A number of key pieces of legislation were passed at the state level, while major Federal policy initiatives have been introduced and are moving rapidly through the legislative process.
Three major telehealth policy initiatives that physical therapists should be aware about, and their impacts on the future of their profession and on public health are discussed below:
1.] Physical Therapy Licensure Compact (April 2017)
Prior to April 2017, physical therapists and physical therapy assistants could not use home state licenses to deliver healthcare services across state borders. This was a barrier for patients in remote locations in which the preferred healthcare provider for physical therapy services was based in another state. With the absence of a national license, and given the difficult and costly process of obtaining multiple licenses, both physical therapists and patients were handicapped in the provision of and access to quality care.
The Physical Therapy Licensure Compact (PTC) was championed by the Federation of State Boards of Physical Therapy (FSBPT) to enact legislation which reduces regulatory barriers to interstate mobility and cross-state practice. Physical therapists in states which have enacted this legislation can expand their services to patients in member states of this compact with just their original state license.
This Physical Therapy Licensure Compact paves the way for broader adoption of telehealth platforms which was previously confined within state borders by regulatory complications. Now, technology-enabled remote physical therapy services can be provided to patients who have limited mobility – such as early-stage patients in post-stroke rehabilitation programs- without requiring the physical therapist or patient to physically cross state borders. This development has dramatically reduced the cost & logistical burden of providing physical therapy service and increased public access to affordable healthcare.
With Colorado, Kentucky, Mississippi, Montana, New Hampshire, North Carolina, North Dakota, Texas, Utah, and Washington signing PTC into law by April 2017, the Compact was formalized with the creation of the Physical Therapy Compact Commission. As of February 13, 2018, 15 states have enacted the compact legislation and 8 states have introduced the bill on the house floor.
Check out the map below to learn the status of legislation in your own state.
Image courtesy: www.fsbpt.org
2.] CONNECT for Health Act of 2017
Medicare currently allows reimbursement for services which do not include those provided by physical therapists. The Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2017 was introduced onto the floor of Congress in May 2017 to expand the access to telehealth services by providing authority to the HHS secretary to issue waivers enabling physical therapists to provide reimbursable telehealth services.
The bill introduced legislation to reduce limitations on health care provider type, limitations on telehealth specific codes, restrictions on qualifying originating sites, geographic limitations and limitations on the use of store-and-forward technologies. The bill allows for the possibility of including Physical Therapists in the approved list of healthcare providers who may be reimbursed for dispensing remote services. With the inclusion of additional codes designated for telehealth services, PTs can expand the suite of services, providing patients improved access to the services best suited to their needs. The bill also expands the definition of qualifying originating sites, including the homes of patients, further expanding access to care via telehealth.
Finally, reducing the limitations on the use of store-and-forward technologies will significantly improve the incorporation of frontier healthcare technology in the delivery of physical therapy services and reduce costs by optimizing utilization. Healthcare platforms that employ store-and-forward technologies enable the asynchronous, remote delivery of care. As such, Physical Therapists provide patient care at a distance, and patients can receive timely support without enduring the travel and wait time associated with a traditional visit.
In addition, this bill allows telehealth services and remote patient monitoring services to be included in bundled payment and global payment models. This provision aligns with the shift from volume-based care to value-based care, thus enabling Physical Therapists to provide patients with better outcomes at a lower cost.
As of the date the bill has been referred to the Subcommittee of Health. Check the current status here.
3.] Medicare Telehealth Parity Act of 2017
The Medicare Telehealth Parity Act of 2017 has the potential to enable physical therapists to improve their practice by offering telehealth services covered by Medicare.
The Medicare Telehealth Parity Act of 2017 proposes an incremental expansion of telehealth coverage under Medicare. It aims explicitly to increase the scope of coverage by including additional telehealth providers such as physical therapists and occupational therapists, and by reimbursing telehealth services provided by these professionals. The bill unfolds in a three-stage, phased expansion. The initial phase includes the expansion of approved originating sites with the addition of new sites – such as any federally qualified health center or rural health clinic. The inclusion of additional telehealth providers and services is a part of this initial phase. In addition, rural health clinics and federally qualified health clinics will be authorized to act as distant sites under the initial phase plan in this bill. This will allow PTs to provide telehealth services covered by Medicare from these locations.
The second phase of this plan adds the home telehealth site as an eligible originating site, which allows PTs to serve a patient while the patient remains in the home. The third and final phase of this plan further expands the roster of originating sites while adding coverage for remote patient monitoring services for certain chronic health conditions.
Overall, the Medicare Telehealth Parity Act of 2017 is poised to reduce the regulatory hurdles in the way of patients, who desire affordable and accessible physical therapy, and their PTs, who are ready to help their patients by adopting new telehealth solutions. The bill had been introduced in June 2017 and is currently under review by the Subcommittee of Health. Check out its current status here.
The way forward
Wider adoption of the PT licensure adoption compact by the states in US and the successful signing of the ‘CONNECT for Health Act’ and the ‘Medical Telehealth Parity Act’ into law will pave the way for the much needed proliferation of accessible and affordable care. These legislative changes can bridge the growing gap between outdated healthcare policy and newer aspects of modern healthcare, such as the growing preference of patients for mobile healthcare and the advent of new technologies now revolutionizing the delivery of healthcare.
BioVirtua is an example of technology helping Physical Therapists to provide telehealth services and value-based care to their customers. By adopting a telehealth solution platform such as BioVirtua, PTs will be in a position to leverage the upcoming policy changes.
BioVirtua sequences human movement, in-person and remotely without using wearable sensors to unlock quantifiable insights for identifying abnormalities, rehabilitation, and human performance.
Biovirtua is a firm believer in one of the most simple and efficient ways of improving healthcare: focusing on the patient, and doing so in a straightforward way. The company’s primary mission is to promote the accuracy and precision of both remote and in-person care of persons with acute and chronic medical conditions by leveraging innovations in software, hardware, and by listening to the patient. BioVirtua is led by a team of experts in healthcare, technology and big data applications.
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