Pandemic and PT: Why Now is the Time for Telehealth Advocacy in Rehab

UPDATE: As of March 17, 2020, CMS has implemented temporary measures that allow greater use and reimbursement of telehealth for rehab therapists. Read more in this blog post.

For many of us, the past couple of weeks have been surreal—almost dystopian. We have gone from living our lives as normal—observing the freedoms and routines most of us take for granted—to considering every potential action and activity through a new, exceptionally cautious lens. In the interest of keeping ourselves, our loved ones, and our communities as healthy as possible, we’ve introduced a new term in our vocabulary—“social-distancing”—and canceled events, meetings, social engagements, and appointments. And the more people stay home, the less they frequent the businesses they would normally support—including the clinics where they are receiving rehab therapy treatment.

Our most vulnerable patients are forgoing medically necessary care.

Rehab therapy clinics across the country are experiencing massive drop-offs in patient attendance. In just a week’s time—from the week of March 2 to the week of March 9—WebPT users saw 10.4% fewer patients, and we expect to see that percentage plummet even further in the coming week. Whether they are canceling scheduled appointments or holding off on booking additional visits, patients are embracing the preventive advice we’ve all received over the last several days—and rightly so. That’s especially true for those patients in high-risk populations, like diabetics and the elderly. Unfortunately, many of those patients are the ones who need our care the most—and while we certainly cannot fault them for making what could be, quite literally, a life-or-death decision as they opt to stay home, we also wrestle with the long-term musculoskeletal health implications of abruptly halting their rehab therapy plans of care.

The projected decline in patient attendance will have major ramifications for not only business viability, but also population health. 

At the same time, we wrestle with the very real—and very serious—impact to our livelihood. How will clinics stay afloat amid such a rapid decline in billable visits? How can we even begin to develop a strategy when we have no idea how long this pandemic will last or how much worse it’ll get?

Perhaps the hardest thing to come to terms with is that while healthcare providers in many other disciplines have an incredibly simple solution to these challenges—telehealth—physical, occupational, and speech therapists are not widely granted the ability to conduct and bill for virtual visits. Medicare has explicitly omitted rehab therapists from its list of telehealth-eligible providers, state law is largely vague or silent on the matter, and commercial insurances vary wildly in their telehealth policies and requirements.

Telehealth advocacy has not been a universal priority—until now. 

Until now, this has not been a priority issue for many of us. Rehab therapy is hands-on, we posited; that is our differentiator—our value proposition. Our patients simply can’t experience the full benefit of our services when they receive treatment remotely. And while I don’t think any of us could have predicted the situation we’re facing, it should definitely shift our perspective on the matter now. Suddenly, telehealth is our only viable solution to ensuring care continuity for some of our most vulnerable patients. Unfortunately, the majority of clinics are not equipped for telerehab, and even if they are, rehab therapy providers cannot universally receive payment for it outside of cash-pay arrangements.

Of course, hindsight is always 20/20. Clearly, we should have been pushing harder for more rehab-inclusive telehealth policies before we found ourselves in the throes of a crisis. But, we didn’t. And now, we must.

Your industry—and your patients—are depending on your swift action in this time of crisis.

The timeliness of this advocacy push is unprecedented. Our patients’ health and wellbeing is hanging in the balance, and the entire US healthcare system is scrambling to meet the changing needs of patients across the nation—and the stakes are escalating with each passing day. The iron is hot, my fellow rehab therapists. And it’s time for us to strike—with force, conviction, and heart. To that end, the Private Practice Section (PPS) of the APTA is organizing a lobbying effort to support the prompt passage of telehealth legislation that would empower us to meet the urgent needs of our patients—and help mitigate the potentially crippling revenue losses we are currently staring down. I am urging you to assist with this effort in any way possible. Specifically, PPS is asking rehab therapy organizations to:

• Supply data on patient volume and cancellation rates (particularly in comparison to the same figures at this time last year);
• Denote which payers currently reimburse for rehab therapy services delivered via telehealth (and what is required to obtain payment); and
• Detail how rehab therapy clinics could be using telehealth to the benefit of Medicare beneficiaries during this public health emergency—and how the inability to do so is impacting health outcomes for those beneficiaries.

Regardless of whether you’re an APTA member, I implore you to contribute to this effort in any way possible. Send all applicable information to info@ppsapta.org. Keep in mind that this call is not PPS-exclusive. Even if you aren’t part of PPS, your participation matters. So please, share what you can. And while you’re at it, keep your state and federal congressional leaders apprised of this situation—and encourage your patients to advocate for their own benefits as well. The APTA has already created a template that allows constituents to easily message their representatives to request legislative support on this crucial issue. You can access it from this APTA page.

We've also created template letters you can download, sign, and send to CMS to advocate for rehab therapists to be included on the list of Medicare-authorized telehealth providers. You can access those from our downloads. We will also continue providing updated information on the impact rehab therapy clinics are feeling across the nation so you can create informed strategies as the situation evolves.

In crisis, the strong find opportunity—and if there’s one thing I know about rehab therapists, it’s that we exhibit a rare strength unique to not only the healthcare industry, but humankind in general. First and foremost, focus on doing what you can to keep your business going and get your patients the care they need. But let’s not let this advocacy opportunity pass us by. It’s a huge chance for us to secure a better, brighter future for our practices, our profession, and most importantly, our patients.