The Data-Backed Case for Continued PT Telehealth Coverage

We’ve talked at length about nearly every aspect of telehealth as it relates to physical therapy: its advantages, its shortcomings, how to bill for it, how to launch and market it—the list goes on. However, there’s one angle we’ve yet to cover, and it’s perhaps the most important when it comes to the future of telehealth in rehab: the case for telehealth’s continued use and coverage in PT.

Why is this critical now? Because as we move closer to the end of the COVID-19 emergency period—and as more clinics reopen their doors to in-person treatment—telehealth’s role in physical therapy treatment becomes less concrete. Plus, Medicare and other payers have indicated that they may eventually discontinue the telehealth coverage they initiated in response to the pandemic. This would be a huge mistake for many reasons, and Bay State Physical Therapy—a therapist-founded, owned, and operated outpatient physical therapy practice with more than 60 clinic locations—has the data to prove it.

A Bit of Background

On March 23, Bay State PT officially launched its telehealth services, conducting routine patient visits through a contracted and HIPAA-compliant telehealth platform. The team’s goal with implementing telehealth was to maintain care access and ensure patient safety during the COVID-19 emergency period. In under three months, Bay State PT went from having delivered zero telehealth visits to 20,000.

Throughout the entire process, the team regularly gathered and reviewed patient feedback to ensure each clinic’s telehealth services aligned with patients’ evolving needs. This inspired Bay State PT to conduct a company-wide survey, in partnership with Northeastern University, to objectively measure telehealth patient satisfaction. (For more detailed analysis of this study, check out this report.)

The clinical outcomes Bay State PT has recorded over the past three months—in conjunction with the results from its patient satisfaction survey—turned the practice’s president and founder, Steven Windwer, DC, PT, from a self-admitted “telehealth skeptic” to a “true believer.” Perhaps more importantly, though, the data also presents an irrefutable case as to why telehealth should remain a permanent fixture in physical therapy. 

Here are some of the most salient takeaways from Bay State PT’s data study:

Patients liked their telehealth experience.

Like Windwer, many therapy providers are leery of telehealth because physical therapy treatment often requires a hands-on approach. So, when introducing telehealth services to their patients, Bay State PT practitioners feared their Net Promoter Score® (NPS®)—a measure of customer satisfaction and loyalty—would take a significant hit. Much to their surprise, the opposite happened.

Patient loyalty and satisfaction scores remained high.

Prior to March 21, 2020, Bay State PT’s average NPS® score was 86.85. However, from March 23 to June 9, 2020 (when the practice began implementing its telehealth services), its average NPS® score rose to 91.25. Patient satisfaction survey results echoed this trend, with 95% of patients indicating that they were either “somewhat satisfied” or “very satisfied” with their telehealth experience. These numbers were nearly as high as Bay State PT’s in-clinic satisfaction scores, which typically average 98%.

What’s more, the clinic’s survey data show that older patients—who are often considered more technology-averse—were just as satisfied with telehealth as their younger counterparts. “We believe our older patient population, who are most at risk for the COVID virus, truly appreciated the speed at which we shifted to telehealth as well as the convenient access and surprisingly effective interaction with our therapists,” explains Windwer.

Many patients still find virtual care preferable to in-clinic visits.

Even though Bay State PT is upholding the CDC’s COVID-19 safety guidelines to a tee, many of the clinic’s patients (39%) are still uncomfortable returning to in-person appointments. By discontinuing telehealth coverage, Medicare and other payers would not only do a disservice to these patients, but also ignore an important shift in how patients want (and in some cases, need) to receive care. And isn’t that the point of value-based care—to provide a positive patient experience?

The flexibility telehealth affords is attractive to a wide variety of patients, such as:

• frequent travelers;
• those who are are sick with a contagious illness;
• patients who have trouble finding childcare;
• older patients with mobility issues; and
• patients with compromised immune systems.

By and large, extending telehealth privileges on a permanent basis—well beyond the end of the pandemic—would allow practices greater scheduling flexibility and support improved plan of care adherence. 

Patients enjoyed greater care access.

It’s well-known that care continuity equates to better health outcomes, higher patient satisfaction rates, and lower healthcare costs. Thus, lapses in care can dramatically impact the ability to effectively treat patients via conservative therapies, which leads to poorer health outcomes and higher costs. 

Patient no-show rates remain lower today than they were before the pandemic.

Although it has its limitations, telehealth gave Bay State PT a way to sustain many of its patients’ care plans from afar while stay-at-home orders were in place—and with inspiring results. The practice’s no-show rate after implementing telehealth dropped from 13% pre-COVID to 8% today. This was a clear indicator that telehealth services were a valuable and convenient option to patients.

“Given the ease and convenience of telehealth, it actually makes a ton of sense that patients would not cancel their appointments at the last minute,” says Windwer. “Furthermore, if something did come up for a patient, it’s very easy for our therapists to squeeze in the appointment at a more convenient time the same day.”

Patients realized downstream cost savings.

Delays in care affect more than just health outcomes—they often come with a higher overall price tag. When treating patients with low back pain, for example, episodic expenses decrease by 55% when these patients receive physical therapy within three days of onset versus 29 or more days after onset.

Patients reached their discharge goals sooner than they did before telehealth was an option.

In Bay State PT’s case, patients realized individual cost savings in shorter courses of care: patients were reaching discharge goals one visit sooner than they were pre-telehealth. That means one less visit payment. 

And when patients experience uninterrupted care, they are more likely to achieve optimal outcomes quicker—which can help them avoid more expensive interventions like surgery down the road.

Telehealth prevents care disruptions that end up costing the entire healthcare system more in the long run.

All of that is to say that telehealth is not just a quick fix that has helped keep practices afloat and patients healthy during this unprecedented crisis—it truly is a sustainable alternative that allows patients to receive care when life prevents them from attending appointments in person. And it’s imperative that the physical therapy community advocate for continued telehealth coverage, as this will enable them to further diversify their services and strengthen the PT industry as a whole.

Take it from Windwer, the aforementioned “telehealth skeptic”: “Although COVID has brought many unforeseen hardships, it’s also brought with it a few bright lights. One of those is telehealth. I hope private payers and Medicare see the light as I have, and resolve to cover telehealth moving forward. If they have any skepticism, then I implore them to dig into the data. With so many lives lost during the pandemic, it would be a shame to lose this opportunity to improve access and lower the overall cost of care.”

Have more questions about applying telehealth in your practice? Wondering what you can do to advocate for its continued coverage in physical therapy? Let us know below and we’ll steer you in the right direction.