The Downside of Telehealth for Physical Therapists

They say growth only happens when you get out of your comfort zone, which is why I always try to remain optimistic in the face of major change. After all, change drives creativity and innovation—and for physical therapists, that translates to better and more accessible care for every patient. But let’s get real for a second: change can also be difficult. For every positive, there’s bound to be a negative, but acknowledging that there will be challenges makes it easier to address those difficulties when they arise. With that in mind, I want to talk about a few pitfalls associated with telehealth for physical therapy (and how to address them):

1. It’s literally not “hands-on.”

While most aspects of a telehealth visit aren’t too different from an in-person visit, PTs have to navigate a few unique challenges due to the traditionally hands-on nature of their care. As WebPT’s Director of Product Management Scott Hebert, DPT, explained during a recent telehealth webinar, “For manual therapists out there who like to get their hands on a patient, this does take some learning. Ultimately, your creativity is what’s going to help you here.”

The Fix: Get creative with outcome assessments.

Hebert recommends taking advantage of functional movement assessments as well as patient-reported outcome assessments—and asking patients questions about their comfort and ease while performing each movement. “Basic functional movement patterns are super easy to utilize. Just by doing those things, we can identify [for example] if there’s weakness in one hip versus the other and start making recommendations for our ultimate assessment.”

2. Patients may not buy in right away.

Adapting to new technology isn’t second nature to everyone. While many patients jump at the chance to take advantage of remote services and the convenience they offer, others may be hesitant to try something that pushes them out of their comfort zone. This can be especially challenging for patients who are less experienced using a computer.

The Fix: Experiment with a hybrid model.

You may need to do a little convincing to get certain patients on board with trying this method of care delivery, and that may require a little creativity on your part. One alternative could be offering a hybrid model where you assess the patient in person for the initial visit (and any subsequent progress updates and reevaluations) and only use the telehealth option for regular treatment sessions.

Even if you do everything right, there will always be some patients who want in-person treatment exclusively. Ultimately, you want your patients to feel comfortable with any and all care you deliver—no matter how you deliver it. So, some patients may simply be better suited to onsite appointments.

3. There’s a period of adjustment.

When you’re first implementing telehealth services, your patients won’t be the only ones adapting to new technology. Your providers and front office staff will also require training on scheduling best practices, device setup, and new software functionality. You may also need to get buy-in from your team.

The Fix: Create an open dialogue with your staff.

To address this, be sure to set aside some time to talk with your staff and address questions like:

• Why is telehealth important to your business?
• How can telehealth be an effective treatment option for patients?
• What types of patients/conditions are (or are not) appropriate for telehealth?
• How will your team use your new technology?
• How should clinicians handle common patient technology issues?

Even after you’ve trained your staff, there will inevitably be hiccups to your process, and you may need to adjust things accordingly. However, being proactive about training can help smooth many of those potential bumps in the road.

4. It relies on non-clinical skills.

Before the rise of telehealth, physical therapists already had many skills in their proverbial toolbox. But with the introduction of virtual services, many PTs will realize that some of their non-clinical skills are either underdeveloped or nonexistent. Telehealth requires providers to think creatively and leverage their communication skills to assess the patient. On top of that, PTs who have quickly adopted telehealth have had to learn the ins and outs of video call etiquette as they go. As WebPT Co-founder and Chief Clinical Officer Heidi Jannenga, PT, DPT, ATC, mentions here, “When you meet with patients in person, you don’t have to worry about this sort of thing, because you hear the same things the patient does, so you know when to speak up or shut a door. But making those adjustments on the fly is tough when you can’t hear what the patient hears—and a small noise on your end might sound like a blaring, crackly mess on the patient’s end.”

Moreover, PTs who provide virtual services also take on the role of technical support. When patients struggle with their device or experience issues with the software, it’s up to the provider to troubleshoot.

The Fix: Conduct mock treatment sessions with your team.

To prepare your team for the unique complexities that can arise during virtual treatments, we strongly advise conducting mock sessions with fellow clinicians as well as creating helpful resources. This can alleviate a lot of anxiety that comes with diagnosing and addressing surprise technical problems and instill a level of comfort and familiarity with treating patients remotely.

5. Not all tools are secure.

Finally, there’s the issue of patient privacy and compliance. As regulatory attorney Emily Wein notes in this article, “Your computer, your iPad, your iPhone, or whatever interface or kiosk you have at your employer—these are all potential devices that could store or transmit your personal health information.”

The Fix: Ensure your WiFi network, devices, and software are secure.

For this reason, it’s absolutely essential to ensure your devices are connected to a private and secure Wi-Fi connection and that therapists transmit any materials containing PHI via a secure portal.

Speaking of security, it’s important that your video platform meets all HIPAA compliance standards. If you—like many other practices—implemented telehealth in response to the COVID-19 pandemic, there’s a chance your software does not meet the usual security requirements, as federal payers temporarily offered some wiggle room in terms of compliance. However, providers should expect these relaxations to be rolled back eventually, so whatever video platform you choose should be completely HIPAA secure. (Even better if it works directly with your current EMR, like WebPT Virtual Visits does.)

Change is often necessary, but it can also be nerve-wracking and fraught with obstacles. Should you make telehealth a permanent fixture in your physical therapy practice, it’s important to acknowledge the associated difficulties so you can better prepare and ensure the transition goes as smoothly as possible. After all, most of your patients are new to this process, too, and they’re looking to you for guidance and support. Are you ready?