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Telehealth Trends as Need for PT Grows
Despite the fact that one in two American adults has some kind of musculoskeletal issue, many aren’t getting connected with the physical therapy they need. And despite the fact the PT industry has been growing, there are still many barriers to care.
Direct access and telehealth are helping overcome the obstacles that hold patients back. David Grigsby, MPT, Cert. MDT, has long championed both.
“If the deductible is greater than 5 percent of their income, [patients are] skipping care up to 40 percent of the time depending on the condition,” Grigsby said. “Think about the people who are not getting access to care because of cost. What if you could offer them something that reduced the price, the time and the energy for them to get to therapy?
“What if you could reduce the number of people skipping care just by giving them access and expanding your reach?” he said.
Direct access essentially allows a patient to get physical therapy without a referral from a primary care physician and still have it covered by health insurance. Though they differ, all 50 states currently have some kind of direct access law.
Telehealth expands reach further by providing options and convenience. Sessions can be had in real time via HIPAA compliant Skype-like software. It can also be as simple as an email or text. Grigsby integrated telehealth into his MidSouth Orthopaedic Rehab practice about 10 years ago.
“It kind of happened [by chance]. You’ve got friends that call you, family members who call you … folks are always asking about neck problems, shoulder problems and knee problems,” Grigsby said. “So, you get on the phone with them or you text them back and forth and say do this, try that, see the effect.
“We were thinking as we were sitting there … why don’t we do this more often?” he said. “Why don’t we perform telehealth? So it started with a patient here and there.”
Today, direct access patients make up 80 percent of Grigsby’s practice with an increasing number taking advantage of telehealth services.
“I hope [practitioners] implement some form of telehealth in the future because it is exploding, it is growing and it is coming close to you soon,” Grigsby said.
Nationally, physical therapy has a $37 billion share of the health care market, a reflection of 3.3 percent annual growth over the past five years according to a report by economics research organization IBISWorld. The global telemedicine market is anticipated to grow at a compound annual growth rate of 14.3 percent through 2020, according to a Nathaniel Lacktman, Esq. Healthcare Partner, Foley & Lardner report.
The Towers Watson 2015 Employer-Sponsored Health Care Center Survey found that about 70 percent of employers had planned to offer telemedicine services as an employee benefit. An overwhelming majority (90 percent) of health care executives said their organizations have implemented or are developing a telemedicine program, according to the Foley 2014 Telemedicine Survey Executive Summary.
The leap to telehealth comes with some caveats, Grigsby said.
“We’re great at empowering people. We show them what to do to improve and move on from their current condition to get better, but even the best physical therapists can drop the ball every once in a while,” he said. “We can be the best in the clinic and move to telehealth and drop the ball because it’s different than what we’re used to doing in the office.”
There’s the experience factor, but assessing outcomes is key to improvement as with any aspect of physical therapy practice. Grigsby has long used Focus on Therapeutic Outcomes (FOTO) technology to analyze his outcome data.
The data analyzed by the system is risk-adjusted for age, body-type and situation, so he gets an accurate picture of what can be expected from treatment. It tells him how many visits, length of treatment and a percentage of expected improvement for a given patient.
“When marketing telehealth and direct access, this is definitely a significant benefit to differentiate myself from others with tangible and measurable evidence of treatment effect and satisfaction,” said Grigsby, who practices the evidence-based McKenzie Method® of Mechanical Diagnosis and Therapy® (MDT).
“MDT, I believe, is critical for sustained telehealth and telehealth growth,” Grigsby said. “It gives the physical therapist the ability to assess the need of the patient without having to perform an assessment within the physical location first.”
The MDT system begins with a thorough mechanical evaluation to establish a “cause-and-effect” relationship between historical pain behavior as well as the response to repeated test movements, positions and activities.
A systematic progression of applied mechanical forces utilizes pain responses and mechanical responses to classify the disorder. Clinicians then develop a specific plan of care based on those examination results that empowers patients to treat themselves when possible.
“The assessment leads to the best, individualized treatment. If the direction and load of treatment are correct with online assessment, the effect will be observed in reduced/centralized symptoms, improved mechanics and reduced neuro signs,” he said. “The patient will be empowered to perform the effective treatment on their own with self-management strategies and graded exposure programs.”
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