Though employers and workers’ compensation insurers have been utilizing telemedicine for quite some time, there’s been a recent uptick in interest surrounding virtual physical therapy, also known as telerehab.
Telerehab provides virtual access to physical therapy and is intended to be a replacement for an in-person visit to an outpatient facility. According to a recent white paper released by MedRisk, while not all treatment is translatable to telerehab, “online exercise demos, virtual workout supervision, and secure communication tools make it possible to supplement in-clinic physical therapy with valuable remote services including patient follow-ups, home treatment plans, questions and answers, and consultations with specialists.”
Sean Sullivan, chief operating officer and vice president of Business Development for the national rehab and wellness provider Go2Care, said telerehab can include the whole spectrum of what is called “musculoskeletal care management.”
According to Michelle Despres, vice president and national product leader at workers’ compensation firm One Call, telerehab is convenient because it can be done via a cell phone, tablet or a computer. The process can work via live or pre-recorded videos and mobile apps, said Despres. Remote patient monitoring can be achieved by using health and fitness trackers or through patient self-reporting.
“They would have access to one on one live treatment with a physical therapist (PT), the idea being that there’s a convenience factor. If someone would like to be treated, we offer hours between 6:00 AM and 10:00 PM. There’s a lot of flexibility. Most outpatient clinics are not open to those hours,” added Despres. “There may be a possibility that someone could say at lunchtime, ‘I’m going to do my PT. I’m not going to leave my office. I’m going to do it right here.'”
She added that injured workers could do it anywhere they have the privacy and the availability to perform their visit.
Highly adaptable, telerehab can begin with online videoconferencing and move toward live, face to face interaction, according to Sullivan of Go2Care.
With a remote home exercise program, for example, patients can get access to automated solutions when they’re not with the physical therapist to monitor how they’re doing, he explained.
“We’re also looking at telerehab being defined as a home exercise program support application. This is an apps based concept,” said Despres. “It allows the treating therapist in the brick and mortar facility to offer their individual patients and injured workers the ability to log into an app, much like a fitness app, that many people use on their phones or their tablets and have the opportunity to have their home program delivered electronically.”
The app allows injured workers the ability to access their home exercise program and provide feedback on the assigned exercises.
“The PT can customize their exercises within the app. The PT also has a dashboard that they can access at any time that’ll show them when the injured worker has done their exercises, how often, what their compliance is,” she added.
The physical therapist can pull up the information to determine if adjustments need to be made.
Interest in Telerehab Grows
While there’s been traction in both the group health and Medicare markets, there has been a slow adoption rate by the workers’ compensation industry, despite the fact the concept has been around for quite a while, said Sullivan.
“You’ll see articles about someone testing it out in 1990 with some population of patients that had a spinal cord injury. Or the VA using it for remote veterans for very specific subsets of conditions,” said Sullivan.
“In workers’ compensation, to my knowledge no one yet has any deliverable data or outcomes information to be able to say that it’s being adopted at X rate in the work comp space,” said Despres.
Momentum began to shift this year.
“There was a push, not from the carriers but from…the employers,” said Sullivan. “I’m having a lot of carriers come to me saying, ‘We want to do it,’ but they don’t know where to start. When the carriers right now are talking to me, they’re saying, ‘Do we do the prevention? Do we do the treatment, or do we do the monitoring?'”
He expects carriers will pilot one or all three aspects to determine the best fit.
According to both Despres and Sullivan, this type of virtual treatment is best suited for soft tissue injuries, strains and sprains.
“Not every condition’s appropriate for telerehab,” said Sullivan. “When a patient comes to see us, the very first thing we do is we implement a triaging system that determines whether that patient is too complex to be seen online. Things like common sprains and strains, lateral epicondylitis, early carpal tunnel syndrome, things that we can address remotely,” explained Sullivan. “It’s not going to be complicated disc herniations. I’m focused on joint sprain and strain as what we’re going to have the most success treating.”
Despres added that it’s driven both by diagnosis and circumstances. She provided the example of an individual that had fractured their neck and their wrist.
“The wrist came out of a cast and required therapy, but this person lived hours from everything. It was at least two hours to get to a facility for therapy for their wrist. There were no home health options in the person’s area. There were not a lot of options for anything that this person could receive at home, and putting a person in a car for two hours or four hours a day in order to receive therapy, especially if they’re in a halo for their neck, is not a great approach,” explained Despres. “Someone like that would be a great candidate for a virtual visit, because their circumstances have dictated it.”
Someone who travels quite a bit or does a lot of overnight travel could also be a good candidate for telerehab.
“It’s difficult to get some continuity of care if the person either is not home enough to have therapy with their therapist’s facility, or they have to try to go to different facilities,” said Despres.
Not much is needed for telerehab to work, said Sullivan and Despres.
“They don’t require anything except the injured worker has to have their own Wi-Fi or their own device a cell phone, a smartphone or a tablet, or a computer,” said Despres.
The employer doesn’t have to set up anything, though they might choose to offer a private room that employees could use at lunchtime or at their own discretion.
“They could give them an on site opportunity, but that would just require a space. It wouldn’t require any particular equipment,” she added.
“It can be done from anywhere. We’re servicing a manufacturing site in rural America. There’s not a whole lot around it, but there are 600 employees,” Sullivan said. “We just set up a kiosk at the location. The employee has the freedom to elect to conduct that visit in the comfort of their home, should they choose. But they’re not choosing that, at least, to date.”
Sullivan described a large pilot program with a national employer.
“We go ahead and set all the visits to occur at the employer worksite. The technology needed is a computer. We set them up with a webcam, and we put it in the nurse’s office,” said Sullivan.
Benefits of Telerehab
According to Sullivan, employees like the idea of personalized treatment.
“Since we are actually integrated with your employer, we know all about your job as a mechanic. We know all about the types of push/pull forces you’re working with,” said Sullivan. “We’re actually going to provide you rehab that’s a little bit more tailored to what you might recognize as work conditioning.”
MedRisk’s white paper, Telerehabilitation & the Injured Worker, noted several benefits of telerehab, including “greater patient compliance, smoother care coordination among clinicians, a more flexible rehabilitation timeline, and cost and time savings for key stakeholders.”
In addition, the paper noted that injured workers benefited from increased access to care.
A Good Fit for Some
Telerehab might not work for everyone, said Despres, who added that it’s a better fit for those who embrace technology.
“I think by and large, as a society, we think it’s going to be the younger folks,” said Despres. “This will be a no brainer for the younger group, but I do think we can’t discount the older population either. Anyone who embraces technology and possibly leads a busy life. Someone whose employer might say, ‘Hey, you have to do your therapy outside of work hours.’ or whatever the case may be.”
While Sullivan said there is no specific data on utilization, such as by gender or age, usage is trending towards a younger population that’s looking for convenience.
In addition, workers may be more open to telerehab where employers promote the treatment option, said Despres.
Sullivan said he’s seeing telerehab opportunities in certain industries.
“We’re finding our sweet spot is heavy industry, working with oil and gas sector, working with transportation,” said Sullivan. “These guys are on the move. Working with distribution and warehouse facilities, where we see the type of injury that we can service in high volume.”
MedRisk’s white paper stated, “The value and the convenience for traveling sales reps, cruise ship staff and employees in the transportation and distribution industries is enormous.”
Small businesses also stand to benefit from telerehab.
“For the first time, small businesses or mid sized businesses that formed cooperatives or aggregates now have access to an online solution, where if you’re an employer and you’ve got 10 people, you’re not going to get the same kind of on site PT access as Amazon gets, right? You don’t get access to the same type of benefits,” explained Sullivan. “Since we’re online, we want to go to the carriers and say, ‘Hey, we can be available to any of your clients, no matter their size and no matter their location.'”
A challenge, both Despres and Sullivan said, is that while everyone wants to know about telerehab, no one really knows how to implement it.
“I hear, ‘Hey, how can we get that as a solution?’, but I find that most people haven’t clearly defined in their head what that means,” said Despres. “When I ask payers ‘What do you have in mind?’ Beyond the term telerehab, I don’t find that people have a real clear plan for what they think it is.”
A clearer definition of how it impacts the injured worker is needed, she added.
“Everything doesn’t necessarily require us to touch a person to be successful,” said Despres. “I think there’s a place for it. We’re going to do a pilot for six months to come back and give some solid answers as to where it fits into the work comp world. Hopefully, at that point we’ll have a better understanding of how these folks are going to adopt it.”
Sullivan added there are barriers to expanding workers’ comp, including the fact that not a lot of workers’ comp laws have specific language to address the concept.
Another challenge, he said, is that employers are not as quick to adopt telemedicine options.
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