History of Telerehab
This goes without saying, but I’ll say it anyways. COVID-19 put telehealth on the forefront of healthcare delivery conversations. Over the last year and a half, telehealth has skyrocketed in usage and is a rising star in the way individuals choose to access healthcare. In a poll completed by Sykes, 61% of Americans responded that they had experienced a telehealth appointment by March 2021 and 88% of Americans reported they wanted to continue using telehealth services for non-urgent consultations.
However, telemedicine is far from a new mode of healthcare. In 1959, the Nebraska Psychiatric Institute was the first documented hospital to use early videoconferencing technology. They used this to provide group therapy, long-term therapy, consultation-liaison psychiatry, and medical student training at the Norfolk State Hospital in Norfolk, NE. (As Kintinu is based out of Nebraska, this was an interesting discovery!)
Hospitals in Massachusetts and Arizona followed suit and further developed the application of telemedicine throughout the 1960s and 1970s. By 1990, telemedicine was used widely in hospitals, particularly in ICU and stroke care.
In 1993, the American Telemedicine Association (ATA) was founded to promote adoption of telehealth practices amongst providers, payers, and patients. While providers and patients have wrapped their arms around telemedicine, payer sources and federal and state regulations have been sluggish in the adoption of telehealth.
Impact of COVID-19
Work comp healthcare plans were the outlier and began authorizing telehealth treatments prior to the pandemic. Their ability and willingness to adopt telehealth services set them up for an easier transition for their clients when COVID-19 came about. Similarly, their early espousal of telehealth also allowed providers the space to offer virtual health options for their plan members. The partnership between the providers and the work comp payer sources has been a shining light in the midst of an otherwise difficult time navigating healthcare throughout the pandemic.
The onset of the COVID-19 pandemic forced all other insurance and healthcare payers and regulators to temporarily change their laws for specific telehealth modes allowed during the state of emergency. This particularly impacted rehabilitation services (physical therapy, occupational therapy, and speech therapy). Prior to the pandemic, these rehabilitation services were not typically performed virtually as most insurance companies would not pay for them. The pandemic has temporarily allowed these services to reach millions of Americans, which has been a welcome change to say the least.
However, we need to stress the temporary aspect here. Many payer sources have approved payment on these telehealth services until 2022. This includes the Center for Medicare and Medicaid Services (CMS), the federal agency that administers the nation’s major healthcare programs including Medicare, Medicaid, and CHIP. CMS has specific laws around how and where their beneficiaries access telehealth services from.
The most rigid of these rules are CMS’s originating site requirements for patients and the list of practitioners that are allowed to provide telehealth services. While these have been temporarily adjusted, they remain issues beyond the state of emergency.
An originating site is the location where a Medicare beneficiary receives telehealth services. CMS requires that the originating sites are located in a county outside of a Metropolitan Statistical Area (MSA) or a rural Health Professional Shortage Area (HPSA) in a rural census tract. The originating sites also must be a physician or practitioner office, hospital, critical access hospital, rural health clinic, federally qualified health center, renal dialysis center, skilled nursing facility, or community mental health center.
In short, Medicare beneficiaries must reside in a rural location and be able to access a physician’s office, hospital, clinic or skilled nursing facility in order to receive the telehealth services. Outside of the pandemic, CMS does not typically allow for telehealth services to be received in someone’s own home.
These originating requirements are restrictive and difficult to navigate. Even if a Medicare beneficiary meets the rural requirements for telehealth services, they have to be able to drive or access other transportation to a facility to receive them. As we’ve learned over the last year and a half, telehealth services can be provided with great success in the patient’s home environment.
Beyond the originating site requirements, there is a specific set of practitioners that Medicare will typically cover telehealth services for. This includes physicians, nurse practitioners, physician assistants, nurse-midwives, clinical nurse specialists, certified registered nurse anesthetists, clinical psychologists and social workers, and registered dietitians. Physical, occupational, and speech therapists are not included on this list outside the pandemic.
Benefits of Telerehab
While telerehab has certainly assisted with reducing the risk of viral spread, there are many more benefits to accessing rehab services virtually.
Some of these benefits include:
- Decreased patient travel time & cost
- Decreased time away from work, school, or home
- Increased rural access to services
- Increased access to specialty rehab providers
- Improved healthcare equity among underserved and minority groups
- Improves access to individualized & focused rehab programs
- Improved outcomes because rehab occurs where it matters most for the patient (i.e., in the home, community, workplace, etc.)
- Improved access for home-bound patients or those with difficulty accessing transportation
- Increased patient compliance to required sessions
The ATA, among other organizations, continues to be a leading advocate for all insurance and healthcare payers to permanently adopt tele-based physical therapy, occupational therapy, and speech therapy services. While some commercial payers have already announced their decision to do so, it is vital that CMS follows suit and leads the way for the remainder of the payers.
The ATA recommends reaching out to congress or your state representatives to urge CMS to permanently adopt approval for telerehab codes.
To learn more about telehealth policy or how you can get in touch with your representatives, visit any of the following sites:
American Telemedicine Association (ATA)
The Center for Connected Health Policy (CCHP)
Alliance for Connected Care
National Consortium for Telehealth Resource Centers