“It’s important to remember that the alternative to telehealth for many is not in-person care, it is no care because of barriers.”
—Marla Kaufman, MD
At the 2019 annual meeting of the American Association of Physical Medicine & Rehabilitation (AAPMR), the session on telemedicine was packed with physiatrists curious about how telemedicine can help them provide better and more efficient care for their patients. The session, conducted by physiatrists who serve as medical directors for telerehabilitation in the VA system, was titled, “TelePM&R: Lessons Learned and the Road Ahead.”
Rebecca Tapia, MD, Associate Program Director, University of Texas Health Science Center SOM at San Antonio PM&R Program, opened the session emphasizing that seeing patients remotely offers advantages to both patient and physician, but it has to be used wisely.
In fact, studies have shown that teleRehab offers a reduction in healthcare costs. Research also shows that patients are willing to try it, and when they do, they report high satisfaction levels. TeleRehab allows for both synchronous and asynchronous interactions. Synchronous visits occur in real time, while asynchronous interactions can be recorded by the patient and then stored for review at a later time by the doctor.
These features work together to create a care model that is accessible to a larger range of patients than traditional office visits. For physiatry patients in particular, it makes regular medical care feasible when mobility and transportation are an ever-present concern. But according to Tapia, the benefits aren’t limited to this subset of patients if a few caveats are remembered.
She emphasized that telemedicine does not replace in-person care. Rather, it is an adjunct to face-to-face visits. In particular, it is rarely appropriate for an initial visit to take place via telehealth. But once provider has an established relationship with the patient, initiating telemedicine can fill in gaps of care and be beneficial to both patient and provider.
The provider also needs to maintain autonomy in selecting the appropriate setting for patient care. As with other aspects of care, this decision needs to be made by a physician with consideration for the patient’s particular circumstances—telemedicine isn’t a one-size-fits-all proposition and no single set of conditions for choosing it can be applied.
In addition, the provider must know the requirements that apply in their specific circumstances. As larger numbers of patients and physicians embrace telemedicine, the policies that pertain to it will necessarily change. Each provider must know what his or her state and the particular payor require for a telemedicine visit, and then adhere to these policies.
The provider must be constantly on the lookout for technology issues. Does your platform make access more difficult for your patient? Is it HIPAA compliant and encrypted (no Facetime!)?
Reimbursement is evolving. Thirty-seven states now have “parity laws” that say insurance must cover telemedicine if in-person medical care would be covered in the same situation. However, there are no CPT codes for telemedicine, and GT modifiers must be used. This complicates billing and reimbursement and should be clarified with the payor.
To be sure, there are hurdles for patient care via teleRehab. However, those hurdles are low compared to those physiatry patients may need to overcome for in-person visits. With a little care, teleRehab can improve the efficiency of your practice, the patient experience, and the overall constellation of care you are able to provide.
In our next article, we’ll take a look at the nuts and bolts of a teleRehab visit.
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