sedgwick cms 2009 capabilities overview the future is here and... · presented telerehab: the...

PRESENTED

Telerehab:The Future is Here and Now

Michelle Despres, PT, CEAS II, CETS

VP, National Product Leader

One Call

Aideen Turner, MPT, cert. MDT, CEAS

CEO & Founder

Virtual Physical Therapists

2019

DENTAL | DIAGNOSTICS | EQUIPMENT + DEVICES | HOME HEALTH + COMPLEX CARE | PHYSICAL THERAPY | TRANSPORT + TRANSLATE

©2018 One Call Care Management. All Rights Reserved.

Agenda

• Learn how telerehabilitation is transforming physical therapy

• Identify cases where telerehabilitation can help control costs and

improve outcomes for injured workers

• Gain insight on how telerehabilitation can be a preventative solution

• Participate in a live demonstration



Virtual Healthcare - Are We Ready?



Who Might Participate?

Source: Retrieved from www.Healthpopuli.com



Telerehabilitation

• The delivery of rehabilitation services

via information and communication

technologies, including:

– Assessment

– Monitoring

– Prevention

– Intervention

– Education

– Consultation

• Services include: PT, OT, Speech,

Audiologists, Dieticians, etc.

Telerehabilitation Encounters



Technology Requirements

User:

• Smart device

• Internet with at least 1 Mbps

Application:

• Encrypted, HIPAA compliant

• Internet based real-time communication (iRTC) video streaming located on private cloud

• Security:

• Network and web application firewalls with encryption

• Unique user passwords

• Encryption in transit and during sessions

• Transit layer security (TLS) across all sources



Patient Experience

Simple Process for a New Patient:

• Download the App

• Complete:

• Past Medical History including Medications

• Pain Diagram & Numeric Scale Rating

• Patient Specific Functional Scale (PSFS)

• Schedule Appointment

• Start Live Video Assessment



Pain Scale



The Evaluation

Mechanical Assessment

• Effective evaluation without hands-on contact

• Able to differentiate non-musculoskeletal ailments

• Validity/Reliability studies

Source: Retrieved from www.MckenzieMDT.org



Case Study: Transition to Virtual Care



Virtual Treatment Strategies

• One-on-one approach

• Cert. MDT clinicians

• Emphasis on education

and empowerment

• Objective is to reduce fear

• Able to observe

performance of essential

job tasks



1. Convenient – anytime, anywhere

2. Removes transportation barriers

3. Able to immediately initiate care

4. One-on-one care

5. Text/e-mail communication between visits

6. Centered around patient empowerment vs.

passive treatments

7. Observation of essential job tasks

Benefits of Telerehab



• Technology dependent

• Application based

• Internet connectivity required

• Manual contact not available

– Assessment of tissues

– Tactile feedback

– Balance

• Equipment may be needed

• State limitations

– Signed consent

– Licensure

Limitations of Telerehab

Telerehab & Low Back Pain



Source: Retrieved from http://www.virtualphysicaltherapists.com/2018/04/04/disability-from-lbp-increased-by-over-50-since-1990-where-we-are-going-wrong/

Low Back Pain

Low Back Pain



Low Back Pain Costs

Source: Spine 2010 Nov 15;35(24) Source: Burdon of Musculoskeletal Disease in US 2006



Case Study: Construction Helper

• 23 y/o male; lumbar strain; injured while shoveling

• Symptoms reported: severe low back pain & bilateral radiculopathy to back of knees

• Referred for PT

– Started virtual treatment next day

– MD ordered: 24 visits

– Working light duty

• Diagnosed virtually with a lumbar derangement

• Treatment outcome:

– 6 visits total

– Reported 100% resolution of symptoms

– Ready to RTW full duty

PT Type Evaluation Duration Total Visits Savings

Virtual PT Next day 25 days 6 $2.3K

Brick & Mortar Facility 5 days 27 days 7.4 $1.1K



Low Back Pain Treatment Outcomes

• Average treatment visits

(national): 6

• Cost savings

– Decreased number of

visits

– Decreased lost time

– Decreased cost/visit

Legislative Update



Physical Therapy Compact

Source: Retrieved from http://ptcompact.org/ptc-states



Parity

• Majority only reimbursed for live video

• 36 jurisdictions (including DC) have enacted laws that govern private payer parity reimbursement, but not “at the same rate”

• Medicare major limitations on originating site (patient) and distant site (clinician) and types of service. No telerehab

• CMS Proposes more reimbursement for telehealth 2019 Physician Fee Schedule (Virtual check-in services via phone/text, remote monitoring of recorded image/video, and prolonged preventative services)

• Medicaid 48 states and DC covered for live video but many restrictions

Parity Laws require private payers to pay for telehealth the same as if those services were rendered in-person.

Telerehab for Injured Workers



Benefits & Outcomes

ProvidersSpecially Trained (Certified MDT)

6am-10pmEach State

1:1 TreatmentEvaluation to Discharge

5/5Patient

Satisfaction

>50%PM appointments

(6pm-10pm)

Convenience:Same day appointments

Faster RTW

Reduction in medical spend

15%Adoption Rate

85%Improvement

35%Fewer Visits to Reach

RTW Goal

2.5 Days Faster to

Initial Evaluation

20 daysFewer to DC

PT Type Evaluation Date Average Visits Average Duration

Telerehab PT Next Day 7 19 days

Brick & Mortar Facility 2.7 days 11 38 days


©2018 One Call Care Management. All Rights Reserved. 25

Telerehabilitation States



Case Study: Truck Driver

• 62 y/o male; thoracic pain; fractured

finger

• Symptoms reported:

– Severe chest pain

– Fear of driving

• Diagnosed virtually with a thoracic

derangement

• Treatment Outcome:

– 75% better at 7 visits

• Resumed driving 8-10 hour days

– 100% better at 9 visits

• Returned to full duty driving 10-12 hour

days

Alternate Telerehab Uses



Pre-Surgical Rehabilitation (“Prehab”)

• Aide in preparation for surgery

– Range of Motion

– Strengthening

– Maintain fitness

• Reduce fear and anxiety



Home Exercise Program Support

• Mobile technology

• Built in/customizable exercise protocols

• Videos

• Reminders, badges

• Feedback loop

• Patient dashboard

• Provider dashboard



Wearables



Prevention: Wearables for Baseline Testing

• BBraun & 270 Vision Create Opportunities to Advance Affordable Medical-Grade Data Collection for Physical Therapy

– 2018 Winner of Best Digital Platform (Juniper Research)

– Range of Motion

– Grip Strength

– Force Measurement

• Industry Movement from High Cost to Low Cost & “Throw Away”

• NHS Independent Review concludes the technology is feasible, acceptable, and reliable



Prevention: Joint Mobility vs Body Mechanics

• Proper body mechanics are essential in preventing injuries

– Lifting, welding, sitting, reaching, pulling, etc.

• Loss of joint mobility is usually a precursor to an injury. If detected

and corrected, rate of injury can be reduced.

• Ergonomics



Prevention: Early Symptom Intervention

• Wellness

– Application based

– Voluntary

• Job coaching

– Live view

– Instant feedback

• Triage for first aid vs OSHA recordable

• Proactive symptom management

– Education

– Stretching/strengthening

– Body mechanics



Potential At-Risk Identification

• MTAP Assessment - Function, risk and motivation

• Link sent to Injured Worker to complete assessment

at home

• Recognized by:

– Official Disability Guidelines (ODG)

– American College of Occupational and Environmental Medicine

(ACOEM)

– American Medical Association (AMA)

– Medicare

• Predict ‘secondary gain’:

– Objectively identifies inconsistent perceived disability

• Patient facing reports

– Enhances injured worker-provider communication directing focus on

function and return to work

Real time information on functional improvement and psychosocial risk.



PGAP® Progressive Goal Attainment Program

A cognitive-behavioral therapy RTW program published in Official

Disability Guidelines (ODG)

Goals achieved through:

• Targeted treatment of psychosocial risk factors

• Structured activity scheduling

• Graded-activity involvement

• Goal setting

• Problem solving

• Motivational enhancement

• May be coupled with physical therapy

• Max 10 week programSource: https://www.pgapworks.com/en/index.php

https://www.pgapworks.com/en/index.php



Disrupting Pain & Opioid Use

• Psychosocial coaching in all 50 States

• Support for at-risk PT claims

• Assigned to:

– Cases that exceed ODG guidelines

– Noted use of opioids/anxiety meds

• Inclusion of treating physician and network providers to support behavioral goals & assignments

• Opioid Risk Prediction Tool– 6-day supply = 13.5% chance of continued opioid use 1-year later

– 11-day supply = 25% chance of continued opioid use 1-year later

– 31-day supply = 42% chance of continued opioid use 1-year later

• Outcomes: Prevent opioid abuse before it starts & helping people change when change is difficult

Targets patients with low motivation and a history of past

struggles to change.

Live Demonstration

Thank youMichelle Despres, PT, CEAS II

[email protected]

Aideen Turner, MPT, Cert. MDT, CEAS

[email protected]

sedgwick cms 2009 capabilities overview the future is here and... · presented telerehab: the...

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