Insurers Will Have a Big Say in the Future of Telehealth Services

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Originally posted via Content Staff.

The coronavirus pandemic left physical therapists and occupational therapists with little choice but to embrace telehealth technology, but just how much of that sticks around after COVID-19 abates is anyone’s guess.

PTs, OTs and speech therapists got some good news in April, when the Centers for Medicare and Medicaid Services said telehealth treatment would be covered at the same rate as office visits. Most private insurers followed suit, loosening their payment restrictions and making no monetary distinction between virtual and in-person treatment. But is this decision permanent or just temporary? No one is sure at the moment because the widespread adoption of telehealth services is so new.
In an interview with Kaiser Health News, part of the Kaiser Family Foundation, Dr. Preeti Raghavan described the switch to online medical services as a “once-in-a-lifetime thing.” Raghavan, an associate professor of physical medicine, rehabilitation and neurology at the Johns Hopkins University School of Medicine, said that before March, her department didn’t conduct any patient visits remotely, but now, nine out of 10 visits are done online.

“Tele-rehab was very much in the research phase and wasn’t deployed on a wide scale” before the pandemic, Raghavan told Kaiser Health News. “It usually takes a long time – 17 years – for an idea to become accepted and deployed and reimbursed in medical practice.”

Glenn Melnick, a health-care economist at the University of Southern California, told Kaiser Health News that telehealth services will remain an option post-COVID-19, but there could be changes to current practices. “Pieces of it will” remain in place, he said, “but we have to figure out which ones.”

Raghavan said remote PT and OT treatments have many pros and cons. On the negative side, manipulation of tight muscles and other hands-on forms of patient care simply can’t be performed virtually, but on the other hand, therapists gain more insight into patients’ living situations.

“When you see them in their home, you can see exactly their situation,” Raghavan told Kaiser Health News. “Rugs lying around on the floor, what hazards are in the environment, what support systems they have. We can understand their context.”

Therapists can use video links to assess how a patient moves or walks and can demonstrate home exercises. In addition, video-game programs similar to Nintendo Wii offer another treatment option, using motion sensors to help patients improve balance or specific skills.

Hospital systems also are stepping up their hospital-at-home programs due to COVID-19. Prior to the pandemic, at least 20 U.S. health systems had some form of hospital-at-home program, Bruce Leff, a professor at the Johns Hopkins University School of Medicine, told Kaiser Health News. He said that for many patients, these programs are just as safe as treatment in the hospital and can cost 20 percent to 30 percent less.

Countries such as Australia, England, Italy and Spain have long-established hospital-at-home programs, in which patients’ homes are temporarily outfitted with equipment such as monitors, communication devices and backup Internet and power sources. Stable patients with common diagnoses such as heart failure, pneumonia and kidney infections are visited by nurses or home health aides, sometimes several times a day, according to Kaiser Health News.

Those health-care providers can perform necessary tasks such as blood tests or inserting IV lines, while medical devices monitor their blood pressure and oxygen levels and doctors manage their care from remote “command centers,” according to Kaiser Health News.

To free up beds for COVID-19 patients, many hospitals now are treating patients with mild cases of pneumonia at home, Kaiser Health News reported. A small device called a pulse oximeter clips onto the patient’s fingertip to measure heart rate and estimate the proportion of oxygen in the blood. The devices typically cost only a few hundred dollars and can be sent home with patients or bought online.

“We do it on a case-by-case basis,” Dr. Gary LeRoy, president of the American Academy of Family Physicians, told Kaiser Health News. He said it’s a good option for relatively healthy patients who don’t have underlying health conditions that could lead them to deteriorate rapidly, such as heart or lung disease or diabetes. Patients are urged to call their doctors if their readings get low or if they experience symptoms like fever, chills, worsening fatigue or a bad cough, according to Kaiser Health News.

“Having a personal physician involved in the process is critically important because you need to know the nuances” of the patient’s history, LeRoy told the publication.

The COVID-19 crisis has proven that in many cases, telehealth services work, but the insurance industry’s lobbying group, America’s Health Insurance Plans, hasn’t said whether remote services will continue to be covered at the same rate as in-person visits, according to Kaiser Health News. Establishing a lower payment rate for remote services would “have a huge impact on continued use,” Mike Seel, vice president of the California consulting firm Freed Associates, told the publication.

Similarly, insurers haven’t said whether they will allow patients’ primary health-care providers to deliver treatment remotely or require outsourcing to a third-party telehealth service, which could make patients less satisfied with their care, Kaiser Health News said.

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