Telehealth: The New Age of Physical Therapist Engagement

Transcription

1 Telehealth: The New Age of Physical Therapist Engagement 2017 WPTA Spring Conference April 20 21, 2017 Matt Elrod PT, DPT, MEd Board Certified Neurological Clinical Specialist Counsel of the APTA Board of Directors: Frontiers in Rehabilitation Science and Technology (FiRST) FiRST Council Meeting FiRST Council meeting at NEXT Wednesday June 21 st, :00 4:00 PM EST Location to be determined APTA HUB: Frontiers in Research, Science and Technology (FiRST) Open to all members (Non eligible individuals can participate) Can sign up for alerts 1

2 TELE-TIMELINES Telehealth Webpage launched Envention of Telephone Nebraska used twoway interactive television Institute of Medicine: not a singular technology Patients should receive care whenever they need it Patients should receive care whenever they need it Majority of attendees could vision their practice using Telehealth Foreshadowed telemedicine U.S. Indian Health Service, NASA, and the Lockheed Company Personal Experance APTA BOD Postion APTA WorkGroup and devlopment of resources Telehealth HOD P TELEHEALTH HOD P [Position] Resolved, It is the position of the American Physical Therapy Association (APTA) that telehealth is an appropriate model of service delivery for the profession of physical therapy when provided in a manner consistent with association positions, standards, guidelines, policies, procedures, Standards of Practice for Physical Therapy, Code of Ethics for the Physical Therapist, Standards of Ethical Conduct for the Physical Therapist Assistant, the Guide to Physical Therapist Practice, and APTA Telehealth Definitions and Guidelines; as well as federal, state, and local regulations. Image Courtesy of Alan Lee, PT, DPT, PhD, CWS, GCS 2

3 Store and Forward Consultation: Spoke and Hub C Supervision 3

4 Intervention Key Resources APTA Website: American Telemedicine Association: The Center for Connected Health Policy Research in Telehealth Tousignant M, Moffet H, Nadeau S, Merette C, et al. Cost analysis of in home telerehabilitation for post knee arthroplasty. J Med Internet Res. 2015; Mar 31;17(3):e83. doi: /jmir Truter P, Russell T, Fary R. The validity of physical therapy assessment of low back pain via telerehabilitation in a clinical setting. Telemedicine and e Health. 2014;20 2: Russell T, Hoffmann T, Nelson M, Thompson L, Vincent A. Internet based physical assessment of people with Parkinson disease is accurate and reliable: A pilot study. J Rehabil Res Dev. 2013;50 5: Chumbler NR, Quigley P, Li X, Morey M, Rose D, Sanford J, Griffiths P, Hoenig H Effects of Telerehabilitation on physical function and disability for stroke patients: a randomized, controlled trial. Stroke. 43(8): Russell TG, Buttrum P, Wootton R, et al. Internet based outpatient telerehabilitation for patients following total knee arthroplasty: a randomized controlled trial. J Bone Joint Surg Am. 2011;93: Rees RS, Bashshur N. The effects of telewound management on use of services and financial outcomes. Telemed e Health. 2007;13: Marshall SG, Shaw DK, Honles GL, et al. Interdisciplinary approach to the rehabilitation of an 18 year old patient with bronchopulmonary dysplasia, using telerehabilitation technology. Respir Care. 2008;53: Scalvini S, Zanelli E, Comini L, et al. Home based versus in hospital cardiac rehabilitation after cardiac surgery: a nonrandomized controlled study. Phys Ther. 2013;93: Clinical Trials US National Institute of Health Tousignant M, Moffet H, Boissy P, Corriveau H, Cabana F, Marquis F. A randomized controlled trial of home telerehabilitation for post knee arthroplasty. J Telemed Telecare. 2011;17(4):

5 Opportunity & Challenges Laws and Regulations Payment Practice Laws and Regulations Laws and Regulations Federation of State Boards of Physical Therapy (FSBPT) The Model Practice Act for Physical Therapy (2011)and Policy Recommendations for Appropriate Regulation (2015) PT Interstate Compact Majority of states do not have Laws and Regulations 5

6 Interstate Physical Therapy Practice: A glimpse of the Future What s the PTLC? A legal contract between states A piece of legislation that must be adopted by state legislatures State based solution to a national issue no Federal or Congressional involvement! What Will it Do? Create a new, faster way for PTs and PTAs in participating states to obtain a privilege to practice in another participating state Create a Commission to administer the compact, including promulgation of rules What it won t do: Change your practice act or scope of practice 6

7 Access & Portability Benefits of the Compact Consumers living near state borders Utilizing tele practice technologies Residencies and Fellowships Specialists New Health care delivery models: Medical Homes, Accountable Care organizations, etc Traveling therapists Traveling groups: Teams and Performers Disasters Continuing education PTLC Basics: State Requirements To participate in the PTLC, states must require: Background checks Continuing competence (amount, type doesn t matter) NPTE PTLC Basics: Licensee Requirements To obtain a compact privilege, a PT or PTA must: Hold an unencumbered license in a compact state Have no adverse action against license or compact privilege in previous 2 years Meet jurisprudence requirement of any state in which the licensee is seeking a compact privilege Pay applicable fees 7

8 PTLC Implementation Process 10 States Pass Compact Legislation Compact Commission Forms Commission Develops Rules, Sets Up Processes Licensees Apply for Compact Privileges Current Status: 9 AZ, MO, OR, TN, MS, MT, ND KY, UT WISCONSIN: Plan to introduce later this year Legislation and Regulation: Direct An Analysis Of State Telehealth Laws And Regulations For Occupational Therapy And Physical Therapy. Inter J Telehealth. Spring 2014 In laws and Regulations Arkansas Mississippi New Hampshire Oregon Pennsylvania Utah Additional requirements Must obtain informed consent (Kentucky, North Dakota, Wyoming) Must be present in state (Alaska) Must identify in patient record that PT occurred via telehealth (Washington) Wisconsin: Telemedicine/Telehealth Definition "Telehealth" is a service provided from a remote location using a combination of interactive video, audio, and externally acquired images through a networking environment between an individual at an originating site and a provider at a remote location with the service being of sufficient audio and visual fidelity and clarity as to be functionally equivalent to face to face contact. "Telehealth" does not include telephone conversations or Internet based communications between providers or between providers and individuals. Wisconsin Statute (29w). 8

9 Laws and Regulations No reference found. Medicare NO!! Medicaid NO!! Private Payer????? Payment Medicare Physician Nurse practitioner Physician assistant Nurse midwife Clinical nurse specialist Clinical psychologist Clinical social worker with master's degree Registered dietitian Nutrition professional 9

10 Payment Source: The Center for Connected Health Policy Recommendations for Private Payers Direct conversation with third party payers Follow their directions Discuss submitting claims for telehealth services using Place of Service (POS) 02: Telehealth The location where health services and health related services are provided or received, through telecommunication technology and Education/Medicare Learning Network MLN/MLNProducts/downloads/TelehealthSrvc sfctsht.pdf and Guidance/Guidance/Manuals/Downloads/clm 104c26.pdf 10

11 Telehealth Checklist Informed consent Verbal or Written Pre Screening Professional standards Documentation Licensure Supervision Provider & End user acceptance Chronic care model Healthcare consumerism Infrastructure: technology and workflow Stakeholder collaboration Documentation Time in Time Out What telehealth will be provided Patient agreement for tele service and recording Quality of connection & impact on treatment Any breaches People present/role Typical progress note Example of secure system 11

12 Key Takeaways Telehealth provides opportunity for access to care Practitioners should be in contact with PT boards & chapter Practitioners should communicate with payers All telehealth is not the same Key Resources APTA Website: American Telemedicine Association: The Center for Connected Health Policy 12