Physical Therapy is increasingly accepted as a first line of treatment for low back pain and other musculoskeletal (MSK) conditions, and is currently being recommended by the CDC and the Canadian Health Service. As Physical Therapists are increasingly being seen and accepted as MSK experts, why don’t we see more people accessing and using the services of a Physical Therapist?
One answer lies in people, the public, and primary care providers not really understanding what Physical Therapists do. Granted, what Physical Therapists do varies by specialty and practice environment, but one common thing they do is assess, monitor, and improve human movement. Physical Therapists are experts in human movement, especially in the MSK and orthopedic setting.
Physical Therapists assess movement to determine whether normal movement and function is happening. They use palpation and established clinical tests, in order to determine what types of things might be inhibiting optimal human movement. And they talk to, and listen to, people, asking questions to obtain a thorough history to better understand the etiology of the patient’s issue and any other medical, social, or lifestyle issues that may contribute to or influence recovery. But if you, as someone who is dealing with a MSK issue, or seeing MSK patients, are not familiar with what Physical Therapists can offer, why would you ever seek one out?
Another barrier to people seeking the services of a Physical Therapist is that many believe that they will experience pain. They may have heard this from a friend or someone else based upon that person’s experience. They may actually have nothing to worry about, but their fear of pain is real and should be respected. In some cases pain can be a necessary part of testing or treatment, but the vast majority of treatment provided by a Physical Therapist should not involve the person experiencing increased or additional pain. This is a myth that must be addressed by Physical Therapists.
A third potential barrier involves the customer experience and convenience. Many people believe, and with good reason, that they will need to physically go to the office of a Physical Therapist for 5, 10, 12, or even more visits. Depending on their condition, and the way Physical Therapists are currently paid, this is often true. This requirement is disruptive to patients’ lives in that they have to leave work or leave home, travel, and physically show up to a clinic in order to be able to see and utilize the services of a Physical Therapist. In the vast majority of cases, in order for a third party payer to cover even a portion of the cost of seeing a Physical Therapist, the patient must be physically present in the Physical Therapist’s office.
Telehealth is one possible solution to this inconvenience. 
It is a hot topic with many people talking, blogging, and even legislating about telehealth. Ideally telehealth will be able to help more people remotely. Though very few Physical Therapists are offering this option yet.
There are many perceived restrictions and challenges to telehealth, the primary one being lack of payment by those third parties. Another is the conservative culture of medicine and health care in general. Health care providers are slow to adopt new methodologies and new technologies, though once they do adopt them they tend to commit. But this “new technology” is just another tool. And we use plenty of tools in practice
If we, as health care providers, would focus on the patient and their experience, and not on the technology, we might be more apt to offer a telehealth option. If we focused more on their experience and offering an option that improves that experience through improved convenience and less disruption to their lives, and focused less on who will pay for it today, we might find it is something that some of them would value and choose, even if that means they would bear the financial responsibility for that visit, or course of treatment.
Offering this option is not an either/or proposition. Educating people about what Physical Therapists not only do but how PTs can benefit them, letting them know that pain during treatment is not as common as they may believe, and offering a more convenient option to help people achieve their functional and movement goals, seems like a series of wins for everyone involved.
Health Coda is a company I am working with to bring what Physical Therapists do to more people. Their telehealth platform, Physera does just this. The company’s primary goal is to have self-insured employers offer access to their employees in order to keep them healthier, get seen earlier, and reduce the cost of MSK conditions. By removing barriers, we believe we can get more people to see a MSK expert earlier, resulting in decreased severity of MSK issues, and reduced costs around imaging, procedures, and long courses of treatment that are the norm today.
These same benefits apply to individuals who might not be covered under a self-insured employer’s plan, or one who is not yet on board with Physera. Telehealth also provides an opportunity for Physical Therapists in private practice, and other settings, to augment their in-person care, as well as reach and help more people. Like any tool, it may not be the best in every situation. But, just like Physical Therapists themselves, there are plenty of situations where the tool is a great fit and is not being utilized.
5 thoughts on “Telehealth and Physical Therapists”
Keep me posted on development of this. We are interested. Thanks!
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Great article. As the CEO of a telerehab solution myself, I recognize not only the obvious potential for expanding and improving patient care but the absolute necessity for our profession to embrace this technology now. As you stated, many practice owners are adverse to change especially when it comes to technology and traditional care models. But look around. The world is changing. QUICKLY. PTs must be open and actually adapt to these changes if we want to stay relevant in the medical community.
I consider telehealth as a part of the customer service, so I totally agree on implementing it. Basically you say that it can be a good way to follow the patient case and educate them in the subject and there is no doubt about it. Technological advances are always scary as we are not used to work with them, but if it helps to our patients it help us right? Good article!
How would insurance pay for it.
Also what are the requirements from Calif APTA and Consumers Affairs: PT Board re: documentation.
Also malpractice/legal liability.
Thanks for your question, Hiten.
How would insurance pay for it? I don’t know that they would pay any more than they currently do, unless they saw value. But they would still pay. But people pay for value. If they want something and value it, they will pay for it. That’s really the gist of the original article. The question and challenge is my mind is how do we convince people to want what they need, and provide improved value so we aren’t in a lowest bidder scenario at every turn.
You provide outstanding value. Physical therapists save people (& insurance companies, employers, society) money. You prevent complications and provide solutions. Usually for the same or less than a single MRI. Definitely for less than a surgery. And you provide equal or superior outcomes in a vast number of situations. Again, without the risk of complications, infection, etc. When we start valuing what we do, we will be better able to communicate that value to people and society.
Requirements: First the CPTA does not regulate anything. It’s a non-profit professional organization. Second, the PT Board in each state, and in some cases country (or it’s equivalent) regulates the practice of physical therapy/physiotherapy. The regs don’t change.
Malpractice & liability: How does the price point change anything? When you choke at McDonald’s do they incur less liability than when you choke at Chez Panisse? The experience is different. The food is different. But liability?
Another thought on insurance and the market:
The hazard of the current insurance model is that it does nothing to ensure quality, is not selective in who is included in their networks, and simply looks for the lowest bidder. This is not the message they share with employers, the government, or individuals buying insurance. But because of this, there is a huge opportunity to work directly with employers who are increasingly the new “insurer”. They are paying the bills. They are accepting all the risk. They are increasingly using the companies that used to be “insurers” as third party administrators only. The checks may say Blue Shield, but they’re actually coming out of the employer’s reserve account. Blue Shield just gets a fee to administer and provide the network of lowest bidders.
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