Physical Therapy Going High-Tech
Traditional physical therapy is being challenged by an aging population, an aging working population, on-demand expectations of consumers, and patient accessibility issues. The good news is technology is making PT much easier to deliver and tailor to the changing preferences of patients. But with that technology comes different risks that you’ll need to consider as you accommodate your clientele. What you need to know about physical therapy going high-tech during the pandemic.
Heightened awareness of the dangers of pain medications, especially opioids, and the expansion of many health insurance programs to include physical therapy as a covered treatment for chronic pain could increase business at your PT practice. As welcome as a growing clientele is, it comes with new demands for nontraditional treatment methods, including telemedicine, virtual reality therapies and in-home care. Some practices are using a combination of all three!
Depending on the technology you choose, you may need to reassess your professional liability, workers’ compensation insurance and commercial auto insurance policies as well as your overall employee training and safety measures. Let’s look at a few of the tech-enabled therapy options and their associated risks.
Telemedicine and Physical Therapy
Telehealth — medical service provided by telephone — isn’t generally reimbursable for physical therapists under Medicare and Medicaid, so providers must be very careful about furnishing telemedicine to patients covered under those programs.
For patients in group health plans or other commercial insurance, payment varies as do permissible treatments and locations of treatment, so check with the payer before initiating services, according to the American Physical Therapy Association.
That said, school districts have, since the shutdown due to COVID-19, been looking for ways to provide special education students with occupational and physical therapy remotely. Other institutions have sought similar remote access to services.
In April 2020, the Centers for Medicare and Medicaid Services (CMS) temporarily changed rules governing home health agencies’ use of telehealth, allowing for expanded use of and reimbursement for telephonic physical therapy. But you must verify that these regulatory waivers are still in place and that your particular services and patients qualify.
Those physical therapists working via telephone should do a full assessment of the professional services liability exposures they may have, such as misdiagnosis, accessibility issues for those with hearing or speech problems, and verification of a patient’s comprehension of the therapist’s instructions.
Your practice should also work with your insurance professional to ensure your professional liability insurance covers telehealth. Additionally, it’s possible your practice will need to develop liability and informed consent clauses or forms for your clients to sign.
Virtual Reality Therapies
Physical therapists often spend a substantial amount of time coaching patients past mental and emotional barriers that block initiation of or progress in recovery. Virtual reality tools can help them overcome those obstacles by immediately engaging them in a gamified world that eliminates the distractions and fears of interpersonal relationship building and trust.
For example, patients who enter therapy believing they can’t perform certain daily tasks, like making a bed or buying groceries, are frequently willing to try these activities in virtual reality (VR) mode much sooner than in the real world. Through VR, they find — in the privacy of their home or therapist’s office — that they can accomplish movement or endeavors they thought were not possible.
Important to note are the risks that can be involved in VR and gaming. A neurological assessment and coordination with other caregivers can provide crucial contraindications or impediments that should be considered.
More online physical therapists are cropping up each week. They use videoconferencing, online coaching, apps that track recovery, and emailed exercises. The typical program begins with a clinical assessment (some done online), followed by a classification or diagnosis, a treatment plan, and some sort of monitoring and follow-through to gauge progress or completion of the regimen.
If equipment is needed, the therapist provides the prescription and resources, most of which can be ordered online. It’s important to check with the patient’s insurer to ascertain requirements for payment, because many mandate some in-person contact between the patient and the clinician, even if treatment will be delivered online. And, as always, the therapist’s insurance contract must be reviewed to assure that the firm’s professional liability coverage applies to online services.
A cyber risk insurance policy that includes business income loss will also be important for therapists working online. Breach of patient data and a shutdown of provider computer networks can generate expensive claims.
In-home Care for Physical Therapy Going High-tech
While CMS rules limit payment for in-home physical therapy to patients meeting very specific criteria, many insurers are more liberal. It may even be possible to conduct therapy in a person’s office or other institutional setting. And, of course, many senior-living residences and nursing homes routinely contract with physical therapists for on-site visits.
Whenever your employees conduct out-of-office treatment, you must be aware of the potential risks that differ from those for in-office care. Injury to and illness of your therapists caused by animals, obstacles and other humans are a specific safety concern that should be discussed with your workers’ compensation insurance professional. Special training may be required to avoid harm. If any employees begin crossing state lines to serve a patient, that will require an adjustment to your workers comp policy.
You’ll also bear greater responsibility for employee travel, even if they use their own vehicle. A commercial auto policy can be written to cover both company cars and the use of private automobiles, so be sure your insurance doesn’t have gaps for what are termed “non-owned vehicles.”
And since therapists will likely carry company equipment with them when visiting patients, you should consider an inland marine insurance policy so gear that is stolen, damaged or lost in transit has coverage.
Other Tech Aids for Physical Therapy Going High-tech
Remember that technology in your office supports your mobility and accessibility. That includes computer systems that store and crunch data as well as communications networks, video recorders, and virtual reality goggles and implements.
Your business continuity and disaster response plans should reflect your technological capabilities and loss exposures. With all systems and protections in place, your therapists should be able to reach an ever-wider clientele — safely for all.
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