sedgwick cms 2009 capabilities overview the future is here and... · presented telerehab: the...
TRANSCRIPT
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
DENTAL | DIAGNOSTICS | EQUIPMENT + DEVICES | HOME HEALTH + COMPLEX CARE | PHYSICAL THERAPY | TRANSPORT + TRANSLATE
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Virtual Healthcare - Are We Ready?
DENTAL | DIAGNOSTICS | EQUIPMENT + DEVICES | HOME HEALTH + COMPLEX CARE | PHYSICAL THERAPY | TRANSPORT + TRANSLATE
©2018 One Call Care Management. All Rights Reserved.
Who Might Participate?
Source: Retrieved from www.Healthpopuli.com
DENTAL | DIAGNOSTICS | EQUIPMENT + DEVICES | HOME HEALTH + COMPLEX CARE | PHYSICAL THERAPY | TRANSPORT + TRANSLATE
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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
DENTAL | DIAGNOSTICS | EQUIPMENT + DEVICES | HOME HEALTH + COMPLEX CARE | PHYSICAL THERAPY | TRANSPORT + TRANSLATE
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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
DENTAL | DIAGNOSTICS | EQUIPMENT + DEVICES | HOME HEALTH + COMPLEX CARE | PHYSICAL THERAPY | TRANSPORT + TRANSLATE
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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
DENTAL | DIAGNOSTICS | EQUIPMENT + DEVICES | HOME HEALTH + COMPLEX CARE | PHYSICAL THERAPY | TRANSPORT + TRANSLATE
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Pain Scale
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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
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Case Study: Transition to Virtual Care
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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
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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
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• 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
DENTAL | DIAGNOSTICS | EQUIPMENT + DEVICES | HOME HEALTH + COMPLEX CARE | PHYSICAL THERAPY | TRANSPORT + TRANSLATE
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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
DENTAL | DIAGNOSTICS | EQUIPMENT + DEVICES | HOME HEALTH + COMPLEX CARE | PHYSICAL THERAPY | TRANSPORT + TRANSLATE
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Low Back Pain Costs
Source: Spine 2010 Nov 15;35(24) Source: Burdon of Musculoskeletal Disease in US 2006
DENTAL | DIAGNOSTICS | EQUIPMENT + DEVICES | HOME HEALTH + COMPLEX CARE | PHYSICAL THERAPY | TRANSPORT + TRANSLATE
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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
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Low Back Pain Treatment Outcomes
• Average treatment visits
(national): 6
• Cost savings
– Decreased number of
visits
– Decreased lost time
– Decreased cost/visit
Legislative Update
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Physical Therapy Compact
Source: Retrieved from http://ptcompact.org/ptc-states
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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
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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
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Telerehabilitation States
DENTAL | DIAGNOSTICS | EQUIPMENT + DEVICES | HOME HEALTH + COMPLEX CARE | PHYSICAL THERAPY | TRANSPORT + TRANSLATE
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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
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Pre-Surgical Rehabilitation (“Prehab”)
• Aide in preparation for surgery
– Range of Motion
– Strengthening
– Maintain fitness
• Reduce fear and anxiety
DENTAL | DIAGNOSTICS | EQUIPMENT + DEVICES | HOME HEALTH + COMPLEX CARE | PHYSICAL THERAPY | TRANSPORT + TRANSLATE
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Home Exercise Program Support
• Mobile technology
• Built in/customizable exercise protocols
• Videos
• Reminders, badges
• Feedback loop
• Patient dashboard
• Provider dashboard
DENTAL | DIAGNOSTICS | EQUIPMENT + DEVICES | HOME HEALTH + COMPLEX CARE | PHYSICAL THERAPY | TRANSPORT + TRANSLATE
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Wearables
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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
DENTAL | DIAGNOSTICS | EQUIPMENT + DEVICES | HOME HEALTH + COMPLEX CARE | PHYSICAL THERAPY | TRANSPORT + TRANSLATE
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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
DENTAL | DIAGNOSTICS | EQUIPMENT + DEVICES | HOME HEALTH + COMPLEX CARE | PHYSICAL THERAPY | TRANSPORT + TRANSLATE
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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
DENTAL | DIAGNOSTICS | EQUIPMENT + DEVICES | HOME HEALTH + COMPLEX CARE | PHYSICAL THERAPY | TRANSPORT + TRANSLATE
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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.
DENTAL | DIAGNOSTICS | EQUIPMENT + DEVICES | HOME HEALTH + COMPLEX CARE | PHYSICAL THERAPY | TRANSPORT + TRANSLATE
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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
DENTAL | DIAGNOSTICS | EQUIPMENT + DEVICES | HOME HEALTH + COMPLEX CARE | PHYSICAL THERAPY | TRANSPORT + TRANSLATE
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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
Aideen Turner, MPT, Cert. MDT, CEAS