Introducing Telehealth Options from Oregon Running Clinic
Helping to Understand and Navigate Telehealth: The New Wave of the Future
I recently went to a PT conference in Denver in February and attended a telehealth lecture and they reported that by 2025 nearly all healthcare will be delivered digitally. I was a bit shocked hearing that statement, thinking there is no way that could happen to the physical therapy industry, as digital care will never be able to replace manual therapy. But after recent events, I’m getting a glimpse into the future as to how this could and likely will be.
What is Telehealth?
Telehealth is a newer healthcare offering, where a healthcare provider performs remote medical or healthcare service to a patient via a HIPPA compliant online platform such as video conferencing.
Telehealth appointments are typically used for follow up visits but are increasingly used for initial evaluations as well. These services could include evaluation, treatment, advice, assessment, demonstrating exercises, monitoring patients’ exercise form, consulting and any other case management.
Patients login to an online portal on the platform to communicate with their provider. This has historically been used for patients in rural settings or where there are limitations in access to healthcare, and is practiced in many states by nurses, physicians, dietitians, and psychologists, and is not a new concept. Though telehealth has been legal in Oregon since 2016, it is still a fairly novel concept to both physical therapist providers and patients, after all, largely what we do as physical therapists is physical. But this may become more of the norm than the exception, especially in these recent days and next several months in order for patients to remain in contact with and under care with their healthcare providers. Telehealth for PT is here to stay.
How Telehealth Works in Oregon & Other States
Telehealth or telerehabilitation is regulated at the state level, so the rules lawful practice of telehealth varies from state to state. In Oregon, an Oregon-licensed physical therapist may practice telehealth PT to a patient who is either physically in Oregon or who is domiciled in Oregon. This can be confusing, so here are some examples:
An Oregon resident who may be traveling out of state would be able to have a telehealth visit with an Oregon-licensed PT, as long as they still live in Oregon.
A non-Oregon resident would not be able to receive a telehealth visit from an Oregon-licensed PT while they are located out of state unless that doctor has a PT license for that state, and unless that state has legislation allowing telehealth to be practiced by PTs.
A non-Oregon resident who is physically located in Oregon can receive a telehealth visit from an Oregon-licensed PT, regardless of permanent residence.
In regards to Oregon Running Clinic, I have both an Oregon and Idaho PT license so I am able to practice telehealth PT for patients in Oregon and Idaho.
Telehealth and Insurance
Regardless of the legality of telehealth, there is little standardization of whether commercial insurances will pay for such services.
For self-pay patients, it’s business as usual so there are no restrictions to access for care.
However, it’s a different story when dealing with insurance carriers. Each health insurance carrier has its own policies for telehealth, and historically, Physical Medicine and Rehabilitation (the insurance benefit category that Physical Therapy falls under) has not been included or covered for reimbursement by commercial or federal Payers for telehealth services, as PTs have not been a covered entity.
However, in light of recent events with COVID-19, a temporary waiver has been issued on this restriction by CMS for Medicare beneficiaries which temporarily allows for e-visits to be billed by PT for current active Medicare patients, but not telehealth in the classical sense. Because of CMS temporarily lifting the restriction, many other commercial payers have followed suit for their non-Medicare members as well. This is payer-specific, so each patients’ plan benefits must be checked individually to see if they are temporarily allowing this.
If you are a current active patient that typically goes through insurance for PT and are interested in telehealth, contact me and I’ll be happy to assist you in checking this. I will give an update to some major insurance carriers’ temporary policy changes updates. Please note they continue to change daily, so for most up to date information, contact your carrier directly.
Regence Blue Cross Blue Shield of Oregon will be covering PT visits as the same as in-person visits for rehabilitation billing codes for the time being when delivered remote/telehealth but all co-pays, coinsurance, and deductibles will apply.
United Healthcare will be covering PT visits via telehealth from 3/18-6/18. All copays, coinsurance, and deductibles still apply.
Providence Health Plan of Oregon will be covering PT visits for active current patients for therapeutic exercises and activities, not for new initial evaluation. Copay, coinsurance snd deductibles apply.
Cigna will be covering evaluation and therapeutic exercises for physical therapy visits.
Aetna is covering some physical therapy billable codes but is plan specific. Please check with your carrier for specific plan provisions.
Blue Cross Blue Shield and Premera Blue Cross of Washington are covering some of the physical medicine and rehabilitation services, check plan for specific details.
If you are a current active patient having your insurance billed for PT at this time, wish to have teleheath PT as an option, and do not see your carrier listed, please contact me and I can assist you with checking the plan provisions.
Why Telehealth? Sounds Like a “Tele-Headache”
So with all the confusing regulations, and recent and ongoing changes to teleheath, why would a patient or provider even consider it? Now we will take a look and the pros and cons. As mentioned earlier, telehealth will be the wave of the future, and by 2025 it is expected most healthcare will be delivered digitally.
Telehealth can be used in different ways and offers a number of benefits, including:
Provides health care on-demand
Helps patients avoid the terrible Portland and Vancouver traffic and decrease commute time
Provides cost savings to the patient
Can provide better access to more professionals and specialists
Allows niche practices to reach more patients
Enables co-treating with other specialists
Improves access to better healthcare for patients in rural settings
Improves access to wellness visits upon discharge from physical therapy
Allows those unable to leave home (illness, childcare, etc, weather, travel) to still receive care
Can be used for running medicine consulting, training, coaching and progressing or modifying online home exercise programs
What about the cons? When I first heard of telehealth for PT this is the first thing that came to my head. Physical Therapy is very hands-on, especially for the evaluation as there are many clinical specials tests we perform that give us the information needed to make appropriate clinical diagnoses, assessments, and decision-making during an evaluation.
In addition, manual therapy treatments are performed as described – by hand. There are so many little nuances that would be hard to assess via telehealth. Plus, a lot of tactile cueing is used in PT to help patients perform therapeutic exercises correctly for motor learning to occur. I have yet to figure out how that could be substituted by telehealth. So there are indeed limitations, and it is not appropriate for all patients or their conditions. Collaboratively, if we embrace telehealth as an option to supplement the physical therapy plan of care, then I think I have to agree it has its place in Physical Therapy Practice now and in the future, not just as an interim during the COVID-19 pandemic. In a time where so much has changed so fast, literally overnight, telehealth must be embraced by both providers and patients in order for us to help patients stay on track with progressing with their health and wellness now and in the immediate future.
HIPPA compliant platform through Clocktree has been added to the Oregon Running Clinic Website and patients and clients can book appointments directly online for both PT follow up virtual visits and also for running medicine consulting. Learn more about Clocktree here! I’m excited and looking forward to being able to connect with patients now both in person and virtually!!!
-Dr. Jen Davis, Oregon Running Clinic