Tech Advances Allow PTs to Treat Some Patients Remotely, Increasing Access to Care and Lowering Costs

September 17th, 2019
By: Content Staff

With physical therapists in high demand and many patients, especially those in rural areas, struggling to get the care they need, technology is beginning to bridge the gap. That’s according to a recent article from Scientific American, which reports that remote rehabilitation, or telerehab, is a trend picking up steam.

A shortage of PTs and inadequate insurance coverage for patients, including high co-pays and limits on the number of covered PT sessions, are the main drivers of this trend, according to Scientific American. The technology-based solutions include high-tech interactive systems, video-chat sessions with PTs and app-based programs.

Board members at the American Physical Therapy Association are embracing telerehab, pushing for Medicare to cover telehealth sessions and advocating for improved direct access, meaning a referral from another provider is not required to get PT, Scientific American said.

Low reimbursement rates from insurance companies have forced many PTs to see many more patients per day than is optimal. When PTs buck this trend by seeing only one or two per hour, the result for patients often is higher out-of-pocket costs because the PT doesn’t take insurance or is an out-of-network provider. Through Skype and other tech options, PTs can increase their efficiency and see more patients each day without lowering the quality of their individualized care. That allows PTs to offer patients a more affordable route to the PT they need, Scientific American reported.

Among the high-tech telerehab options is the Virtual Exercise Rehabilitation Assistant (VERA), an interactive device that guides patients through exercises in their home and records them in 3-D video as they move. An avatar gives patients instructions and feedback in real time, and PTs can visit with patients online and review videos of them doing their prescribed exercises, Scientific American reported.

Hospitals, medical practices and clinics can lease or buy the VERA system, which is temporarily placed in patients’ homes. The system allows PTs to charge patients a low monthly fee instead of the traditional per-visit charge, according to Scientific American. Since many patients recovering from surgery can’t drive, the VERA system increases patients’ access to care and eliminates the need for PTs to drive to patients’ homes, enabling them to see more patients each day.

Janet Prvu Bettger, an associate professor of orthopedic surgery at Duke University, ran the first clinical trial comparing VERA with in-person PT. Though full results haven’t been released, the initial findings show that patients recovering from knee-replacement surgery did just as well with VERA as with in-person PT, Scientific American reported. Three months after their operations, patients who used VERA had achieved the same level of pain reduction and had regained the ability to perform basic movements like climbing stairs, the report said.

Moreover, patients using VERA were readmitted to the hospital at a lower rate than those undergoing traditional PT. According to the study, the VERA system resulted in average savings of $2,745 per patient when compared with traditional PT, Scientific American reported. Full results from the study have been submitted for publication in the Journal of Bone and Joint Surgery.

One explanation for VERA’s solid results is that the system holds patients accountable and doesn’t allow them to tell PTs that they are doing their prescribed in-home exercises when they are not. The VERA system documents patients’ at-home PT exercises, so lying isn’t an option, according to Scientific American.

At a conference in March, Mary O’Connor, director of the Center for Musculoskeletal Care at Yale School of Medicine and Yale New Haven Health, presented findings from a study in which VERA patients reported an average satisfaction score of 91.2 on a scale of zero to 100. In her study, VERA patients also had some in-person visits, Scientific American reported. Going forward, PTs will have to determine which patients can use VERA for 100 percent of their care, which patients need solely in-person PT and which patients could benefit from a combination of both.

“Telerehabilitation is not a complete substitute for a skilled and trained physical therapist,” she told the publication. “We use VERA as an extender of the physical therapist to make the home program more effective and care less costly.”

Another telerehab solution is an app called Kaia that is used only to treat patients dealing with back pain. The app uses guided exercise videos, patient education and mindfulness techniques. Researchers at the Technical University of Munich found that patients using Kaia reported having less pain after 12 weeks than a control group that received in-person therapy and online education. The researchers told Scientific American that they are in discussions with a major U.S. insurance company to set up a similar trial, indicating that the lower cost of telerehab appeals to insurers.

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