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The Role of Telehealth in Value-based Care: Does it replace us, displace us, or augment what we do?

In case you missed it, our latest webinar was jam-packed with industry-leading commentary on the industry shift towards value-based payment models and how physical therapists can participate in this new world of reimbursement. Keet’s President, Holly Taylor, guided a dynamic conversation between a panel of three leading PT experts:

Holly is a leading expert in healthcare reform who brings more than 30 years of experience in healthcare and is an authority on healthcare reform and value-based care strategies.  As the moderator for this webinar, she rounded up advice and insight from our all-star panelists. 

— Watch the on-demand webinar here! — 

Speaking to the enormous change that occurred in 2020, Holly said, “Over the past year when so much changed, healthcare providers were thrown in the deep end and had to either entirely, or partially, rely on remote care pathways to care for their patients. One of the big lessons learned in all of this disruption was that, when it’s needed, providers are able to transition to deliver telehealth and remote patient management through various technologies.”

The impact of VBC and MIPS on rehab therapists

Beyond remote patient management and telehealth, the other large market driver in PT right now is the move to value-based care. The U.S. saved an estimated $600 billion in 2020 thanks to the success of value-based care models. And now, the PT industry is poised to capitalize on that success too. 

We polled the attendees who participated in our live webinar recording and found that 47% are already participating in CMS’ MIPS, with 11% planning to participate in 2022. 

Because it’s not really a question anymore of “if” but rather “when” therapists will start participating — we asked our panelists why participating in MIPS is important for rehab therapists even if it’s not yet required.

  • Kelly Sanders, PT, DPT, OCS, ATC President, Movement for Life

“We participate in MIPS and I think the biggest thing we see is that this is the largest, universal option for physical therapists to participate in any type of MIPS or MACRA legislation programs. That’s why we do it. We went back to the skills acquisition idea and we believe this is a skill we’re going to have to have. This is something we’d rather learn now, and figure out the kinks now, while it’s still voluntary. As opposed to potentially figuring it out when it’s mandatory at some point. And again, being the only value-based care program that is widely available we felt that it was important to do that. 

We also really like the discipline it’s provided in outcomes measures. We’ve done patient satisfaction surveys for years but this really created a lot of discipline around it and made it a big objective for us. So for those reasons we think it’s important in getting to more standardized care. Having that dialogue of accountability—that we’re accountable for the care we provide. This is the only program that is widely available, and while not perfect, again it is something that helps us on that path to becoming accountable. As we’ve seen these programs develop, we believe these programs are here to stay and we want to be earlier adopters.”

  • JeMe Cioppa-Mosca, VP of Rehab Services, Hospital for Special Surgery (HSS)

“I would echo what Kelly said. I think that in general physical therapists don’t necessarily love data, but I think the way healthcare is headed is value-based care and MIPS. Big data is critical to our success and we do have to get better at proving the effectiveness of our care. 

As a profession, we need to get much more comfortable with standardized information as far as PROMS, functional outcomes, being able to be accountable for our care, and making sure people are progressing along the episode or continuum when physical therapy is not working. So I am a strong believer. I do know we have across our network an adoption concern because I think it’s a mindshift for people. But it’s coming and I always like to get on board sooner than later—while it’s voluntary and not mandatory.”

  • Larry Benz, DPT, OCS, MBA, MAPP President, CEO, Confluent Health

“I think accountability is the big factor. It’s a standardization and it prepares you cadence-wise in your workflow processes. Kind of like when we were first introduced to modifiers, way back when. I also think many practices have adopted an outcome system over the years and now we have this CMS standardization that is all payers, it’s not just Medicare.

It brings an added respect to the industry. We should all be on the frontline of being accountable. If providers at this stage of maturity aren’t collecting, through a third party, outcomes… I mean ‘Why not? What do you have to hide?’ I think it’s a transparency issue. And again these programs elevate us as a profession and allow us to be on the frontlines and broadcast, ‘We’re held accountable by third parties.’”

Primary market drivers for choosing a rehab therapist

Everyone in the healthcare ecosystem is looking for ways to reduce unnecessary costs and increase the quality of care provided. A big theme here is reducing unnecessary utilization and increasing utilization that improves outcomes. And this is exactly where physical therapy has the value to provide by reducing unnecessary downstream costs.

Another path toward managing musculoskeletal disease in cost-effective ways is the use of digital health platforms. While some folks advocate for the use of these platforms to totally replace in-person physical therapy, this is not our position at Keet. We do find tremendous value in a hybrid care model that supplements clinical care with digital health services in those cases where it makes sense for individual patients.

So we asked our panelists: How will these new care delivery models associated with alternative payment models alter how patients seek PT care? Will the focus be on cost? Direct access? Quality of care?

  • Larry Benz, DPT, OCS, MBA, MAPP President, CEO, Confluent Health

“We know that direct-to-consumer (DTC) marketing works. And now the question is ‘Will it work in healthcare too?’ Well, the evidence suggests that more and more patients—particularly females who tend to be the decision-makers—do look at their options for direct access and they also look at their options in terms of the reviews.” 

“That being said, there are a lot of factors, such as deductibles. We’ve seen that folks have become accustomed to having those high deductibles, as well as accessing providers directly and understanding that they have to go through that deductible. I think that bodes well for us. Particularly where direct access has been so successful.” 

Another factor is choice. Value-based care and clinical integration might actually decrease choices. Then you have incentives. We worked very hard over the last two years on our own company’s self-insured product by looking at the impact of copays in aches, pains, sprains and strains to see if our own employees will access PT first. We’ve also done a two-state pilot with Anthem on direct access for patients who have low-back pain to find out if a reduced or zero copay helps—and it certainly does. But really it comes down to the messaging. In my opinion, right now access trumps just about everything, including the whole construct of quality. I think it’s access, availability, word of mouth—these are all extremely powerful right now.”

  • Kelly Sanders, PT, DPT, OCS, ATC President, Movement for Life

“I would echo a lot of what Larry said. I think the convenience and access factors have become an enormous part of our practice. Yelp reviews—the digital word of mouth—have become more and more important. Patients want to know what other patients are saying. So patient satisfaction and patient testimonials are important. 

It really comes down to that access and convenience point. After going through Covid-19 the convenience some people experienced, whether that be telehealth or pulling up to Target and having your merchandise delivered to your car, I don’t think that expectation at the consumer level is going to go away. This access piece has become so important. Whether that is digital access to scheduling or having access to telehealth that’s available on-demand when they have downtime in their schedule—I think we really need to think as providers how we’re going to meet our patients where they are and make it convenient.

As things have started to return to normal we’ve seen a rapid decline in telehealth usage. We’re launching some new programs and starting to use it a bit differently as part of our business continuity plan. We have practices in California and fires are something we hadn’t even thought about using telehealth for. But since we had it in place last summer, it became something that was a big part of our not having to close our clinic for two days. Same thing with power outages. There were some protests in proximity to our clinics where we needed to close for safety and telehealth really became a part of that continuation of providing access to our patients. 

We’ve also started looking at using telehealth potentially for staff who may be on bed rest or taking a prolonged leave. So it’s becoming an integrative part of our model. With digital practice increasing, we believe that our providers having the ability to interact with patients and have meaningful dialogue through that medium will be an important access point and an important part of our practice.”

  • JeMe Cioppa-Mosca, VP of Rehab Services, Hospital for Special Surgery (HSS)

“I strongly believe that telehealth is here to stay and that it is a tool and a skill. We’ve learned it and now we need to make sure that our therapists are trained on it. I do not feel that it is simply ‘in-person care with a camera.’ I think it’s a different skill set that has to be taught to do it successfully. As Kelly mentioned, I do believe it will and should be integrated as part of our bag of tricks to take care of patients. It’s awesome for business continuity and emergencies. 

Our telehealth business is probably 10% – 12% of our overall right now, and at some points last year it was 90% – 95%, so it definitely has gone down because people like in-person care, but there is still a subset of people who prefer telehealth. I can tell you that our routine 6-week and 12-week (post-op)  visits are now done almost entirely by telehealth and virtual health. So convenient for the patient because they do not have to commute into Manhattan and they don’t need to pay for parking. So we have shifted into more of this hybrid model, both on the physician side and the rehab side.

As it relates to our primary market drivers, I am a very strong believer in direct access. I think we have a population that wants immediate care and people want what they want when they want it. So being able to provide the right clinician at the right time for the right condition is going to be very important. At HSS we’re working on a lot of predictive modeling so that if a patient answers a few questions digitally, we can route you to the right place. I think we’ll continue to see more of this. 

Another thing we’ve talked about is that we believe the PT has the potential to be the PCP for musculoskeletal (MSK) care. I think therapists in general do a full MSK evaluation better than any other healthcare practitioner, PA or NP out there. So I think we have the opportunity to move into that role for PTs to do a significant amount of triage. And we’re seeing that especially with our employer contracts and where we’re on-site with some employers who are self-insured. PT is the first stop for almost everything.”

Digital health platforms: Do they replace us, displace us, or augment what we do?

We asked our panelists to outline any further thoughts they have on how they’ll continue to use telehealth post-pandemic, as well as any other strengths or weaknesses they perceive with taking a hybrid approach or using a digital health platform in rehab therapy practice:

  • JeMe Cioppa-Mosca, VP of Rehab Services, Hospital for Special Surgery (HSS)

“I would like to emphasize that in our opinion there will always be a piece that will stay virtual and it’s great to have that when something goes wrong. However, the digital aspect will be integrated in a hybrid model. We were predicting around 20%—that might be a little high—of everyone’s care will be done via telehealth over the next year or two.

We need to embrace that telehealth is part of the delivery system now. We need to be much more open-minded. The digital world is here and it’s going to look very different in the next five years. I don’t think it is a replacement for in-person therapy at all. For some people, educationally-sound, self-directed therapy can work, but it’s not for everybody—it’s for a subset of the population. This is why predictive modeling is so important. I do think of it as a huge asset for monitoring and seeing how people are doing when they don’t have a visit scheduled and you want to maintain your connectivity. 

In a situation where one therapist can review 25 patients in a dashboard format and see how they’re doing—this can extend what we could possibly do. So, I think we just need to be open-minded to these new technologies and figure out how they get integrated or augment our primary skill set.

When people have great hands, there is no replacement for great hands. And that has to happen in person.” 

  • Kelly Sanders, PT, DPT, OCS, ATC President, Movement for Life

“I really think digital health platforms will be a key to opportunities, especially for smaller practices, in the future. I could see certain smaller, regional payers or other pilot groups requiring telehealth so I do think that the opportunity to participate in future projects makes it a good skill to have.

The biggest threat as therapists is that I don’t feel like we’re that savvy or open to change. I think that’s a threat. I think some of these companies are savvy and looking to have different ways to provide care. As physical therapists we need to push that envelope a little bit more and look at different ways to provide care. We can care for a lot of things in a digital environment, but there are also a lot of things we can’t care for virtually. A lot of our work is building that rapport with patients in the clinic. This is so unique to physical therapy—the coaching and the support that go along with that process. I’m not sure we can make those connections in a purely digital world.” 

  • Larry Benz, DPT, OCS, MBA, MAPP President, CEO, Confluent Health

“I think we have to use the experience during Covid-19 to learn quite a bit. Covid is best thought of in certain circles as an accelerator for certain technologies. Certainly telehealth has shown to be extremely effective for behavioral health interventions and primary care. I look at it from a physical therapy standpoint using three lenses. Does a technology or an implementation replace us, displace us, or augment what we do? In my mind, we have evidence that this technology will not replace us. 

The number of telehealth visits has gone down significantly since our patients had the option to start coming in again. This gives us an omnichannel approach. This gives us a chance to sell our diagnostic capabilities. PTs are so good at triage. Telehealth can be used for some of the initial parts of the evaluation. Therefore I view it as an augmenter in the hands of PTs. I see it as part of virtualization in an omnichannel approach where there will be a percentage of patients who can be treated in a totally virtual environment. But the vast majority of patients are treated with some element of hands-on and on-site care.

That being said, from a classic strategic lens, telehealth is absolutely a threat. But again, I come back to “replace, displace or augment.” Some uses are meant to replace a PT’s episode entirely, but some components are for patient monitoring and self-management. So, I’m cautiously optimistic that over the next few years these technologies will evolve over periods of time. At the end of the day it’s still a personal connection that the patient has with their trusted physical therapist.

Big Takeaways

At the height of Covid-19, 43% of all Medicare visits were being performed via telehealth versus 1% in 2019. What does this show us? When necessary, providers and the industry can innovate and adapt to meet patients’ needs. This spirit of innovation is exactly what we need to hold onto as we move forward with transforming our healthcare system on the path to value-based care (VBC). 

The two biggest takeaways from this webinar were that providers need to:

  • start preparing now to participate in value-based care models; and
  • meet patients’ desire for convenience and direct access to care.

My Healthcare Belief

In closing, we asked all webinar participants what their healthcare belief for the future is—and also for them to share their beliefs over social media using the hashtag #myhealthcarebelief. Come join our conversation on Twitter here. 

At Keet, we believe:

  • Tech alone will not fix healthcare.
  • The provider-patient relationship is sacred.
  • The status quo is harmful.
  • Patients should be our focus.
  • Healthcare is more than just medical care.
  • Human connection heals.
  • In restoring humanity to healthcare.

We would love to hear your thoughts on LinkedIn, Twitter and Facebook. Please share your belief for the future of healthcare and tag #myhealthcarebelief on your post.

P.S. As mentioned on the live webinar, if you’d like to access the HSS telehealth evaluation guides for MSK, you can find it on Amazon here