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    New Telehealth Bill Includes PTs, Could Mean Big Changes for Medicare

    A newly introduced bill aimed at expanding the use of telemedicine in the Medicare system would allow reimbursable telehealth services for physical therapy and permit use of the technology in more populated areas.

    Called the Medicare Telehealth Parity Act of 2014 (.pdf), the bill introduced by Reps Mike Thompson (D-CA) and Gregg Harper (R-MI) would gradually roll out changes over 4 years. The changes would eventually remove current limits on the population areas that qualify for Medicare's telehealth reimbursements, allow for much-expanded remote patient monitoring, and include rural health clinics as approved telehealth care sites.

    Another important feature of the bill: a provision that outpatient therapy services, including physical therapy, delivered via telehealth technologies would be reimbursable under Medicare.

    Although Medicare currently allows some telehealth delivery, the system limits reimbursable use to rural areas, and requires beneficiaries to travel to "originating sites," with no provisions for remote patient monitoring. The proposed bill would use a phased-in approach to remove those population-based limits and allow the addition of remote patient monitoring for specific conditions. The bill also requires the General Accountability Office to study the use of remote patient monitoring for outpatient therapy.

    This year, APTA's House of Delegates approved a resolution that supports the adoption of telehealth technologies in physical therapy as "an appropriate model of service delivery" when provided in ways that are "consistent with association positions, standards, guidelines, policies, procedures, Standards of Practice for Physical Therapy, Code of Ethics for the Physical Therapist, Standards of Ethical Conduct for the Physical Therapist Assistant, the Guide to Physical Therapist Practice, and APTA Telehealth Definitions and Guidelines; as well as federal, state, and local regulations."

    APTA will monitor this bill and alert members on its progress.

    APTA offers resources on telehealth in physical therapy—including a link to Board of Directors definition and guidelines--on its telehealth webpage.


    Comments

    I really wonder what APTA is thinking here. Apparently they don't see the big picture where actual physical contact will begin to be phased out by using videos. Reimbursable? At pennies on the dollar. Thanks again for selling us down the river. This is Another reason why I wonder why I waste my money on membership.
    Posted by Scott Schultz on 8/1/2014 5:53 PM
    In response to Scott's comment...I suspect the big picture is that telemedicine ( rehab) will be a useful tool in our tool bag and not the demise of hands on therapy. There are many reasons why this would come in handy...rural areas where geography is quite spread out, states where PTAs must have an observed visit at a given frequency. It's up to the individual to embrace technology, use their clinical judgement and advocate for its proper place. As far as membership goes, I have found APTAs support very helpful, especially when I changed my paradigm to ask not what the professional association can do for me but what can I do for the profession and the association. That shift helped build my professionalism and network of very knowledgeable people tremendously.
    Posted by Matthew Mesibov on 8/1/2014 11:13 PM
    I can see the benefit in some situations. First, it can be a way to do supervisory visits with a PTA. The PTA can be on-site, and the PT can participate remotely for part of a visit to collaborate. Also, as a wound specialist, I can really see the value. If I worked for a home health agency, a wound center, or an integrated health system, it can be very valuable to assess and follow-up more patients since it is a specialty field with limited practitioners. A wound specialist could do tele-consults with in-home nurses, to assess progress and update the plan of care as needed. It would allow the specialist to see a lot more people without needing to travel to each. Recently I had a patient with a diagnosis I didn't have a lot of experience with, and she had a lot of other challenges that made it difficult to follow the standard tests. I contacted another PT within my company at another site to discuss the case, but he was not able to come in person. If we could have done a teleconsult in real time, without discussing it asynchronously via email, it would have been very valuable. I don't think telemedicine will replace hands-on PT. But, it may help with follow-up when that contact is not necessary, will help us see people who are otherwise inaccessible, and will open up some new pathways for care.
    Posted by Renee Cordrey -> =IX]AH on 8/2/2014 7:52 AM
    In response to Scott's comment, we cannot ignore technology and the impact it will have on our healthcare system. Either we can determine how it will be implemented, which is one of the reasons we passed the Telehealth motion in this year's House of Delegates, or we can let other groups define it for us and lock us out. I would much rather we (APTA) be in control of how technology is implemented in our practice and be involved in developing the payment systems for it.
    Posted by Mark Dwyer on 8/2/2014 10:28 AM
    Fully agree with comments posted by Mark Dwyer on 8/02/14
    Posted by joseph roman on 8/2/2014 1:25 PM
    I agree with Mark. It is critical that our profession find a way to stay at the table for these innovated conversations and dictate our contribution to such.
    Posted by Larry Parker on 8/3/2014 12:45 AM
    Please sign our petition to have Medicare cover hearing aids under HR 3150. http://petitions.moveon.org/sign/to-pass-hr-3150.fb73?source=c.fb&r_by=6379786 Please repost to all social media. We need this to go viral so Congress hears our voices. Janice Schacter Lintz, Chair, Hearing Access Program
    Posted by Janice Schacter Lintz on 8/3/2014 10:05 AM
    I think I am missing some points about hearing aids. Before I consider signing this petition, can you please explain to me why a PocketTalker (cost <$100 including ear buds or headset from Radio Shack) would not be more cost effective and sufficient for the one with hearing loss? Hearing aids cost $2,000-$3,000 or more, and my patients easily lose them and cannot afford to continue to replace them. Within my own family, members with hearing loss have mixed opinions about hearing aids and PocketTalkers. I have been recommending to my patients and their families to not get hearing aids but a PocketTalker that has 3 types of frequencies each with volume control. Please enlighten me. I really do want to better understand your perspective and rationales.
    Posted by Dr. Lise McCarthy, PT, DPT, GCS on 8/3/2014 4:01 PM
    Tele-medicine and information technology in general is here to stay. The fear of replacement is very real, physical therapy as a profession has been complacent in the past. We allowed others to define our worth and lost a great deal of perceived value. We must not only participate, but we must domimate the conversation and define how tele-health will affect our practice standards, where this type of communication will be effective and where it will not. Physicians are already experimenting with tele-medicine and they are defining what can and cannot be treated on online. Check out American Well, they have been developing interactive online "virtual" visits for several years-- it is here.
    Posted by Susan Keegan on 8/3/2014 8:56 PM
    I agree with Susan. Telemedicine is here to stay. We need to be at the forefront to define what and how this is utilized. My understanding this has been used in very rural states for some time and is beneficial to the patient. I know our counterparts in Speech therapy are using this all the time. I do think we need to clearly define the boundries of telemedicane with regards to physical therapy and what is appropriate and that this does not in any way replace the "hands on" contact with the patient. I suggest that we see if any of our counterparts around the globe are using telemedicine. How awesome would it be to conference with the best in the world on our patients. I think we need to be aggressive and promote this in our daily practices, work with the powers that be to be the practitioner of choice, and be at the forefront on the delvelopment of the telemedicine system.
    Posted by Lynn Busdeker, PT on 8/5/2014 8:26 AM
    Agree with 90% of the comments here - except Scott Schultz. APTA is involved in healthcare change and keeping physical therapists at the table. APTA also needs OUR involvement and dues income to keep fighting for patient's access to physical therapists. In case Scott hasn't been paying attention, reimbursement for traditional face-to-face visits is declining. Absent a plan for the future, Scott will be out of a job. What's your plan, Scott? Keep on doing the same thing and expect different results? Like it or not, America is moving to a 'tiered' healthcare financing system. Some basic services will be available to most everybody - that may include telehealth services. The more expensive, face-to-face services will not be available to everyone. Sorry, that's just going to be a fact. Patients will be able to 'upgrade', or pay more for additional services. This may be through insurance or and additional, out-of-pocket 'cash pay'. The bottom line, telehealth gives more patients access to basic physical therapy services. It also preserves patient choice. If they find the service valuable, they can buy more. I think telehealth is a good thing for physical therapists. Tim Richardson, PT
    Posted by Charles Richardson -> =GR^EM on 8/5/2014 11:41 AM
    I support the action of the APTA. Physical therapists must take the lead in advocating for ourselves or we will lose a valuable resource for augmenting our services. Medicine is going in this direction and for many reasons, including the support of the technology industry, I believe this direction will flourish. Awareness of how to practice using telehealth should be included in PT education and continuing education. It is an amazingly effective way to reach people. It is ripe for creative thinking within our profession right now.
    Posted by Deborah Brandt on 8/5/2014 3:06 PM
    should start using fitness builder and get reimbursed for just a few moments of your day.
    Posted by Blaine Warkentine md mph on 8/5/2014 4:54 PM
    Does anyone know if this bill would have any effect on whether or not we as PTs could provide telehealth services to clients/patients outside of our state of licensure? I feel that an important limitation to our ability to provide TH services is that we are currently limited to only having such clients within our own state.
    Posted by Jarod Carter on 8/6/2014 8:12 PM
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