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Winning Over Telehealth Skeptics to Improve Patient Adherence and Access to Care

June 17, 2022 • Advocacy • Heidi Jannenga

Progress of technology in medicine has always run into resistance along the path to greater acceptance. The old is tried-and-true, the new presents uncertainty, and challenges what we think. More importantly, new methods require us to make changes to set workflows and practices and few people are eager to break their routines in favor of something unfamiliar.

The healthcare industry has shown how advances big and small can improve and save lives, albeit slower than other industries. However, the patient experience amidst this progress has not always been kept at the forefront. And as such, patients are understandably skeptical of the so-called “latest-and-greatest” technological tools, which is only compounded by the general consensus of dissatisfaction with the US healthcare system. In this case, it’s telehealth: something that has proven its efficacy, but has yet to see a rate of adoption and use that corresponds to its value.

So, as we come out of one of the worst business disruptions of our lifetime with a tool that assisted us in maintaining continuity of care, why are we so eager to return to the status quo? We must all embrace telehealth as an opportunity to expand the patient reach of our profession and make it a goal to include telehealth with evidence and data so that patients understand how it can help them achieve their goal of a healthier life.

How widely used is telehealth?

So, just how prevalent is telehealth in PT clinics? We recently completed our annual survey of PTs in advance of our industry report, and while the full report won’t be available until August, here are a few of the key findings:

  • Nearly half of therapy professionals indicated that their organization currently offers telehealth services to patients. (I should note that this data was collected in late 2021 and early 2022.)
  • An additional 9% of respondents indicated that although they don’t currently offer telehealth services, they plan to add these services in the next year.

The necessity of telehealth during the pandemic was definitely the impetus for its wider adoption; in WebPT’s 2021 State of Rehab Therapy report, nearly 83% of those who had implemented

telehealth in their practices cited continued operation during the COVID-19 pandemic as the reason for doing so. That boom created numbers that are outliers, to say the least; a HHS study found that Medicare telehealth visits during the pandemic rose 63-fold—not a rise that we’re likely to see again. But it’s been disappointing to see the numbers for telehealth drop to levels below what I believe they should be, given its perceived value from both clinicians and patients alike.

Do patients actually like telehealth?

The discussion around the relative popularity of telehealth requires a bit of nuance.

At first glance, it would seem that telehealth isn’t a home run hit with PT patients yet—according to our aforementioned 2021 report, more than 70% of rehab therapy organizations report that their patients show slight to zero interest in telehealth. And a similar study from NPR, the Robert Wood Johnson Foundation, and the T.H. Chan School of Public Health at Harvard found that while 82% of patients who used telehealth were satisfied with the experience, 64% expressed a preference for in-person visits.

But the top-level statistics from surveys don’t always tell the full story, and parsing the data further can offer more context. That same WebPT data showed that the larger the organization, the more interest their patients showed in telehealth. And there is some anecdotal proof that patients are fans of telehealth in practice. As Bay State Physical Therapy president and CEO Steve Windwer attested in this blog post, his clinic’s Net Promoter Score® actually increased upon the introduction of telehealth.

I would suggest that telehealth’s failure to fully catch on in a post-pandemic world is on us as providers. It’s our job as therapists and healthcare providers to educate our patients on  the benefits of telehealth, and to do better in communicating with patients to address their fears or concerns. With an easier method of conducting follow-ups and checking exercise progression, therapists can also do better in treatment modifications for telehealth visits versus in-person visits.

What are the benefits of telehealth?

Telehealth has the potential to be a gamechanger not only for the quality of health care provided to patients, but also for the number of people that can access healthcare services.

As I’ve noted previously, 10% of patients that could benefit from seeing a PT actually do so; the rest are left to medication and other means of treating their condition. The reasons are well-documented: some are unable to get to a doctor’s office due to a lack of transportation, prohibitive geographic distance, or because they are elderly or otherwise struggle with mobility. For many it’s financial reasons; whether their insurance has a high deductible or they have no insurance, patients simply can’t afford to seek the care they need. Whatever the cause, the overwhelming majority of those who need the skill and knowledge of a PT, OT, or SLP don’t get it or never seek it out.

It’s disheartening as a caregiver to consider the good that could be done for that 90% if the barriers to medical care could be lowered or removed—and if telehealth could be used as an access driver to bring that number down. That’s especially true when considering how many patients are now dealing with the effects of long-COVID, and the extensive road to recovery they potentially face. Fortunately, there is early evidence that those patients who are getting physical therapy to deal with the after effects of long-COVID are benefitting from PT in their recovery.

Telehealth is definitely not the “magic bullet” that closes the gap entirely — a recent study from the Journal of Rural Health notes that 24 million Americans and nearly one-third of the rural population still lack the necessary broadband access—but it can still help a considerable number of people who weren’t getting care previously. One recent study found that “the use of telehealth services for the management of chronic Acute Coronary Syndrome (ACS) conditions was comparable, or even more efficient, than in-person care when follow-up encounters were assessed.”

And while the benefits to patients are always the first concern, telehealth can also provide a boost to PTs and OTs and their clinics. As Windwer noted in his blog post, no-shows decreased and the cost of care declined after his clinic introduced telehealth. And the introduction of remote therapeutic monitoring (RTM) as a part of virtual healthcare options is another revenue stream for therapists to tap at a time of decreasing reimbursements.

CMS adding remote therapeutic monitoring codes is a big win.

Just as telehealth presents a new opportunity for PTs and other providers, RTM offers PTs and OTs a new tool for creating a better patient experience—and better patient outcomes—virtually.

Every provider knows the struggle with adherence, and the blind spot we have when it comes to what patients are doing once they leave the clinic. That’s why I believe that RTM is such an important tool as part of the broader remote care movement. RTM can minimize those blind spots and give therapists more information to work with in guiding patients on their recovery. Rather than an imposition, I believe most patients would probably appreciate additional oversight from PTs and OTs if they knew it could lead to better results from their treatment. And if they can still get quality care while cutting down on both wait times and the number of times they have to come to your clinic, that’s all the more reason to continue with a course of treatment.

Therapists owe it to their patients to start using RTM and telehealth not only for improved outcomes  but to demonstrate to CMS the value of digital services. As I’ve stated before, PTs and OTs have been given a tremendous opportunity with the introduction of RTM codes, and it falls on us to show the quality of care we can provide when given the right tools.

How do you communicate telehealth to your patients?

Communication is key for any productive patient relationship, and imparting the benefits of telehealth is no different. There’s a good chance that a patient’s hesitance about telehealth is simply due to the fact that they’re unfamiliar with it in practice, and perhaps assume that it means they’ll get a lesser quality of care. It’s your job as a provider to explain what telehealth services you provide and how they work, how telehealth can benefit them, and what your expectations are for patients using it.

Educating your patients is all about understanding and anticipating their concerns. Do they lack the necessary equipment to use telehealth, and are worried that getting it will be an unnecessary expense? Are they worried that the appointments won’t be covered by payers? There are a number of different concerns we might not be considering as providers, and figuring out what those are requires us to engage our empathy as we would for any other part of a patient’s treatment. Telehealth may not be the right mechanism for providing treatment to every patient, but it should be used to augment our in-person treatment offerings.

There is of course no single right answer; each patient will have their own concerns and perhaps their own technological hurdles to overcome. If you’re unsure about how to proceed when talking to patients about telehealth, HHS has put together a handy guide for providers on the topic.

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I don’t think it’s hyperbolic to say that telehealth is a major part of the future of healthcare, and I’m excited for the potential changes it can bring. I’m on record as an advocate for a hybrid model of healthcare that pairs in-person visits with telehealth and RTM as the path forward to improved accessibility and results. To get to that better future, however, requires a bit more confidence and persuasion on the part of PTs, OTs, SLPs, and other healthcare professionals to bring patients to our side.

If you’ve implemented telehealth in your clinic, I’d love to hear about how you were able to effectively communicate with patients about telehealth and its benefits. Drop your story in the comments below.

Heidi Jannenga

Heidi Jannenga, PT, DPT, ATC, is the co-founder and Chief Clinical Officer of WebPT, the leading practice management solution for physical, occupational, and speech therapists. Heidi advises on WebPT’s product vision, company culture, branding efforts and internal operations, while advocating for the rehab therapy profession on a national and international scale. She’s an APTA member,...

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