New Reimbursement Rules Pave the Way for High-Tech Disruption in Physical Therapy

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By Lukas-Karim Merhi and Gautam Sadarangani, Co-founders, TENZR Health

Updates to federal regulations are shaping up to make 2022 a game-changing year for the U.S. physical-therapy industry, particularly when it comes to technology.

In November, the Centers for Medicare and Medicaid Services (CMS) released the 2022 Physician Fee Schedule final rule on five new Remote Therapeutic Monitoring (RTM) codes, slated to go live on January 1. These new codes broaden the use cases for Medicare reimbursement of remote monitoring beyond the existing Remote Patient Monitoring (RPM) codes—a development that, according to the National Law Review, represents “one of the latest advancements to modernize reimbursement for digital health”.
RTM allows recognized health professionals (including physicians, physical therapists, and occupational therapists) to track factors such as respiratory system status, musculoskeletal system status, therapy adherence, and therapy response using FDA-approved medical devices. CMS releasing its final rule on the new RTM codes is a positive step forward, because it shows that the agency recognizes the value of these remote technologies to augment in-person care.

Faster and more complete recoveries  

The legislation allows physical therapists to implement new treatment modalities via emerging remote technologies, and to be paid for that additional work—a factor that will help drive adoption. The increased use of these technologies will likely have a broader impact by enabling therapists to have more influence on patients outside the clinical setting, reducing clients’ rates of dropout and reinjury, and leading to faster and more complete recoveries. 

 Physical therapists typically send their clients home with a set of exercises designed to retrain healthy movement patterns. The therapist will demonstrate these rehabilitation exercises at the clinic, but it’s up to the client to complete them at home, generally referring to a printout or a set of videos. Without in-person guidance from their therapist, however, many clients find it difficult to perform the exercises properly, and some simply find it hard to stay motivated because the exercises are repetitive and boring, or even painful.

This is where RTM can prove invaluable; recent advances in sensing technology can help fill the gap in guidance that exists in between in-clinic sessions. New wearable tracking systems, for example, enable therapists to measure and assess patients’ joint mobility more efficiently, and they can aid in guiding and motivating clients through their rehab exercises.  
At home, clients use the wearable tech to track and measure the quality of exercises completed and gain instantaneous feedback on their progress. Some of the latest iterations boost client engagement by gamifying the process, providing users with tangible results as their “scores” improve. This can give clients extra incentive to complete their rehab exercises and stick with their treatment program. 

Expanded Telehealth Access 

The CMS’s new RTM codes are a big step in the right direction, and will ultimately make the process of delivering care both more efficient and more effective. Moreover, there’s another piece of proposed legislation before Congress that, should it pass, could move the needle even further.

The Expanded Telehealth Access Act, proposed by a bipartisan group of senators in November, would extend reimbursement for telehealth services to physical therapists, audiologists, occupational therapists, and speech language pathologists—with the possibility of making even more providers eligible.

Montana Republican Steve Daines is the ranking member of the Senate Finance Subcommittee on Health Care, and he is one of the senators who introduced the bill. In a statement, Daines noted that his constituents sometimes face long commutes to get to healthcare providers, and that distance is a “significant barrier”.

“Particularly in our rural communities, telehealth is no longer just an innovative option for accessing services, it has become a vital lifeline to care,” he said.

If it passes into law, the Expanded Telehealth Access Act will make it easier for patients to access tech-enabled services from a wider range of care providers—and this, in turn, will encourage further adoption of more advanced and innovative technologies. An increasingly sophisticated set of tools will provide therapists with even more nuanced and accurate insights. 

Up until now, a PT would assess a patient and devise an exercise plan through in-person fee-for-service sessions. Under the proposed legislation, this could all be done via telehealth. Devices such as wearable sensors can enable the therapist to have a more complete, data-driven telehealth visit with patients, help the patient stick to their rehab plan, and therapists can review the collected data and use it to adjust treatment plans. These are all good things for the patient—patients who stick with their therapy have a higher rate of recovery—and they could all soon be reimbursable. With the latest medical technology, supported by forward-looking regulations, practitioners will be empowered to help their clients live healthier, more fulfilling lives throughout 2022 and well beyond.

Author Bio:

TENZR Health was co-founded by Lukas-Karim Mehri, Co-Founder and CEO and Gautam Sadarangani, Co-Founder and President & COO. TENZR combines intelligent wearable sensors, healthcare expertise, and gamification to support rehabilitation professionals holistically carry the patient through the rehabilitation journey. Lukas and Gautam are expert biomedical engineers and entrepreneurs focused on leveraging novel biomedical technologies to empower patients, providers and healthcare systems with the goal of improving outcomes and patient experience.