By Dan Rubinstein
The global pandemic sparked by COVID-19 has battle-tested the American healthcare system in ways we could not have imagined. As physicians and direct care workers on the front lines have fought to save lives and treat critically ill patients, other patients and providers have been left on the sidelines. Physical therapists are eager and able to help patients, however, the available options are frustratingly blocked by lack of awareness, education, antiquated regulations and billing rules.
According to the US Bone and Joint Initiative (USBJI), more than half of US adults report a chronic musculoskeletal (MSK) condition. As hospitals have canceled elective surgeries, and physical therapy clinics are closed to reduce the spread of COVID-19, many patients are not receiving care.
We have the technology and tools to deliver the care these patients need while maintaining social distancing. Telehealth is the answer. It will provide access to the millions of patients who need care. In fact, the CDC has explained that medical providers need to increase their use of telehealth to treat more people in this time of high risk.
The prevalence of MSK conditions alone should warrant activating treatment options during this crisis. Instead thousands of physical therapists (PT) have been laid off or furloughed because they cannot do in-person care.
Prior to this pandemic, there were already too few PTs in the US to meet the care needs. The CDC recommends physical therapy as a first-line of treatment for pain, but this lack of access leaves many patients with options that lead to worse outcomes. With too few PTs to provide the recommended course of treatment, we have seen an overuse of pain medications, unnecessary surgeries, leaving many patients untreated.
Today, the social distancing measures needed to protect us from COVID-19 have made a bad situation worse. Access to telehealth during this crisis is critical. Many Americans have conditions that are not being treated, and sheltering in place and working from home may exacerbate existing problems for some.
There is some hope that the situation will improve. On April 30th, The Centers for Medicare & Medicaid Services made physical therapists eligible telehealth providers, which is a great start to making treatments more accessible to some of our highest-risk populations.
And yet, despite the tremendous possibility that this will open up telehealth physical therapy to millions more Americans, there is still a complicated web of regulations that are keeping telehealth providers from delivering care to people when and where they need it.
For example, the practice of physical therapy is regulated by 50 state level boards and one in the District of Columbia. They control licensing, fraud and abuse, privacy regulations, etc. These 51 regulatory bodies require that a PT is licensed in each state where they might want to deliver care, in turn, it is very difficult for PTs to expand their telehealth practices into areas with greater need.
Today as COVID-19 moves throughout the population, physical therapists need to be able to flex more easily and bring care to the most affected areas with the most need. Just as states have been able to recruit front-line healthcare workers from other areas, we need the ability to have PTs respond where the needs are greatest.
In addition, different states have a huge range of laws governing the reimbursement of telehealth appointments. Some states only stipulate that telehealth appointments may be reimbursed, leaving it up to the insurers to decide. In other states, the law states that insurers must cover telehealth and pay the same amount to providers as they do for in-person appointments.
Physical therapists cannot provide service and not be paid. This not only prevents PTs from offering telehealth services but prohibits them from taking the time to engage in adequate training to deliver remote care.
We need to urge states to temporarily allow licensure reciprocity in this time of crisis to improve access for patients. Some states including Missouri and Connecticut have already made this possible, but others need to prioritize work to join the compact of states who already allow reciprocity. With the right actions, we can emerge from this crisis with a system that is stronger and better positioned to treat patients who need care.
In his daily press conferences, Andrew Cuomo, Governor of the hard-hit state of New York, has talked often about how the state is managing to care for patients by implementing a “surge and flex” strategy. He says, “The only way we can make this work is if we flex the system so that we take all hospitals, all hospital networks and we work together as one system, which has never been done.”
This is the time. Our healthcare system as a whole has to surge and flex. The laws that have governed how we work in healthcare, that have kept us bound by geographies, are no longer serving our populations who couldn’t even access the care they needed if a pandemic wasn’t happening.
Dan Rubinstein is the CEO of Physera, the provider of high quality, evidence based virtual care for musculoskeletal (MSK) conditions. With a nationwide network of licensed physical therapists, Physera’s program provides care navigation, MSK triage, diagnosis, and personalized guided exercise therapy through the convenience of your smartphone.