Applying Telehealth to Complex Rehab Technology

Published in Complex Rehab on October 29, 2020

An interview by Kyle Walker with Dr. Mark Schmeler, Greg Packer and Dan Fedor 

Telehealth applies to all segments of our industry in different ways. Because of COVID-19, it is much safer to have as few people as possible physically present for a wheelchair evaluation for a new piece of equipment. However, not all patient populations are suited to be evaluated by telehealth due to their disease-state.   

Recently, Kyle Walker, Director of Operations in Assistive Technology inclusive of CRT, and Orthotics & Prosthetics in VGM HOMELINK interviewed Dr. Mark Schmeler from the University of Pittsburgh, Greg Packer, President of U.S. Rehab, and Dan Fedor, National Director of Reimbursement for Complex Rehab for U.S. Rehab about telehealth in CRT, how it affects providers, clinicians and payer policies. Below are excerpts from the interview. Listen to the entire interview on your favorite podcast player by searching for Industry Matters podcast or online

How Telehealth is Applicable to CRT 

KW: Mark, what can you tell us about the history of telehealth, where it started, and what's transpired? 

MS: I will say the telehealth concept [has] probably been around as long as the telephone…[and] it expanded to other areas that made a lot of sense, like psychiatry, radiology, and cardiology. Those were probably the areas of healthcare that made the most sense. It even expanded from there into paramedics in the field...Military medicine is another example of combat-related medicine. From there, it just grew along with the technology. 

I think when video became part of the process, that opened up a great opportunity, that was probably in the 1990s. We did some preliminary work there with CRT. What was really holding us back was more the technology and the bandwidth, and then actually the innovation. I think as video conferencing has become just part of mainstream society now, it's presented a lot of opportunities for telehealth. And there's been a lot of work done in that area. It just really hasn't caught on. But now that we have the pandemic, we're kind of forced into carefully looking at telehealth. And so that's sort of where we are today. It’s just a matter now of we've got some preliminary work done and research in the area. We just got to define it more, come up with standards of practice. But I think historically, and moving forward, it's going to be here to stay.  

KW: Yourself and Rich Schein had done some research back in the early 2000s, if I don't recall. Can you speak to that a little bit? What did you look at and what was the outcome of some of that research?  

One of the first studies that we did on a larger scale was we actually provided teleconsultation into outpatient clinics in community hospitals in rural parts of Western Pennsylvania. The reason we went to the community hospitals versus the home is that many homes, especially in rural areas, didn't have the bandwidth, the setup, or the equipment to do it. We looked at about 50 cases where we provided telehealth support to other therapists who just didn't have the expertise in CRT and help them through the process, help the supplier through the process. Probably the most important thing we found that with those 50 cases is that the patients were actually satisfied with the process. They liked being able to go to a community hospital rather than driving far into a larger city or metropolitan area. But we also looked at the outcomes of those cases and we didn't really find much difference in patient satisfaction with their equipment, whether they got it in-person or they got it through telehealth. 

Choosing the Right Patient 

GP: You have to select the proper patient population. Telehealth is not for every patient. If you're a new injury and you're in the hospital, that's a different setting. Plus, if you have a high-end injury, telehealth may not be something that works best for you. It's the selection process. That's really going to be something that has to be refined… 

MS: …You know, telehealth is not for everybody. And when we look at some of the best practices that have been documented position papers and guidelines prior to COVID is, step one is ensuring that this person is appropriate for telehealth. And there's going to be a lot of scenarios that they're not.  

But I think one of the strategies that I see in the future is when you get a new referral, your first step in telehealth, whether it's the ATP or the clinician, is just having a phone conversation, which is another form of telehealth. It’s just getting some background information about what their situation is, and then giving them the option of coming into the clinic if they have a way to get here or we can take the approach that we'll send someone to your house and connect with us through video conference. 

How Has Telehealth Been Viewed by Payers and ACOs 

KW: Dan, right now, there's been a lot of changes obviously in our country since the pandemic and really relating to policies around telehealth and those services. Can you give us a kind of overview, and in terms of what kind of transpired and where things are at from a policy standpoint in the willingness of payers to adopt some of these? 

DF: Yes, there's been a lot of policy considerations because of telehealth. I think the realization of the in-person encounter due to this public health emergency has brought to light the need and also the viability of telehealth. 

One of the considerations that we currently have to consider that the policy requirements currently haven't changed.  They're still requiring what they were requiring for an in-person visit. So that's where some of the challenges come in with telehealth right now. Hopefully going forward, if this continues in the future, as we all believe it will, there'll be some clarification and some flexibility or some type of a understanding of those limitations and to still yield good results for the best possible outcome for the patients.  

KW: So, to summarize, [telehealth is] multifaceted, right? We have to look from a payer standpoint, what are they looking at from an outcomes perspective, from value, from the care of their members? To the clinician, Mark in your wheelhouse, the effectiveness of what you guys are doing, as well as the CRT provider. I think it all goes hand in hand. Greg, you alluded to earlier, as our industry continues to transition towards pay for performance model and value-based care, I believe it is very imperative that we continue to evaluate the effectiveness of that, and think smarter, and practice these methods or challenge the traditional status quo. 

MS: Right. Yeah, I'll just, I'll just say from an ACO perspective, the number one outcome that they're looking for is keeping people out of the hospital. Keeping people in their home, living with their family, doing what they want to do. And the methods for doing that are somewhere out there yet to be defined. If we want to be providers within that accountable care organization, we have to show them how we're helping them to achieve that overall goal of keeping people in their home. 

The full interview was first featured on September 15, 2020, U.S. Rehab Launches a New Telehealth and Complex Rehab Technology Educational Course. Listen on your favorite podcast player or online.  


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