What if you’re a PT working in the therapy department of a hospital with a sports medicine program, and you find out that one of your high school athletes has just gotten injured? He/she calls you, uncertain whether to visit your clinic or just go straight to the ER.
“Wouldn’t it be slick if you could leverage the videoconferencing technology of telehealth?” says Doug Cundiff, MPT, MPH, in a podcast interview for Rehab Management magazine. “Let’s take a look at your ankle” he continues. “Let’s go through some movements. Let me observe the swelling, and then we can make a decision from there.”
Cundiff points out that this is just one example of how telehealth can be leveraged to support business, as well as better patient care and outcomes. “This could save a visit to the clinic,” Cundiff says. “It could save a trip to the ED. If you could offer those services that you would in a clinic virtually, that’s going to separate you from your competition and certainly be of value to your clients, and maybe that client becomes a referral source for you to other patients.”
Cundiff, who is Vice President of ReDoc 360 Professional Services, which provides support to Net Health’s rehab therapy clients, was interviewed by Rehab Management’s Frank Long on telehealth opportunities and challenges during COVID-19.
In the brief, roughly 13-minute podcast, Cundiff, who works closely with hospital outpatient therapists, many of whom have seen their visits drop as a result of COVID-19, shares his observations about the use of telehealth, its challenges, and benefits. He discusses:
- How telehealth can not only fill in the gaps but guide us to think differently about what is essential to us
- Why telehealth should be considered part of the rehab therapy “toolbox” for the long-term
- Trends he’s seeing among rehab therapists backed by statistics
- Challenges for both therapists and patients and advice for getting started
“Our goal is not to get back to how it was, the prior normal,” he advises. “What are we going to do that was different from before? This is our chance to reset. The technology for telehealth has been there. …I think that will go a long way in showing your community that you’re here to stay. You’ve adopted and you’ve adapted. And let’s get back to taking care of your needs.” View Video Transcript
Hello. I’m Frank Long Editorial Director of Rehab Management and Physical Therapy Products. Telehealth. Who hasn’t been confused, concerned, or downright frightened about using telehealth as a way to keep rehab clinics operating during the COVID-19 pandemic? But amid the uncertainty there are also opportunities, important opportunities the clinic directors and managers really should look at more closely. To learn more about them and find out how to navigate the key challenges of telehealth, we’re speaking with Doug Cundiff, Vice President Net Health 360 Services Rehab Therapy. Doug, welcome to the program.
Thank you for having me, Frank.
Doug, let’s get right into this.
One clinic owner that I’ve spoken to recently described, “using telehealth as a revenue channel,” as something, “like picking up aluminum cans to pay your mortgage.” So to what degree can telehealth services actually help fill in the gaps that were created by the loss of face to face, in-clinic visits?
Well, Frank, I appreciate you using the term, or that gentlemen, using the term as filling in the gaps. Certainly, when the COVID-19 event hit us all, it changed the way we do things now and moving forward. We had a number of clients who saw anywhere from a 60 to 100% reduction in visits. The stay at home orders caused us to think differently about what was essential to us, let alone who else was defining what was essential out there. We had limited to no access to services but what telehealth has allowed us to do, you talk about gaps, is it’s allowed us to stay connected with the patients where we need to stay connected. Some going into the event may have just had a surgical event or an acute event that even though they couldn’t come into the clinic, they still needed our attention. And while we can’t offer our hands-on care to move them along the best that we could through education and guidance and be able to see visually where they are with some movements and function and make some recommendations. Telehealth does allow you to maintain the delivery of that expertise.
If I think about other opportunities, this is not a short term thing that we should be thinking about. At the end of the day, telehealth has been out there. It’s been out there in a number of different healthcare professions, and even outside of telehealth a type of virtual interaction has been out there. We’re doing one today with the Zoom meeting. So being able to think forward on how can we get through this now and fill the gaps, but how can we build this into our toolbox for the long term and leverage this advanced technology is going to be important. So yeah, is it fill in the gaps now? Yes, but there’s going to be a broader audience and more ways we can leverage this technology in the future.
Doug, are existing telehealth programs expanding? I mean, isn’t an expansion going to be necessary for telehealth to be viable over the long term.
Telehealth has been out there for some time and certainly has been leveraged in our profession for quite a while. But moving forward, we are seeing an openness to the adoption of this technology. As we speak today, we’re also seeing the beginning of in-clinic visits ramp up more so. We did a survey not too long ago, and I would say about 25 to 30% of the clinics we work with did not see a change or did not stop with in-clinic visits, but many did. And now we’re starting to see a ramp-up of those services too, but they’ve also explored and adopted telehealth or telemedicine type services in many instances. And from what we’re hearing, they’re going to keep that in their toolbox and make sure that they expand and offer those services moving forward.
What are some of the challenges to consider when starting or expanding a telehealth program?
Great question. So we spent a lot of time, and I’m sure many of our listening and viewing audience has, the rules and regulations they can be a bit overwhelming. Between what the state requirements are, what the CMS allows for, what payers are requiring. There are some due diligence and homework that needs to happen there so from a challenge standpoint, one bite at a time, get through that, and make sure you’re comfortable with that. And then making sure that you have a plan to roll that out, that’s certainly going to be important.
Also, we need to appreciate the unfamiliarity of this service platform, whether you’re on the patient side or the provider side. From the provider standpoint, as a physical therapist by training background and a matter PT, OT, and speech, very few of us have learned this trade or technique in school, right? So you learn it on the job or you go to different CEU classes, whatever it may be. The unfamiliarity, that’s a hurdle that we need to come over. So how can we do what we’re typically accustomed to delivering hands-on? How can we go through a patient assessment and look at functional movement? How can we do different types of strength testing with patients by having them demonstrate certain activity, body weights, or lifting something? We need to adopt and adapt to these different techniques. We also need to be creative and think outside the box when we’re doing that and start simple. What are the four, five, six clinical presentations to start with that allow you to have some success, that allow you to build some momentum? And then build and expand your service options, your clinical presentations that you can address moving forward.
And then I’ll say on the patient side. What is their comfort level using technology itself? Depending on your client mix, you might have the millennials who are going to be about this all day. “If I don’t have to come into the clinic, I don’t want to.” Right? They’ll latch on this right away. But then you’re going to have others who are not comfortable using the technology, or may not see the value or how could this be of value to me without me coming in and you put your hands on them to assess and determine the best plan of care for their clinical presentations.
We’ve all done our homework in looking at telemedicine and telehealth, and what’s the differences. You have your e-visits, your in-home health visits, your telehealth visits. Certainly exploring those and determining what makes the most sense for you, that’s an opportunity because it’s an opportunity to reach more clients than maybe you are today. Also, think about situations in the clinic where a patient may cancel a visit because a family member is sick and they can’t come in or maybe they’re sick themselves. Well, is that an opportunity instead of canceling that visit, and again you’ve done your homework, you know the rules and regulations, is that an opportunity to still help that patient continue in their progression and their plan of care by offering a telehealth type visit? It doesn’t have to replace the in-clinic visit, but it certainly can allow a continuation and avoid that disruption of services.
I’ll also tell you a quick story and this, I think is an opportunity and a little out of the box thinking. Maybe not so out of the box, but we were working with a prospect, someone’s evaluating our software solution that includes telehealth. And she was not, as a director of therapy and her department’s hospital-based, wasn’t so sure that she was going to adopt telehealth, but at the same time they were working, they have athletic trainers in their program. They’re working on school contracts for the fall season, hoping fall sports are back.
And as we were progressing our conversation around the solution, we started talking. I said, “Well, if there’s an injury with one of your student-athletes and then you have to decide do they need to go to the emergency room and meet the orthopod there or do they come into the clinic to see you?” Wouldn’t it be slick if you can just ramp up a telehealth visit, a virtual visit? “Let me see your knee. Let me see your ankle. Let’s go through some movements. Let me observe the swelling, the edema, and so on,” and make a decision there. It could save a trip to the clinic, could save a trip to the ed. There are some different ways that if you can offer those services traditionally virtually, that you would do in-clinic instead of doing virtually, that’s going to separate you from possibly your competition and certainly be of value to your clients. And maybe that client becomes a referral source for you to other patients, to other friends of theirs.
Doug, do we have any evidence that telehealth is working as a revenue stream? And do we know whether patients are meeting their goals and that they’re satisfied with the experience?
Yeah. So that’s a great question. So you think about … I shared earlier some, whether you went down to 60%, 100 visits. We had some clinics furlough staff or have to let them go. I mean, there’s a big change. And so I think about it as you’re ramping up and coming out of this event and you’re going to launch and include telehealth if you haven’t already. Have you done that mini proforma? How are you going to start to schedule or how are you scheduling now? And do you have a staggered way of ramping up staffing clinic hours? Don’t just go back to, “Well, these were our hours of operation staffing before. Let’s bring it back.” I think we have to do our due diligence and be cognizant of the financial impact if we just go back to how it was early March.
I think about assuming, if we’re talking about telehealth, assuming that your clinicians are comfortable delivering that service. We talked about some things that they’re going to have to adjust and get used to. Making sure that the training, the education of not just using the technology, but conducting an evaluation, conducting a followup visit. Does your staff feel comfortable delivering that service? And then ultimately telehealth, are your patients comfortable using that? Don’t assume that you do a telehealth visit and you feel really good about that and the patient is connecting the dots, thinking, “That was as good as a visit I would have had in clinic.” Do they understand that, “In lieu of this particular in-clinic visit, we’re doing telehealth today? This is what we did. Next time I see you we’re going to evaluate this. We’re going to progress here.” I think it’s going to be important to connect the dots so that we don’t assume that the patient will see the value that a telehealth visit is replacing an in-clinic visit all the time when it may or may not be the case. I think we want to avoid that.
The last thing that comes to mind, or the next thing that comes to mind are the referral sources. Do your referral sources know the benefits of telehealth for rehab therapy? Do they have an appreciation for the benefit and value it can bring to their patients if they’re sending their patients to you? I think the education that’s needed for the referral sources can be certainly as important so that they see and they hear the outcomes and how well their patients are doing.
Any final thoughts or recommendations?
I think that’s just being careful that our goal is not to get back to how it was, the prior normal. What are we going to do that’s different from before? This is our chance to reset. The technology for telehealth has been there. Is there a way to effectively incorporate that and differentiate your services from the competition? What’s the competition doing right now? Is there a chance to rebrand your services and really leverage and be that innovator? Is there something that you’re good at that you can leverage and position well during these times? And leverage, during the last six, seven, eight weeks, we’ve had to really work together and we’ve strengthened our relationships with our staff, with our patients, with the community. Let’s not let go of that. Leverage that, show them coming out of this is what we’re doing. Here are the options we have available to you. I think that will go a long way in showing your community that you’re here to stay. You adopted and adapted and let’s get back to taking care of your needs.
We’ve been speaking with Doug Cundiff, Vice President, Net Health 360 Services Rehab Therapy. Doug, thank you for joining us.
My pleasure. Thank you Frank.
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