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Remote rehab tools could cut comp costs

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A mix of remote and in-person physical therapy visits could lower costs for workers compensation payers while delivering the same results to injured workers as traditional care.

Pre-recorded physical therapy videos may be more practical than live streaming visits and also produce equivalent clinical outcomes as in-person physical therapy, according to a study presented last week during the American Telemedicine Association's 2016 conference.

Of the 29 patients surveyed, 14 participated in so-called telerehabilitation and 15 participated in traditional physical therapy at Kaiser Permanente's Oakland Medical Center, according to the study, which was conducted by two San Francisco doctors. Each of the patients underwent unilateral, uncomplicated total knee replacement surgery between April 1, 2014, and April 31, 2015.

While the study is not specific to workers comp, telehealth is gaining ground in the industry — especially in rural areas — to speed treatment and reduce costs.

Workers comp professionals typically define telehealth or telemedicine as a virtual interaction involving two or more parties in the claims process. It has long involved telephone communications between injured workers and nurse case managers, for example, but it has evolved in recent years to include remote face-to-face interactions and the measuring of vital signs.

For example, CorVel Corp. has offered telenursing for about six years and virtual physician visits since last year, said David Lupinsky, Folsom, California-based vice president of medical review services at the third-party administrator and managed care services provider.

He added that CorVel has looked into virtual physical therapy, but “we haven't done anything with that yet.”

For the telerehabilitation study, two physical therapists created 23 videos that illustrated the same exercises taught in clinics. The narrated videos were all under three minutes long and included on-screen text-based instructions.

The patients who participated in the study reported exercising for a mean of 47 minutes a day. On average, they logged in 49 times during the period, posted nine videos and five photographs, and sent 10 messages to the physical therapists.

Meanwhile, patients who participated in traditional physical therapy reported exercising for a mean of 60 minutes per day and traveling to physical therapy for a mean of 75 minutes, according to the study, which was originally published by the Journal of Telemedicine and Telecare in March.

Both groups said it was “easy or very easy” to communicate with their physical therapist and reported high patient satisfaction, the study says. In addition there was “no major difference in the average (clinical outcome) scores reported in each group,” which was “surprising, particularly for a group of patients whose average age was over 60.”

Hybrid options

However, it's important to note that most injured workers who are prescribed physical therapy aren't postoperative like the patients in the study, CorVel's Mr. Lupinsky said. It could be difficult for a physical therapist to evaluate and treat an injured worker's back injury, for example, without seeing him or her in person, he added.

Although most states no longer require injured workers to have existing in-person relationships with physicians prior to taking part in video-based visits, a “hybrid model” makes more sense for physical therapy, Mr. Lupinsky said.

A physical therapist might do a hands-on evaluation and make sure the injured worker is able to excercise before managing him or her remotely, Mr. Lupinsky said, adding that the physical therapist might “want to see them back before they close the case out.”

Pre-recorded videos would likely cost less and employers wouldn't have to reimburse injured workers for traveling to appointments, he added.

But not every injured worker would be an ideal candidate for telerehabilitation.

According to Mr. Lupinsky, “When in doubt, refer out. Meaning, if there's ever a concern that a patient isn't appropriate for this medium, send them to a brick-and-mortar (facility).”

Patients' busy lifestyles “can make it difficult for them to attend traditional appointments,” the American Physical Therapy Association in Alexandria, Virginia, says on its website. “Telehealth will not replace traditional clinical care. However, it will give (physical therapists) and (physical therapist assistants) the flexibility to provide services in a greater capacity.”

Outside of workers comp, telemedicine was offered by 46% of employers in 2015, but 24% said they planned to offer it in 2016, and an additional 20% said they're considering it for 2017 or 2018, according to an analysis released earlier this year by Willis Towers Watson P.L.C.