Medrisk Telerehab Patient Experience
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Telemedicine Benefits and Opportunities: COVID-19 and Beyond
How has telerehabilitation helped physical medicine patients through the pandemic, and what role will it play moving forward?
Delayed recovery has always been a concern for the workers’ comp industry. However, when the pandemic hit last year prompting the cancelation of musculoskeletal surgeries as well as physical therapy treatment, interrupted rehabilitation became a very real threat for injured workers and employers alike.
Fortunately, offerings like MedRisk’s Platinum Grade Telerehabilitation program– launched over three years ago– had already begun to nudge telerehab into the mainstream for injured workers. What momentum did telerehab gain during the pandemic, and what benefits do patients stand to gain from this model as we adjust to a “new normal?”
Telerehab Pre- and Post-COVID-19
Even before the pandemic forced the temporary closure of many physical therapy clinics, getting to and from PT treatment was not always easy for injured workers. Patient location, commute time and level/nature of injury often posed a barrier to appointment compliance. Telerehab was seen as a way to overcome these barriers to care and serve as an alternative to on-site medical treatment.
Historically, state-to-state insurance coverage for telerehab has varied. But during the public health emergency, the Centers for Medicare & Medicaid Services and many states approved the use of telemedicine for physical medicine, at least temporarily – and patients have taken full advantage. MedRisk’s own telerehab numbers increased six-fold between January and April, and utilization has sustained above-average rates throughout the rest of the year.
A Different Goal & Approach
In this CompTalk presented virtually during the 2020 National Workers’ Compensation Conference, Brian Peers, DPT, MBA, MedRisk’s Vice President of Clinical Services and Provider Management describes how MedRisk quickly adapted to the access issue created by the coronavirus.
Before COVID-19, access to PT clinics wasn’t a big issue in the U.S. like it is in other countries that adopted telerehab earlier. Instead, convenience drove most of telerehab’s use. Patients in rural areas used it to avoid long distance commutes to a clinic. Some preferred telerehab to taking more time off work and spending it on the road. In the case of a traveling nurse practitioner who spent every night in a different town, telerehab was the reason she could keep working during her recovery.
When the pandemic created an access issue, MedRisk’s clinical team expanded its telerehab hours and criteria, which had been fairly conservative, to make sure patients had access to care. It turned out that more conditions than originally thought could be successfully treated via telerehab. Outcomes were good and patient satisfaction was high.
For example, Chris B. needed post-surgical PT after a quite involved rotator cuff surgery. Normally, he would start therapy in a clinic, but the clinic was forced to close the day he was supposed to start therapy. Delaying PT could have resulted in long-term mobility deficits and a decreased tolerance for lifting that would have prevented a return to full duty. Telerehab got him through the critical stage until clinics reopened and most of all he said, “I didn’t feel like I was totally out there on my own.”
Another patient needed to avoid clinics to protect her immune-compromised daughter, who was a cancer survivor. The patient could not shower alone, couldn’t stand for more than 5 minutes and had trouble getting out of bed after lumbar surgery following a major crush injury and needed immediate PT. Through telerehab, she progressed to standing during whole visits, lifting 10-15 pounds and being able to walk her dogs. When asked what she liked best about telerehab, she was quick to say, “I felt safe.”
MedRisk patients’ experiences align with the those captured in a recent patient satisfaction study published in The American Journal of Physical Medicine and Rehabilitation. Researchers surveyed patients and patient care advocates for pediatric patients who used telerehab during the pandemic.
Online surveys were completed after participating in a telerehab visit. Participants gave very good to excellent ratings for these areas:
- Addressing my concerns and questions
- Communication with my therapist
- Developing a treatment plan
- Execution of the treatment plan
- Convenience
- Overall visit satisfaction
- Value in having a future telehealth visit
Optional qualitative comments at the end of the surveys showed that respondents appreciated having access to the virtual services, which included physical therapy, occupational therapy and speech therapy.
Clinical Outcomes
For legislators, insurers, employers, and other stakeholders to be convinced of telerehab’s staying power, we need to also consider the clinical effectiveness of this model.
In the field of physical therapy, the utility and effectiveness of telemedicine has been analyzed in recent studies, and according to 2016 research, clinical outcomes associated with telehealth sessions may be equal to that of traditional in-person care services.
The Bini & Mahajan study compared the clinical outcomes of total knee replacement patients who underwent traditional in-person outpatient PT to those who participated in PT delivered through an asynchronous video-based tool. The 23 narrated videos created for the study demonstrated the same exercises taught in clinics, were each under 3 minutes in duration and featured on-screen text-based instructions.
On average, study patients engaged with the video-based model reported exercising for a mean of 47 minutes a day. They also logged in 49 times during the study period, posted 9 videos and 5 photographs, and sent 10 messages to their physical therapy providers. And, while patients utilizing the traditional care model logged 11 more minutes of exercise a day, they also reported a mean travel time to appointments of 75 minutes.
Patient satisfaction levels were high among both patient groups, with participants reporting that it was “easy or very easy” to communicate with their physical therapist. On top of this, the study authors write that “clinical outcomes following asynchronous telerehab administered over the web and through a hand-held device were not inferior to those achieved with traditional care,” suggesting that telehealth sessions of this nature are clinically equivalent to the in-person care model.
Conclusion
Telerehab has been proven to be a ready and viable solution during the COVID-19 crisis; however, it is important to remember that a public health emergency is not the only crisis injured workers can face in their recovery. Whether it’s an hour-long drive to the closest PT clinic, an injury that makes it difficult to drive or the weight of family responsibilities, virtual treatment will remain a valuable and cost-effective alternative for ensuring continuity of care for injured workers. For these reasons, industry experts are hopeful that telerehab is finally here to stay.
Telerehab Provided a Safe Place During COVID-19: Toni’s Story
A forklift backed up, pinning Toni C. against metal shelving while she was stocking warehouse shelves in March 2019.
The serious crush injury left her with a fractured tailbone, dislocated pelvis and separated pubic bones as well as a hand injury.
Six weeks post-surgery, she donned a mask and gloves and headed to start PT in a clinic that was not in MedRisk’s network. Because she has a teenage daughter who is a cancer survivor with severe immune deficiencies, exposure to COVID-19 was a huge concern.
Her nurse case manager quickly arranged for her to see MedRisk’s Supervisor of Telerehab Services Jill Carnahan, PT, DPT. Learn more about Toni’s story and successful rehabilitation by downloading the full case study here.
MedRisk’s Brian Peers CompTalk covers COVID-19’s effect on Telerehabilitation
CompTalk is a new session format for the National Workers’ Compensation and Disability Conference – National Comp
Initially thought to solve access issues for workers’ compensation patients in rural areas or working shifts, telerehabilitation ended up being used more for convenience since MedRisk introduced it in 2017.
While many payers appreciated the patient satisfaction it produced, others were slow to adopt.
COVID-19 changed all that. Some jurisdictions closed physical therapy clinics for weeks. Decreased patient volume caused other clinics to reduce their hours or close temporarily. And some patients chose not to start or continue in-clinic treatment during the pandemic.
Suddenly access was the issue, and without telerehab, some injured workers would receive no physical therapy.
MedRisk’s Vice President of Clinical Services and Provider Relations Brian Peers, DPT, MBA discusses this transition and its lessons during “Telerehab During a Time of Crisis,” a fast-paced CompTalk available on demand at https://wcconference.com/telerehab-in-times-of-crises/ .
Dr. Peers recalls embracing the sudden change, pivoting patients toward telerehab, and shares lessons learned during the TED-Talk-like presentation. “We found many conditions previously recommended for in-clinic care, could be treated just as successfully via telerehab,” he said.
He also discusses the future of telehealth and suggests takeaways for workers’ compensation professionals.
Launched this year by the National Workers’ Compensation and Disability Conference – National Comp, CompTalks are a new series of short videos, designed to educate, enlighten, and inspire meaningful conversations. MedRisk is also a Gold Sponsor of the 2020 National Comp conference, which went virtual this year, starting with a free, one-day telecast on October 21, followed by digital educational sessions scheduled two to three times a month until the 2021 live conference in the fall.
About MedRisk
Based in King of Prussia, Pennsylvania, MedRisk is the largest managed care organization dedicated to the physical rehabilitation of injured workers. Clinically driven since its inception, the company has an International Scientific Advisory Board that developed and maintains physical medicine-specific, evidence-based guidelines for workers’ compensation. MedRisk, which has successfully completed a SSAE 18 SOC Type 1 and 2 examinations, ensures high quality care and delivers outstanding customer service. For more information, visit www.medrisknet.com or call 800-225-9675.
Inside Look: The Unique Benefits of Telerehabilitation for Injured Workers
Jill Carnahan, PT, DPT, reflects on how her experience supervising MedRisk’s telerehab team has transformed her perspective on the role of virtual PT visits in injured worker recovery.
When Jill Carnahan, PT, DPT, began working on telerehab cases at MedRisk, she was skeptical. She had previously worked in outpatient orthopedics and women’s health, where therapy was strictly hand-on.
“That’s what’s ingrained in us as therapists – that patients have to be touched to get better,” Carnahan said.
But Carnahan, who now supervises MedRisk’s telerehab staff, kept an open mind as MedRisk launched its telerehab program in June 2017.
As the first managed physical medicine company to offer telerehabilitation for injured workers, the MedRisk clinical staff set out to blaze a new trail in the workers’ compensation industry. Before kicking off the program, they developed proprietary guidelines around how to identify the ideal telerehab patient. Carnahan recognized the company’s concerted effort to screen patients carefully and thoroughly examine the circumstances of each case. The guidelines stipulate that first a patient’s case must be found clinically appropriate for telerehab. Second, the patient must express an interest in participating in the program and have the technology needed.
Once a patient qualifies for telerehab and it is determined when telerehab should begin, Carnahan’s team reaches out to schedule the televisit. These virtual visits are synchronous – meaning patients and providers interact “face-to-face” via webcam. Through the live audio-visual interface, the PT is able to demonstrate appropriate exercises and monitor the patient’s movement on screen. The televisit is also an opportunity for the patient to speak one-on-one with their PT about any roadblocks to recovery and how to overcome them. Following the appointment, stored videos and printable written instructions are available to support patient compliance with their prescribed exercise program.
Convenience, Collaboration & Independence
When asked how her perspective of telerehab has changed since the program launched two years ago, Carnahan says that while she still believes that for many patients, manual therapy will always be an integral component of recovery, she has also seen that telerehab offers substantial benefits to the patient that cannot be replicated in an in-clinic visit.
Naturally, viritual visits are a convenient option for all patients, but for some, they are essential to keeping their treatment plan on track. Patients in rural settings often have to travel a significant distance for an on-site visit. In addition, for those in urban areas who rely on the subway or other public transportation, traveling can become even more complicated when recovering from an injury. Weather and natural disasters can also be complicating factors. MedRisk’s telerehab staff has even extended their hours following natural disasters, such as Hurricane Florence, to ensure workers’ recovery could stay on track. In these instances, travel can be a significant hurdle – one that is mounted through telerehab.
In addition, telerehab allows injured workers with regular on-the-job travel to remain engaged in their recovery as they get back to work. MedRisk’s team of telerehab specialists are licensed in many states, so treatment can continue even as patients cross state lines.
“We’ve seen lots of patients while they are out in the field,” Carnahan said. “Utility workers have logged into their visit from an outdoor location. Truck drivers have called us from the cab (berth) of their trucks. We make it work!”
There is no doubt that mobility and ease of use are attractive features for the telerehab option, but those aren’t the only benefits. According to Carnahan, her transformation from skeptic to telerehab champion is the result of seeing first-hand how powerful these virtual interactions can be.
“The more patients I’ve treated, the more I’ve realized that there is the power of touch and then there is the power of voice,” Carnahan said. “In the clinic, you manually move patients into positions. Sometimes there are distractions. Through the computer, you have to use your words – it’s a back-and-forth process that requires focus, communication and collaboration from both parties. But when the patient gets it on their own, you know they really get it.”
It’s this guidance, Carnahan says, that helps cultivate a spirit of independence and accountability in telerehab patients. For example, Carnahan’s team has sent equipment to patients with cervical injuries so they can be taught via virtual visit to do neck massages themselves at home. Others are shown how to do self-tissue releases and self-joint mobilizations so they can take more ownership of their recovery as they prepare for discharge.
What’s Next
As the MedRisk telerehab program gains traction, Carnhan’s team is growing. The company now offers onsite PTs trained in telerehab to larger employers who want a dedicated therapist available to support their primary and satellite offices. In the months and years ahead, Carnahan expects that, like herself, physical medicine professionals, patients and employers alike will realize the benefits of the program.
“Patients often say to me, ‘Why didn’t I do this sooner?’ I think we are going to be hearing that a lot moving forward,” Carnahan said.
