Telehealth Potential Remains, Trapped by Regulations and Licensure Barriers

Dr. Alan Lee's Perspective article in the December 2011 Physical Therapy journal offers hope tempered with a dose of pragmatic reality - much work still needs to be done if telemedicine techniques can be brought to bear for the benefit of physical therapists' patients.

Some of the barriers on the provider side identified by Dr. Lee include:

• licensing and credentialing - Alaska and Washington state are the only two states to include telemedicine language in their practice acts. New legislation promoting "license portability" is being prepared for the Congress in 2012.

  “Telemedicine is medicine, just practiced virtually”,

  ...said the office of the bill's sponsor, Senator Tom Udall of Utah. 

On the policymakers' side the barriers include:

• billing and reimbursement - payment for physical therapy services is currently dictated by the setting or delivery method, ie: home health, outpatient, hospital, etc,

Telemedicine's biggest benefit is probably its costs savings to both the provider and the patient.

But, new evidence that telemedicine can impact relevant patient outcomes that are "hot topics" among payers and policymakers is increasing.

Geisinger Health Plan, using telemonitoring technology, has demonstrated a 44% reduction in 30-day readmissions compared to a control group.

How Can Outpatient Physical Therapists Use TeleMedicine?

I imagine a scenario similar to the Geisinger program where patients are followed after discharge to monitor their status and identify risk factors before symptoms occurs, or before an adverse event happens.

Can you imagine Skype connection (available for free on newer laptop computers) with your geriatric patients?

What if you could measure the 10-foot Gait Velocity over Skype and predict the need for Skilled Intervention based on slowing gait speed?

What if Medicare would pay - based on this one measure alone?

Comparative billing report on outpatient physical therapy services with modifier KX

On Tuesday, August 2, 2011, CMS released a national provider comparative billing report (CBR) centered on independent physical therapy providers who practice in the outpatient setting and bill Medicare with modifier KX.

The CBR is similar to the original study distributed last summer except this current study will focus on 2010 billing data and is being sent to 5000 additional or different providers.

If you participated last year, like I did, you WILL NOT GET a new CBR this year.

The CBRs are produced by Safeguard Services under contract with CMS and contain actual data-driven tables and graphs with an explanation of findings that compare a provider’s billing and payment patterns to those of their peers located in the state and across the nation. CMS has received feedback from a number of providers that this kind of data is very helpful to them and encouraged us to produce more CBRs.

You should use these CBRs to provide in-house training to your physical therapists on how to correctly append the -kx modifier for Medically Necessary physical therapy services.

These reports are not available to anyone but the providers who receive them.

To ensure privacy, CMS presents only summary billing information; no patient or case-specific data is included. These reports are an example of a tool that helps providers comply with Medicare billing rules and improve the level of care they furnish to their Medicare patients.

For more information and to review a sample of the outpatient physical therapy services CBR, please visit the CBR Services website or call the SafeGuard Services’ Provider Help Desk, CBR Support Team at 530-896-7080.

Note: Please go to this link on the First Coast Service Options (FCSO) website .