Overheard at the American Telemedicine Association Meeting...

Tampa Convention Center: May 1, 2011 - Morning Session. Some snippets of conversation I overheard at ATA 2011...

Telerehabilitation or Telemedicine?

• No professional associations 50 years ago
• Power-based relationships – students, clients, consumers
• Asynchronous vs. synchronous? Store-and-forward (dermatology and radiology) use one way communications to help diagnose patients. Interactive video is synchronous because it happens in real time.
• “Follow the money”
• Who had the most control in 2011? Payers, consumers, providers?
• Ossifying technologies? Eg: BLACKBOARD in academia

“Store-and-Forward” Technologies in Telerehabilitation

• Asynchronous sharing for home exercises and physical therapy prevention of falls. Content server contains files, videos such as a home exercise library.
• Poor broadband connection in Australia?

Is your Telerehabilitation Practice HIPAA Compliant?

• Is Voice Over Internet Protocol (VoIP) HIPAA compliant? Is VoIP a Business Associate (BA) under HIPAA?
• If VoIP is a BA then they must meet the HIPAA Privacy Rule requirements. If VoIP (eg: Skype) works for a covered entity then they are a BA.
• Top 10 Risk Assessment: 58 question checklist (is the checklist validated and published?)
• Non-recorded data falls under the Privacy Rule but not the Security Rule. If data is not in electronic format at the time of transmission (eg: a fax piece of paper or a real –time synchronous video chat) the data does not fall under the Security Rule.
• Hackers are ALWAYS thinking about how to gain access to PHI but are hospital administrators ALWAYS thinking about how to protect their data?

Licensure and Reimbursement for TeleRehabilitation

• SLP doesn’t have “practice acts” but have “licensure laws”.
• SLP Assistants not recognized by Medicare.
• Texas has prescriptive (3 pages) in practice act. Some experts state that “…Texas is a leader...” in telerehabilitation
• APTA Definitions and Guidelines recommend a PT be licensed in the state in which they practice telemedicine.
• Some experts surprised that this definition was not provided by the Federation of State Boards of Physical Therapy (FSBPT)

Model Telerehabilitation Program for Rural Areas

• Kentucky pilot telerehabilitation in rural areas
• Community based rate $89/ 1-hr. session
• Telehealth rate $63/ 1-hr. session

Model Telerehabilitation Program for Occupational Therapy

• 30 sessions on telehealth at AOTA 2011.
• Works in the home. Training spouse/family members. Cash-based OT practice in West LA. Lots of DSL and 4G networks.
• Life coaching for cancer survivors – 12 week program.
• Work in industry using video conferencing to assess work stations and make recommendations for adaptive equipment.
• Does not see an issue with offering “wellness” services for Medicare patients and is able to avoid the “opt out” issue for physical therapists in private practice.
• Using mobile and video devices to connect with patient in a direct access model with “store-and-forward” technology that enables therapists and patients to interact asynchronously (at different times).

You may get the impression from this blogpost that telerehabilitation is a bulleted list of techniques and technologies rather than an integrated body of knowledge, practices and standards...

Your assessment would not be incorrect...

Can anyone help me define and refine this field for physical therapists?

Florida Representatives have Concerns about Telemedicine Bill

A new bill covering telemedicine services (HB 505/SB 1882) was read on the full Florida House of Representatives floor on Tuesday March 8th, 2011.

The bill requires health insurers, corporations, and health maintenance organizations issuing certain health policies to provide coverage for telemedicine services.

The new bill prohibits the exclusion of telemedicine cost coverage solely because the services were not provided face to face.

The bill provides coverage under the state plan without a condition that telemedicine services are restricted to health care providers licensed by the Florida Deptartment of Health.

If the telemedicine bill is passed in its present form it would require the insurer to reimburse for services provided by a health care provider not licensed within Florida

This would render the regulation of health care professionals by the respective professional boards, where telemedicine is concerned, moot with regard to out of state practitioners.

Similar telemedicine legislation is being debated in California, Oregon and Washington state right now.

Nurses have created "Nursing Compacts" with government grants that are, in effect, seperate licenses allowing them to practice across state lines.

Physicians have a "special license" that allows them to practice medicine across state lines and still retain the supervision of their state licensing boards.

Why should Physical Therapists be left out of the party?

A recent randomized, controlled trial in the Journal of Bone and Joint Surgery showed that telerehabilitation, in one setting, can produce superior outcomes than conventional Physical Therapy for Total Knee Replacement.

What do the readers of PhysicalTherapyDiagnosis.com think about telerehabilitation services, such as remote video monitoring?