In light of the COVID-19 crisis, occupational therapy practitioners everywhere are thinking about telehealth, and many of you are actively working to launch new solutions.
Telehealth occupational therapy is going to change the way we practice, and it will impact our profession in ways we have yet to imagine. And, the more we know about telehealth, the better positioned we’ll be to leverage it in ways to best serve our clients.
I set out to write this article so that we occupational therapy professionals would have a comprehensive resource on telehealth OT as we know it today, along with some information to help us stay up-to-date with this quickly changing landscape.
I’ll update this article regularly as the uncharted world of teletherapy begins to take form.
Here’s what you’ll find below:
- What is telehealth?
- Why use telehealth?
- Who is currently using telehealth?
- Where is OT with telehealth?
- OT and telehealth research
- OT and telehealth reimbursement
- How to get started in telehealth
- Platforms for using telehealth
What is telehealth?
Telehealth refers to medical services provided over a technology platform. Pretty much any form of medical care delivered via technology vs. in-person means can be considered telehealth.
That means some of you might already be using telehealth without even knowing it.
If you use a secure texting platform to exchange messages with your patients, you’re already using telehealth.
If you deliver HEP exercises and updates to your patients, as with MedBridge Go, that’s telehealth, too.
If you review patients’ records in a shared health system portal, you’re using telehealth.
And, if you securely message your patients by using something like WebPT’s HEP platform, yep, that’s also telehealth.
Technically, telehealth can be broken into four categories:
- Live video
- Remote patient monitoring
- Mobile health
Live video (also called “synchronous”) is exactly what you’d think. Store-and-forward is also called “asynchronous,” and is used to transmit imaging, as well as store and send health records. Remote patient monitoring involves electronically transferring information like blood pressure results or blood glucose levels. MedBridge Go and other forms of patient-facing HEP software are forms of mobile health.
At this point, most forms of telehealth occupational therapy will use a blend of these methods to deliver care, so it’s honestly not that important to know the four types.
Telehealth was originally devised to bring much-needed healthcare services to underserved or rural populations, enabling patients to receive care when they might not otherwise be able to.
But, even for patients who can access care, telehealth has its appeal. In today’s modern age of on-demand technomania, telehealth is a wonderful option in terms of convenience and, frankly, staying on trend. If other professionals are meeting customers’ demands for on-demand care, why can’t occupational therapists?
Consider a post-CVA patient whose son would normally need to drive her to OT—but now that patient can ask questions and receive teletherapy in the comfort of her own home. That means her son doesn’t have to miss work! And, now that we have so many cities shutting down to stymie the spread of COVID-19, this seems an ideal way to deliver care without endangering our patients or their caregivers.
In any case, teletherapy is great for patient education, management of chronic illnesses, medication management, and more, and we occupational therapists are recognizing ways that we can provide our care remotely, as well.
Now, more than ever, with the novel coronavirus upending everything we know about society, it’s time for us to step up and get serious about incorporating telehealth into occupational therapy.
Who is currently using telehealth?
Physicians: reimbursed for remote care
Physicians have been incorporating telehealth into their practice for years, as Medicare does pay for certain types of remote care. COVID-19 has prompted sweeping changes for physician care via telehealth. I think the title of this NYTimes article says it best—Telemedicine Arrives in the U.K.: ‘10 Years of Change in One Week’.
Mental health practitioners: addressing unmet needs
Therapists and counselors are using telemedicine to deliver care to address the overwhelming need for increased mental health delivery in the U.S.
One of the reasons telehealth is really taking off in the mental health world is that it addresses the fundamental reasons why people don’t seek treatment for mental illness: lack of access and lack of resources.
And, perhaps most importantly, telemedicine delivery is discreet and convenient. Anyone who has experienced a mental health crisis can attest to the fact that real-time, convenient treatment delivered in a private manner is priceless.
Speech-language pathologists: reaching kids in underserved areas
Preliminary research has shown that teletherapy does show promise in addressing the lack of care for children in geographically remote and underserved areas. Perhaps that is why so many teletherapy SLP providers serve a pediatric clientele.
Being a less hands-on discipline than OT and PT, relatively speaking, it’s no surprise that teletherapy has taken off in SLP a bit more quickly.
Physical therapists: telehealth in traditional practice
Physical therapists are definitely getting more excited about telehealth—especially since many out patient clinics are furloughing or laying off PTs during the coronavirus pandemic.
There are several companies popping up that hire physical therapists to treat remotely. At this time, it’s still pretty tough to land a full-time benefited telehealth physical therapy position, so many roles are part-time or PRN. However, many traditional brick-and-mortar PT clinics have started incorporating teletherapy into their practice.
There is also a growing movement of private, cash-based PT practitioners, many of whom are opting to use telehealth as part of a niche-based practice, if not transferring their services to exclusively telehealth in nature.
So where is OT with telehealth?
As I already mentioned, some of us use forms of telehealth already. But if you’re wondering who is working completely remotely as a telehealth occupational therapist, the answer is that more and more people are doing it every day.
The fact is that COVID-19 concerns do not negate the need for OT. In light of this legislation and reimbursement is changing daily, to open the doors for more and more of us.
We are doing our best to track these changes day by day in the OT Potential Club. But, below is a general orientation to where we are at.
The research base has already been rapidly growing.
Before diving into to telehealth, we of course, have a professional duty to understand whether research backs its use.
And the good news for OTs at this time is that telehealth is not some completely unknown, desperate second option for use to just “try out” in crisis. Telehealth OT has been being studied for years, and you will likely even find research that correlates closely to your practice.
As I’ve been reading this research myself, I have found it to be very promising. I hope you check it out for yourself: Research Articles about Telehealth OT.
Here are some of the areas you will find research in to guide your practice:
- Home health (especially home modifications/aging in place)
- Mental health
- Outpatient neuro
- Wellness and preventative care
- Hand therapy
- School-based OT (in light of COVID-19)
The pros of telehealth
- Improves access to those who wouldn’t otherwise get OT
- Easier on the OT’s body
- Puts more emphasis on patient education and pain science
- Delivers care on-demand to meet today’s consumers
The cons of telehealth
- Lacking the human touch of OT
- Can only treat in the state where you’re licensed (at this time)
- There’s no multi-state license compact (like they have in PT)
- Patient acquisition is hard enough with traditional clinics…it’s even more difficult with teletherapy
- At this time, reimbursement for services is still spotty
What about the rules—and what about reimbursement?
Telehealth OT is a bit like the Wild West. There’s very little consistency between states in the way of laws. Some states have established laws and regulations regarding telehealth, while others haven’t even touched the subject. The AOTA provided a chart (accessible to members only) that details information about telehealth and OT on a state-by-state basis, but this has become largely outdated.
In the OT Potential Club, we are working to actively track changing legislation, state-by-state and country-by-country. So, for an in-depth discussion of legislation and reimbursement, please consider joining our forum.
We also just launched a new blog post, where we are trying to provide updates on coverage of OT telelehealth on a state-by-state basis. If you have any updates from your state, please let us know!
One important development, though, that I want to highlight here is that CMS has approved e-visits for established Medicare patients.
If you do provide care to Medicare patients, please read the recent update from CMS on the provision of telemedicine. I’m copying the relevant sections about OT e-visits and the relaxation of HIPAA below:
Clinicians who may not independently bill for evaluation and management visits (for example – physical therapists, occupational therapists, speech language pathologists, clinical psychologists) can also provide these e-visits and bill the following codes:
- G2061: Qualified non-physician healthcare professional online assessment and management, for an established patient, for up to seven days, cumulative time during the 7 days; 5–10 minutes
- G2062: Qualified non-physician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 11–20 minutes
- G2063: Qualified non-physician qualified healthcare professional assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes.
In light of COVID-19 HIPAA requirements have been relaxed. Here’s the complete statement.
Historically, here’s how HIPAA has applied to telehealth:
HIPAA applies to all medical professionals or healthcare organizations that are providing telemedicine services. According to HIPAA Journal, it’s vital to consider the channel of communication used to transmit ePHI (electronic protected health information). Here are the stipulations, and you’ll notice that they sound pretty close to what we use for non-telemedicine!
- Only authorized users shall be able to access ePHI
- A secure system of communication shall be used to protect the integrity of ePHI
- There must be a system of monitoring communications with ePHI to prevent malicious or accidental breaches.
Maintaining standards of care
Across the board, practitioners of telemedicine are expected to adhere to standards of care that are the same—no more, no less—as what they’d provide during face-to-face visits.
What is the pay like?
The pay depends on several factors. Obviously, if you’re a private practitioner, you’ll set your own fee schedule. However, if you join an existing organization as a staff or PRN telehealth occupational therapist, you’ll likely earn similar rates to what you’d make in a traditional brick-and-mortar clinic.
From what I can tell, ranges per hour will be anywhere from $35-45/hour, and in states with higher living expenses, the rates might be higher (how refreshing!).
One important thing to consider is that many of these roles are per diem, so you might not receive sick time, PTO, or health insurance.
What is the schedule like?
The beauty of telehealth OT is that you can set your own schedule. The other side of the coin is that you might not get all the hours you need, especially if you’re a new grad trying to pay off loans.
It’s per diem care at its finest. But this can also be a blessing or a curse, depending on how many hours you need.
Can COTAs provide telehealth?
Telehealth legislation is in huge upheaval right now, so this answer may only be found on a state-by-state, provider-by-provider basis. But, in general, if OTs can provide telehealth (per local legislation) there is a good chance COTAs can, as well.
Several years ago, I did some research about companies that hired COTAs for teletherapy. I found that while some companies only hire OTs, a few do hire OTAs to perform teletherapy.
Here are some of the teletherapy companies that historically have hired OTAs:
How to get into telehealth
As of today, there are three ways you can get involved with teletherapy. Here’s how to do each.
1. Start your own practice
If you start your own practice, you’ll need to understand state laws where you’re planning to treat, get licensed in the state(s) where you’re planning to treat, set up a business, attract your own patients, get liability insurance, set up a fee schedule, and all that fun stuff that goes along with owning your own clinic.
Plus, there’s the tech. You’ll need to figure out the software you’ll want to use, but most solutions make it fairly easy to hang a shingle. (In the next section we will cover available platforms.)
2. Join an existing company
If you’re not feeling entrepreneurial, no problem! You can always find a job at an existing teletherapy company. As mentioned earlier, these companies have the same issues standard OTs do: attracting patients, and if they’re cash-based, it’s a double whammy when it comes to the challenges of marketing to patients. That said, now that we’re hunkering down more to quell the spread of COVID-19, these companies are likely to need more therapists very soon!
Here are some of the companies that provide telehealth OT services:
- Global Teletherapy
- Presence Learning
- ProCare therapy
- Sunny Days of California
- TalkPath Live
- Telehealth OT Services
3. Convince your existing practice to incorporate elements of teletherapy
Telehealth can be a wonderful ancillary service, and it can also add value to a clinic’s offerings. By incorporating a telehealth wing in a clinic or facility, you will help improve patients’ access to care, and might help decrease cancellations.
This would be especially helpful in states where Medicaid is reimbursing OT treatments.
If you’re able to convince your workplace to incorporate telehealth into its practice, you’ll grow immensely in your career. Not only will you spearhead a movement to build a program in your organization (which can look great on the resume if you ever pursue non-traditional OT career paths), you can feel proud that you helped bring your workplace to the forefront of a new horizon (cue sci-fi music)!
Platforms for providing telehealth
Ok, with COVID-19 throwing our lives into disarray, available platforms are in a bit of upheaval, as regulations are changing.
Again, please reference this announcement for updates on how HIPAA is being relaxed. That said, before you commit to a platform, be aware that you’re wise to consult with an IT professional and healthcare attorney before you commit to a setup for your teletherapy. Once the HIPAA guidelines return to normal after the pandemic crisis, you’ll be held to stringent privacy standards.
Let’s start with platforms NOT to use:
- Facebook Live
- Think: any video that is public-facing
Platforms that have been approved—but do not offer comprehensive solutions like payment and robust scheduling
- Plans start at $12/month
- Recently updated speed to 65% faster
- Skype for Business/ Now Microsoft Teams
- Plans start at $8.25/user per month
- Comes with the MS office suite
- More advanced plans offer compliance and security
- Three pricing tiers; must contact company to get a quote
- Includes document management and storage
- Enables document signing
- Zoom for Healthcare
- Consistent, high-quality video
- Commonly used in webinars
- Google G Suite Hangouts Meet
- Free trial; plans start at $6/month
- Incorporates with the Google suite of tools
- Up to 100 participants per call (good for groups)
HIPAA-compliant platforms that provide more comprehensive solutions:
- Blink Session
- Plans start at $38/month; somewhat complex pricing structure
- Waiting room function
- Ability to share clients among therapy team
- Many options; must contact them for quote
- Very robust; some plans come with integrated HEP and patient engagement
- Some plans come with reporting and compliance features
- Free for limited services
- Reviewers on Capterra highlighted the solution’s free option and ease of use
- These same users mentioned that calls drop if the internet service isn’t strong
- Pricing options vary for clinics vs. large systems
- Robust scheduling option
- Visit reminders for patients
- Health Recovery Solutions
- Numerous product and pricing options for various types of practices
- Specialized and setting-specific platforms (e.g. home health)
- Established presence in prestigious healthcare systems
- Rates start at $45/month for EMR; telehealth rates require a quote
- Integrates well with HelloNote EMR system
- EMR built by therapists
- $39/month to start (free trial)
- Part of a wider practice management platform for small businesses in health and wellness (including EMR)
- Includes integrated features, such as free appointment reminders (SMS, email, and voice), mobile app, e-claim filing
- Reviewers report a clean interface
- $30/month to start (free trial)
- Focused on mental and behavioral health; geared toward individuals and small organizations
- Payment integration feature
- $38/month to start
- Unlimited users, storage, and support
- Specifically tailored for mental health applications
- Electronic health record software with Wiley Practice Planners treatment planning solution add-on
- $29/month to start
- Designed to support both in-office and telehealth visits
- Includes waiting room, group sessions, and appointment reminders
- $49/month to start
- Unlimited calls and chats
- Triage queue options; walk-in waiting room feature
How to learn more about OT and Telehealth?
If you are ready to dive even deeper into OT and telehealth, you are not alone. There are more resources out there for you. Here’s some that we’ve found:
Here Comes Telehealth: Podcast from Jason Davies at The OT School House
Parent Coaching in the Teletherapy Context: Webinar Meg Proctor at Live Play Thrive
Starting out in Telepractice: Course from MedBridge
Telehealth for Hand Therapists: Podcast from Hand Therapy Heroes
Telehealth OT Mini Course: Course from Reina at The Telehealth OT
What’s next for OT and telehealth?
Only time will tell where telehealth will take us, but we do know one thing: telemedicine is the future.
After all, Amazon’s new healthcare venture has alluded to a focus on telemedicine, wellness, and end-of-life care in a recent letter to shareholders. With Atul Gawande at the helm of this powerhouse initiative, virtual health will grow in ways we can only imagine.
So whether you enjoy hands-on care or you’re seeking a non-traditional OT role where you use your degree to its fullest, chances are, change is coming. Even if you have no intentions of landing a purely telehealth job, you’ll likely be incorporating teletherapy into your daily practice much sooner than you’d think!