It’s pretty simple, really. Telehealth in physical, occupational and speech therapy allows more treatment for seniors, and better access.
By reducing travel times for therapists between facilities, therapists are allowed to treat more seniors, in different buildings, and faster. With therapists and staffing all around being reduced in long-term care nationwide after the pandemic, telehealth in long-term care makes great sense.
But the Centers for Medicare & Medicaid Services is considering what’s next for therapy and telehealth. With the end of the public health emergency for COVID-19 last week (May 11), seniors’ access to telehealth therapy is in danger.
The Consolidated Appropriations Act of 2023 directed CMS to extend beneficiary access to therapy delivered via telehealth through Dec. 31, 2024. But if nursing homes and assisted living facilities go back to the now seemingly antiquated way of providing therapy for residents — in person vs. telehealth — CMS will greatly limit access for seniors, a result that can be easily avoided with new rules that providers are waiting for from the agency.
But the future is uncertain. CMS “seems” ready to extend telehealth for therapy services, but exactly how remains to be seen. In recent guidance published May 10, 2023, CMS briefly discussed therapy without revealing specifics for telehealth:
“After the PHE ends, we will resume consideration of changes to the Medicare Telehealth Services List exclusively through notice and comment rulemaking. To reduce exposure risk, during the PHE and for an extended period of time for many services, the following have been added to the Medicare Telehealth Services List: . . .
• Therapy Services, Physical and Occupational Therapy, All levels”
– “Physicians and Other Clinicians: CMS Flexibilities to Fight COVID-19,” Centers for Medicare & Medicaid Services
CMS will be coming out with its new rules for telehealth and therapy, but until then, the future of telehealth and therapy is uncertain. In reality, it is a mystery why telehealth in this country is so frowned upon by regulators.
Back in the day, when technology wasn’t what it is today, perhaps regulators had some good reasons to be skeptical of telehealth. But what has happened since then is truly amazing.
The pandemic forced providers to provide new ways of healthcare, and telehealth was thrust upon the public in a way that patients and residents never experienced before. And guess what? Patients and staff loved it — they received needed access to care, all in the comfort of their own homes.
Bottom-line: This forced method of telehealth was a huge help to seniors in nursing homes, not to mention patients nationwide who decided to use telehealth for the first time in order to receive needed healthcare.
But if staffing shortages continue post pandemic, even though the public health emergency is over, why not make telehealth a real part of the everyday fabric of medicine and especially geriatric care? If access is a problem in long-term care due to staffing shortages, why not solve the problem with telehealth, and embrace it going forward?
What we learned about telehealth and therapy from the pandemic is significant. According to Scott Wilson, president of Elevate Therapy Consulting Group, the pandemic only highlighted problems in staffing, and showed the real benefits of telehealth in therapy at the same time:
“In my view, the greatest asset to telehealth is the ability of therapists to get care initiated quickly, especially in the underserved and rural areas. Oftentimes, you will see therapy extenders (PTA’s and COTA’s) in the facilities waiting for a higher licensed therapist to perform the evaluation. Telehealth expedites that initial evaluation and allows treatments for the resident to occur quickly. We are talking two to three days quicker, and oftentimes longer, due to staffing challenges in today’s market.”
But the impetus for telehealth and therapy does not end with the immense access and improved services benefit to geriatric patients and residents everywhere. Don’t forget about the therapists. According to the National Association of Rehab Providers & Agencies representing more than 80,000 therapists, rehab providers and rehab support organizations, including inpatient and adult living and skilled nursing facilities, one main benefit of telehealth for therapy services is the elimination of a common problem: therapist burnout.
According to NARA, in 2021 alone about 22,032 physical therapists have left the workforce, and the demand for physical therapy is only expected to grow over the next 10 years.
Why did they leave? Stress!
According to NARA: “Another large reason why there is a physical therapist shortage is many physical therapists are experiencing burnout. Burnout in physical therapists has increased due to long hours and constantly changing hours. Many physical therapists have chosen to either quit their profession altogether or switch to part-time positions. With the added stress within the industry post-pandemic, many professionals find it hard to establish a good work-life balance and struggle to stay motivated to continue with this practice.”
So not only will the proliferation of telehealth therapy services provide greater access to seniors, especially in rural areas, going forward. It also will help therapists ease stress.
Among other solutions for the therapy staffing shortage that NARA suggests, there’s this: telehealth can help relieve therapist burnout, and get therapists back into the workforce.
Neville M. Bilimoria is a partner in the Chicago office of the Health Law Practice Group and member of the Post-Acute Care And Senior Services Subgroup at Duane Morris LLP; [email protected].
The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.
