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Telerehab’s coming fast

Regardless of what happens to health reform on the national level, the healthcare industry is relentlessly and rapidly adopting technology that will revolutionize patient care.  Big players are seeking out new tech devices, platforms, and applications, buying start-ups and rapidly pushing their products and services into their distribution pipeline.

One example is Zimmer’s recent acquisition of RespondWell, a start-up delivering comprehensive at-home telerehab intended to improve patient compliance with PT and deliver better outcomes. I recently interviewed RespondWell CEO Ted Spooner.  Spooner has a long history in developing tech that delivers services faster/better/cheaper with far less human intervention.  He and his team have taken that experience and used it to build a home-based rehab solution.

The quick backstory – Medicare and other payers are bundling payments for surgical procedures, forcing providers to assume responsibility for any procedure-related care for 90 days post-surgery. In this model, a health care system might get $37,000 to do a total knee replacement; out of that fee, around $5,000 would go to physical therapy.

But there’s a problem – in some places, there’s more demand for PT than there is supply of PTs.  As a result, some patients are on a waiting list – and as a result of that, surgeons, operating rooms, and related staff are not working to full efficiency.

There’s another issue here, one that gets at an uncomfortable reality – many services can be delivered in ways that don’t require nearly as much human intervention.

Telerehab provider RespondWell has come up with a solution, one that uses existing technology, platforms, and communications to “create accessibility and convenience for therapy to patients and give providers visibility to patients to adherence to therapy. Kaiser is one of the early adopters of the Therapy@Home solution.  To date almost all customers are healthcare providers, but Spooner expects payers to be in the mix quickly.

Briefly, Therapy@Home is set up for each patient recovering from surgery; the provider prescribes a therapy plan which is “loaded” into the App. The patient sees a web-based on-screen virtual therapist that helps them perform exercises correctly, while allowing the care team to monitor patient performance and compliance via the internet-connected device’s web camera.

Sessions and communications are recorded and stored for provider access if and when needed.

Here’s one key takeaway; about 60% of in-person PT visits can be eliminated using Therapy@Home.

Considering most total knee patients are older folks, I challenged Spooner on adoption and usage by senior citizens.  He noted that the over 55 population is adopting technology very quickly, driven by easy-to-use smartphones and apps that allow them to connect easily with friends and family.

While RespondWell is focusing on bundled payment-driven care today, this technology/service model (I’m not sure exactly how to describe it) is absolutely transferrable to other types of care – both within PT and in other service areas.

What does this mean for you?

Be a disruptor. Or be disrupted.

10 thoughts on “Telerehab’s coming fast”

  1. For work comp claimants, why not do the telerehab at the work site, if there is room to do so?

    It seems like a great idea and doesn’t have to be limited to home exercise–it could be part of the work day.

  2. We’ve recently signed on to use CHC Telehealth for those WC patients who are mostly homebound. We anticipate it will not reduce the number of medical interventions, but that it will provide us and the patients with more convenience and better outcomes.

  3. In comp, we all know that the longer that a person is out of work, the less likely that they are to RTW. Technologies like this could mean that fewer people will have to miss time from work due to injury. This does not replace MDs or PTs, however, it just extends their reach into the workplace.

    We are only at the beginning of a technology-enabled transformation of how healthcare services are delivered. What was once though of as ‘unlikely’ may soon become commonplace.

    We should keep our eyes and minds open. Disrupt or be disrupted, indeed!

  4. On site physical therapy works quite well, and we use it both at the patient’s home and work place.

    What I’m not clear on is the “virtual therapist” a real person? Is the service being provided one on one, e.g. one therapist/one patient or will therapists be monitoring several patients at a time on several monitors? While in person therapists often monitor several patients at the same time, some with the use of assistants, I’d be concerned about the possibility of a patient not being adequately supervised by video if a virtual therapist is distracted or visually overloaded. If a patient somehow exacerbates the condition during the course of virtual therapy, who holds the responsibility and liability? The virtual therapy company, virtual therapist, the physician who OK’d this type of service, the case manager who arranged the service, the Employer/Carrier, or all of the above.

    I’m going to take the conservative course and wait to see how this works out for others.

    DISCLOSURE: I own a case management company and in no way benefit from referrals to or use of any medical providers including physical therapists.

  5. I would have some concern with WC patients, because PT is a good tool to get the injured worker motivated to start a routine again. Many injured get used to the confines of their home, not sure staying at home w/the comfort of an App would be helpful in all cases.

  6. That technological advances have their place in the healthcare delivery chain is certain, but please do not rush to apply this tool to the global patient community. Here, Medicare has done an outstanding job of partnering key players under a fixed reimbursement model. Split the monies fairly based on usage. If you decrease PT need and spend, more goes to the hospital and implant maker (Zimmer). This will ultimately decrease costs when the payor determines they overestimated the PT portion and then the total/case drops. I’d hate to speculate what the next cost reduction or service will be and what that will do to patient outcomes.

    Physical Therapy does more than instruct patients in exercises- I trust most all know this. And, more than just exercise is needed following a joint replacement. Apparently Zimmer doesn’t know this. The injured worker often needs motivation, education and a hands on approach to reach maximum recovery and potential. An app simply can’t do that. Considering the many co-morbidities that our patients often present with, the risk of eliminating a valuable pair of trained eyes is high.

    Improving patient outcomes remains the primary goal regardless of the payor. A tool like this can help therapists better manage patients but should be used in conjunction with PT, but not in place of PT.

  7. Joseph Noel, PT – I completely agree with you. Apps & cost cutting are fine. The numbers look great & the payer thinks they’re happy. Until . . . we realize we left the human component out of the interaction with the patient, patient outcomes suffer, costs rise due to unintended consequences of automation – all because we treat patients in a way we ourselves wouldn’t want to be treated and wouldn’t accept this for our family and friends.

  8. I agree that the BEST application of telerehabilitation is when it is used in conjunction with face-to-face PT.

    The fact is that telemedicine/telerehabilitation is evolving quickly and will continue to grow as a healthcare delivery model. It will be up to payers and consumers to determine how far it goes. I, for one, envision a future where we will have the convenience and cost awareness to choose between tech and face-to-face delivered care.

    1. Seems to me that you are all saying the same thing with a different spin. The face to face experience will be coupled with a telemedicine platform to enhance engagement, compliance, education, coaching. These are all the things that make a meaningful experience for the patient and promote quicker recovery. Ultimately reducing the care episode length and saving the system $.

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Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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