Occupational therapists help people to fully engage in daily life. They treat the whole person, whether they are recovering from injuries or have developmental or cognitive disabilities affecting their motor skills, emotions or behavior. It is a holistic approach that looks at how a client’s participation in activities has been impacted, but also at the client’s roles and environment. Now that Covid-19 has forced caregivers to work with patients remotely, this can only be achieved via telemedicine.
What is telehealth?
Telehealth, also known as telemedicine, refers to medical services provided over a technology platform. You’re probably already familiar with telehealth, if you:
- Use a secure texting platform to exchange messages with your patients.
- Deliver HEP exercises and updates to your patients.
- Review patient’s records in a shared health system portal.
Telehealth can be broken into four categories: live video, store-and-forward, remote patient monitoring and mobile health. Live video is synchronous, while store-and-forward is asynchronous. Basically, one happens in real-time, while the other does not. Remote patient monitoring is used to electronically transfer information like blood pressure results or blood glucose levels.
Where are we?
It’s time for us to step up and get serious about incorporating telehealth into occupational therapy. Before the novel coronavirus, telehealth was designed to bring much-needed healthcare services to underserved or rural populations. Now, it is the best option, in terms of meeting the demand for delivering care without endangering patients.
Teletherapy is great for patient education, management of chronic illnesses, medication management, and more. More ways that we can provide care remotely will emerge as our way of life continues to shift and change, such as home health, mental health, outpatient neuro, wellness and preventative care, orthopedics, hand therapy and school-based OT.
According to Roger Severino, director of the Office for Civil Rights at the Department of Health and Human Services, HIPAA requirements have been relaxed and medical providers are encouraged “to serve patients wherever they are during this national public health emergency.”
HIPAA has always applied to all medical professionals or healthcare organizations that provide telemedicine services. Stipulations still state that only authorized users shall be able to access ePHI, or electronic protected health information. The integrity of that information must be protected by a secure system of communication. Malicious or accidental breaches are prevented by a system of monitoring any communication containing ePHI. No matter what, practitioners of telemedicine are expected to adhere to standards of care, the same as they would during face-to-face visits.
What about coverage?
There are still plenty of obstacles surrounding providing OT via telehealth. Occupational therapists are not, by definition, telehealth-eligible providers. Congress recently passed legislation providing additional money and relaxing restrictions in Medicare. While this applies to existing telehealth services, it does not expand the definition of who can provide them, nor does it address the CONNECT Act, which would expand service options via telehealth, including OT.
The Centers for Medicare & Medicaid Services (CMS) has issued additional guidance and information regarding the current availability of telehealth services. Information such as payment and coverage relative to COVID-19, including telehealth, is provided in a CMS fact sheet. A memorandum has also been issued, by CMS, regarding the requirements, obligations, and flexibilities afforded to the Medicare Advantage organizations during the outbreak
Medicaid and CHIP programs already reimburse patients for many OT services via telehealth. It varies from state to state. Practitioners should contact their state Medicaid agency with any questions.
Coverage via private/commercial insurance will vary by plan. Many plans are electing to waive co-payments, deductibles and co-insurance, while expanding access for telehealth services. Practitioners should also contact the plans directly to determine their current policy and approach to the provision of OT telehealth services. The situation is very fluid, guidance and policies are issued daily, if not more frequently. Resources are updated as they become available at www.aota.org/coronavirus.