Sorry... I had to! :)
Alright... down to business!
Soon after my Future Thoughts for Private Practice Physical Therapy (PPPT) post, I had some interest expressed to me as to what my vision of what physical therapy practice would look like in the frame of telehealth. I was thrilled to hear that this was a topic of discussion at CSM2014. I'm sure there's some overlap of material here, not to mention lots to add to it; nevertheless, I hope this post will be helpful & encouraging to you. So! Without further ado, here is my Utopian vision of TeleHealth PT style.
TeleHealth PT Style!
I made mention that I felt a large opportunity for the future of PPPT is concierge home health; in some online discussions, I also hinted that a generous segment of this practice pattern would include elements of telehealth's model. The usual questions are present: What would this cost? How would this be billed for? Is there enough business to float this model? Etc. etc. etc.
I'll start with this: Doctors exist to teach their expertise and provide solutions. That, in essence, is the Latin root - docēre [dɔˈkeːrɛ] 'to teach'. However, in the age of information, this is an inherent problem. Information is EVERYWHERE. We come across the problem of supply & demand. Since the supply of information is far in surplus, the price is basically nihl. No one cares about the information; they care what you are going to do about it. In essence, we go to doctors because we want prescriptions - a plan, an intervention, a dosage - and, we want anticipated outcome to the diagnosis and prognosis which we expect to come with every "visit."
So, when you boil it all down, all patients essentially want their Three A's:
If we're all honest with ourselves, healthcare customers want immediate access to the expertise of their healthcare providers. Information is everywhere. BuzzFeed had one of the most entertaining and truthful posts on this very topic regarding brand slogans that are more accurate:
While it is great that consumers can access interaction with their provider's expertise in a telehealth venue; be it a secure network, via traditional telecommunications, an app, etc. - the fact is, these consumers also want to know that their provider is physically available. The consumers demand the physical availability should interventions and/or preventive measures be warranted. They want you to be available for the solutions your accessible expertise comes up with. This is where the client contacts you via an app, gives you a video of their functional movement, describes their symptoms, and/or/hopefully follows your instructions to the letter. And, should you tell them "I'll be right over" or "You need to come in today" - BOOM - AVAILABLE! This of course, depends on if you want to operate from an outpatient clinic, a roaming home health mobile unit, or perhaps both. Of course, the availability needs to be fairly immediate. Within 24 hours is good. However, within 4-6 hours would be even better. After all, since signs, symptoms, complaints, and other concerns are being managed remotely, the physical availability will then be increased since provider are no longer tied down by in-person-clinic-visits or routine home-health-visits (if you're thinking CASE MANAGEMENT - you are spot on - post to come).
I have always championed that healthcare will always carry the aspect of service; specifically a service of and to the human experience. It's a game of managing nerves, anxieties, and unknowns. It requires a human touch in the face of uncertainty, and other times, in the face of despair. Truly, it is the assurance for which this service is of much value in the realm of this industry. In fact, it is a practice by which hope and belief in that which is possible is cherished - this is where the consumer, the "patient" is much better served as we remember they are "the person."
So then, much as many pediatric visits and primary care physician visits end with an obvious diagnosis for which the consumer expected, no required prescription, and a simple treatment plan of "Let nature takes its natural course... call me if the following warning signs show up" - strong skill sets of communicating with empathy, compassion, and confidence will be even more prized in this setting where consumer contact is primarily digital and (hopefully) rarely physical - the purpose of this model of care. This is also a key opportunity by which being a true doctor - a teaching doctor can be taken into account by which the culturing of the next generation of health aware societies can be encouraged.
So How Will It Actually Work?!
Again, all this is humbly, my Utopian vision of what can certainly be. Like any emerging practice pattern, things typically go to cash first. Private cash pay is always going to be the acid test for any market; services and products that demonstrate true value flourish. Those which do not; they go under. In any case, once it is "legitimized" and accepted through time and economics, third party payers start to consider paying such services - typically because the services have a outcome aspect which is favorable. In the case of telehealth, it is due to cost containment and higher level case management.
I anticipate that we are likely to see a subscription based model vs. fee for service - probably in a form which is much like a concierge home provider model. Why? Because it is the ACCESS consumers want - this is the first point of service, and for many, is the continuation of services from an inpatient setting. Many of these patients/residents/clients/consumers - they need full assurance that help is ever present and ready... they are coming out of a 24/7, multidisciplinary care setting to home (usually and mostly) alone.
In any case, much like subscribing to television media via the many outlets that now exist, most people like to get access to as many channels as possible - AND - will pay-per-view only for exceptional circumstances/content. For the telehealth private PT practitioner, one would be able to manage a certain amount of patients until an equilibrium of case management vs. visit-encounters is met.
I also foresee a base of operations with a small outpatient clinic ideally combined with zoned out home health networks once this trend expands. I also anticipate these home health networks to operate within the communicative structure of telehealth. They will be dispatched with mobile units with everything you'd need from a fully functioning outpatient setting (X-Ray, Doppler, labs, you name it). This way, when clientele makes an "emergency" call from a corporate office, or, at another person's home during a get together - the concierge, telehealth PT practitioner is available in just minutes! Be the "problem" a possible DVT, or, just terrible neck pain from "sleeping the wrong way"... the telehealth PT is but a click away.
Bat-Signal anyone??? (We need a PT version of this.. talk about #brandPT challenge!)
Additionally, I sense that the marketing arm of savvy firms will make for some clearly flamboyant tactics. Ridiculous uniforms, crazy visual mobile units with all sorts of paint and branding icons... after all, how could you differentiate the contracted home health provider from each brand? You'll have to do it the same way other industries do... with a news van, contractors, plumbers, IT support teams, etc. Such as.....!
And, no one will ever forget and no one will stop talking about it! Quick! Off to the PT-mobile!
With ACO's taking over in a storm and healthcare going down the cost containment route, telehealth makes sense. For those who have their insured care managed, telehealth makes things affordable, available, and reliable - not limited, unsure, and not there for long. For those who prefer the choice of out-of-network-providers, telehealth becomes the affordable choice for care they trust & the quality they demand. With either path, this makes for a nice stream of revenue for the private practitioner with each subscription... be it conversion from inpatient, carryover from outpatient, or new subscriber from your marketing presence!
For Physical Therapy practice, I sense that those who have experienced the expertise and benefits of a physical therapist will continue to favor PT's for any musculoskeletal concern. If given the option, they would relish the chance to bypass primary care physicians who typically offer very little help of value. Subscribed patients would be able to access PT expertise; be able to make appointments for physical examination, evaluation, and interventions as deemed needed; and, will glean knowledge about their own best health through repeated exposure of easy access to their primary care PT telehealth encounters.
The movement towards the old school "doctors make house calls" service model is something that many find attractive. It offers a sense of personalized care, pampering, and even a pinch of privilege that many can appreciate. As more and more people come across $50 co-pays with limited total visits available... a subscription based telehealth provider will look increasingly attractive and far more "worth the money." It is also far more economical than hiring on 24/7 care-giving. Also, knowing that accessing someone is literally a phone call/text/tweet/app-message/etc. away for no added cost to the original subscription... well, that sure does give people a warm sense of assurance, doesn't it? And, truth be told, this is precisely what the consumer wants, needs, and will be (if not already) looking for.