Physical Therapy’s Place in the Booming Telehealth Movement
This past week the FCC launched a $200M program to support telehealth services and devices. The move signaled what for many has long seemed like an inevitable shift, but which has suddenly become an urgent and pressing need with the onset of COVID-19. Weeks before, just around the time cities like San Francisco began ordering residents to shelter in place, the White House implemented emergency funding to lift major barriers to virtual care, which many private insurers quickly mimicked in their own coverage policies. As a result of all this sudden, necessitated investment in the telehealth industry, the global telemedicine market is set to climb 19% annually from $38 billion in 2018 to over $130 billion by 2025. Many who have been long following and investing in this space are applauding the widespread adoption of these incredibly useful alternatives to traditional medicine.
The increased funding for telehealth initiatives during this crisis not only allows quarantined Americans to receive medical advice and resources from their homes with more ease, but it also critically allows hospitals to focus on the crisis at hand. “With the adoption of the $200 million COVID-19 Telehealth Program, the FCC can now take immediate steps to provide funding so that more patients can be treated at home, freeing up valuable hospital beds for those who most need them and reducing the risk of exposure to the virus,” FCC Chairman Ajit Pai said in a statement.
Yesterday, just one day after the FCC $200M program was approved, telehealth startup SteadyMD raised $6 million in a Series A round. The startup represents a clear and somewhat obvious use case for telehealth: SteadyMD matches patients with doctors across primary care, pediatrics and functional medicine, who can be available to their patients for medical advice, but who can also work behind the scenes with medical assistants for lab orders, prescriptions and referrals to specialists.
The increasing adoption of telehealth services for even wider, less obvious medical applications has been remarkable: tools for paramedics and EMT first-responders, tele-intake methods for hospital admissions, emergency room telescreening tools that allow doctors to conduct exams remotely.
While these advancements have been nothing short of amazing, certain highly manual fields that are critical to the care of many patients have been glaringly omitted from recent headlines. One of the most prominent that comes to mind is Physical Therapy. Sure, out of sheer necessity many Physical Therapists have shifted to virtual sessions. But even those making the shift have acknowledged that Telehealth is not meant to completely replace in-person, hands-on treatment sessions, but instead, is a safe, secondary option.
Earlier this year, The Journal of Bone & Joint Surgery published a study looking at exactly this issue of whether a field like Physical Therapy can truly generate equivalent outcomes in a virtual setting. The trial looked at 287 patients with an average age of 65 who underwent a knee replacement procedure. Following the procedure, 143 were placed in the virtual PT group and 144 in the usual care group. The virtual program used in the study, called TKA, included an avatar [digitally simulated] coach, in-home 3-dimensional biometrics, and telerehabilitation with remote clinician oversight by a Physical Therapist. The study concluded that relative to traditional home or clinic PT, virtual PT with telerehabilitation for skilled clinical oversight significantly lowered 3-month health-care costs and rehospitalizations after TKA while providing similar effectiveness.
These results are incredibly encouraging, but should be looked at through a more critical lens. First, this of course represents just one study, and requires replication many times over. Second, the study cannot truly account for the enormous range in efficacy of in-person Physical Therapy services that exist in the US. The industry is highly fragmented, with over 200,000 licensed physical therapists in the U.S. spread across more than 16,000 outpatient clinics. Where there is consolidation, most often as a result of private equity acquisitions, cost-effective measures are used to increase valuations at the cost of patients, such as reduced time with actual therapists. Such a wide variety in effective care begs the question of whether this virtual alternative is being compared to the highest quality of in-person care available, or to the already criticized, lower quality options many patients unknowingly receive.
Still, the fact that such a study was done even before the COVID-19 crisis is incredibly encouraging for the future of telehealth tools and for the prospect that they may one day enable manual Physical Therapy alternatives for patients who are recovering from major surgeries and procedures, who face chronic lifelong issues, and who rely on these services for a better quality of life.
If history is any indication, we already know that one silver lining surrounding the dark cloud of COVID-19 will be the massive innovation we can expect to come from the crisis. Perhaps with increased telehealth valuations, prospects, and funding, new startups will enter the market to innovate and serve this critical and unique patient need.
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