Dear Editor,

Imagine: you’re a senior citizen recovering from a serious illness or injury, but you can’t leave your home out of fear of coming down with the potentially deadly coronavirus.  Do you risk becoming infected by booking a face-to-face visit? Or do you completely forgo medically necessary care that can relieve severe pain, improve strength, and prevent significant complications including re-hospitalization? 

As we grapple with the ongoing COVID-19 national emergency, this is exactly the dilemma that millions of seniors are now facing when it comes to receiving treatment from their physical and occupational therapists. While telehealth-based physical therapy services can offer a critical lifeline for these patients, Medicare is not yet reimbursing physical therapists for delivering virtual care — creating a substantial access barrier that puts beneficiaries at even more risk during the coronavirus crisis. 

As a physical therapist who has practiced in Northern Virginia for 12 years, I have helped patients deal with unbearable pain, regain their balance, enhance mobility, and maintain independence. Not only is physical therapy a safe alternative to opioids, it is an effective way to prevent dangerous falls, which cause 2.8 million injuries, 800,000 hospitalizations, and 27,000 senior deaths every single year. The ability for us to treat post-surgical patients and immunocompromised individuals with underlying conditions such as cancer, COPD, and lupus is absolutely critical. 

But now, access to these valuable services is threatened by Medicare’s reluctance to enable physical therapists to operate virtually during this unprecedented public health emergency. While more people are discovering that we can provide excellent care through a smartphone or computer, physical and occupational therapists are unable to do that for some of their most vulnerable patients. 

This access barrier is affecting real people in significant ways. For example, before the COVID-19 crisis began, I was treating an elderly patient who suffered a devastating fall a few months ago. A lung cancer survivor and severely immunocompromised, the patient is now struggling to safely move around the house—a challenge compounded by the fact that he does not have a caregiver who can visit him at home. While we made progress before, Medicare’s reimbursement policy will restrict his access to therapy while he remains at home, which will likely result in physical decline. If he could have access to virtual physical therapy through the phone or computer, I could help him navigate in a safe way, prevent injury, and manage stress-induced pain. 

Our region is blessed to have wide access to high speed internet, and, in my experience, the majority of Medicare beneficiaries we serve have access to smartphones, tablets, and home computers. While some patients may initially feel apprehension about their ability to access telehealth, our technical teams can remotely help them walk through the process and easily set up the telehealth application.

Unfortunately, insurance coverage is—by far—the biggest barrier to care. By failing to reimburse physical therapists for telehealth services, Medicare is out of step with virtually all other public and private payers in the region who have pledged to pay for telehealth services at the same rates as an office visit.  

Medicare’s current reimbursement policy for patients who need telehealth physical therapy is a serious—but reversible—barrier to care during this pandemic. Recognizing the importance of keeping patients healthy and out of overburdened hospitals, Medicare has signaled its dedication to expanding access to telehealth. But until the agency finally covers reimbursement for physical and occupational therapists, too many patients will be left without access to essential therapy services.

By R. Benjamin Keeton, PT, DPT, MBA, OCS

Director of Clinical Operations at the Jackson Clinics

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