4 Reasons I Left My Practice For A Telehealth Startup

By Anang Chokshi, PT, DPT, OCS, SCS, Reflexion Health

For years I practiced physical therapy and managed a successful PT orthopedic clinic outside of Los Angeles. I worked hard to advance my career by taking many continuing education courses and participating in residencies and fellowships to allow me to better help my patients. Times were good, schedules were full, and referrals were abundant and I became a more seasoned clinician.

However, like many other physical therapists, I was frustrated by the day-to-day inefficiencies of the clinic. Decreasing reimbursements and the need to see patients multiple times per week were making it difficult to deliver the quality care I felt patients deserved. I knew something had to be done and I felt I was not going to be able to do that in my position. So, against the recommendation of some of my colleagues, I made the decision to try something new. I packed my bags for a telerehab tech startup in San Diego.

My love for physical therapy, treating, helping, and educating patients was still as strong as ever, but I saw a need to rethink the way we care for patients by trying to make physical therapy more efficient and effective. I jumped at the opportunity to work with Reflexion Health to develop telehealth products and services for comprehensive care pathway solutions and demonstrate technology leadership in the rehab industry.

The demand for telehealth options is strong. A recent study from business information provider HIS predicts the U.S. telehealth market will grow from $240 million in revenue in 2013 to $1.9 billion in 2018 — an annual growth rate of more than 50 percent. Following are four compelling reasons I left my booming practice for a telerehab startup.

Extending Our Reach To The Patient
PTs are passionate and genuinely care for their patients. In fact, I would argue we cultivate the deepest relationships with them because of how dedicated we are to getting patients back to doing the things they love. But we can’t deny the frustrating inefficiencies that remain inside the system and often de-motivate us from doing what we do best. I believe telerehab can help our profession get back to treating patients the way we are supposed to.

Some are hesitant to embrace new technology but, if implemented correctly, PTs will find telerehab can maximize the power of innovation for virtual care. This will give patients the care they need where and when they need it, while also allowing clinicians insight to what the patient is doing away from the clinic.

Studies consistently show the quality of healthcare services delivered via telemedicine are as good as those given in traditional in-person consultations.

As therapists, we’re taught to focus on the patient’s individual goals, asking them what their goals are and what they ultimately want to do again. Their responses can vary between wanting to be able to take walks around the block to completing an Ironman. Yet, we only treat them when we see them and base our clinical judgments on roughly 2 percent of their whole week. Sure, patients may say they are adhering to the paper HEP handout you’ve provided. But questions remain: are they adhering to it the way you want them to? Are they doing their exercises correctly? It’s hard to tell.

If we can use remote monitoring and telerehab technology, we can extend our reach beyond the traditional in-clinic setting and into the patient’s home. This would empower the patient to do more at home when they are not in front of you; thereby maximizing their recovery time.

Improve Access To Physical Therapy
Therapists say they feel very busy; patients are scheduled back-to-back for 45 minute sessions and booked two months in advance, but this doesn’t necessarily equal efficiency.

This lack of productivity frustrates me. Why can’t we define a system to assist with the exercises that are repetitive and straightforward to leave time for PTs to elevate their face time with patients who really need the hands on care and their attention?

Not only does telerehab improve access to patients in distant locations, it also allows physicians and health facilities to expand their reach beyond their own offices. Given the provider shortages throughout the world — in both rural and urban areas — telemedicine as an industry has a unique capacity to increase service to millions of new patients.

Of course, there should still be an element of one-on-one interaction to help develop the confidence to complete the rehab program. Outside of self-assurance and safety, technology can be a vital tool in their healing process that is convenient, gathers data, provides feedback in real time, and allows the therapist access to review the ongoing success of rehabilitation. This will enable the clinician to have more data/information to assist with clinical decision making when an in person visit is necessary.

This current time structure inefficiency makes our profession look bad and makes clinicians not well organized. There is an easy fix by implementing innovative technology into our practice.

To Create A More Robust Industry Standard
Another common complaint of PTs is not having the time to get creative with their practice. Seeing patients on a fee-for-service model creates a sense of hustle because the grading scale is on productivity, not on outcomes. The incentive is in the wrong place.

Our knowledge and skillsets are valuable, but due to time constraints we give a rudimentary exercise rather than taking the time to educate patients about why they’re doing the prescribed movements and how it will ultimately lead to their successful rehabilitation. By providing a tool to help patients perform simple exercises at home, such as Reflexion Health’s in home virtual rehab tool Vera, we are able to take the time to further that experience by empowering them with information to know how the exercise helps their recovery overall. This type of robust practice will be what thrives in the value-based payment model.

Practicing at a higher level is key to achieving patient goals, but also creates a practice that is results driven and forward thinking.

To Explore, And Meet Patient Demand
Reducing or containing the cost of healthcare is one of the most important reasons for funding and adopting telehealth technologies. Telemedicine has been shown to reduce the cost of healthcare and increase efficiency through better management of chronic diseases, shared health professional staffing, reduced travel times, and fewer or shorter hospital stays.

With the April implementation of CMS’s bundled payments, it is important to understand how this will affect clinicians and their practice. We all need to shift our thinking and consider a few things:

• How are you going to continue to make a living in this profession and what new opportunities are available now?
• As a clinic, you need to strategize how you’re going to partner with hospitals that are now responsible for managing your patient’s costs.
• How are you going to evaluate your staff now?

You will no longer be able to evaluate on productivity, but will need to evaluate on population management.

In the fee-for-service world, we were always worried about coverage and cost. But looking forward, we’ll be able to get back to the basics, making it imperative we focus on empowering the patient and setting specific goals for them.

The greatest impact of telerehab, in my view is on the patient, their family and their community. Telerehab reduces travel time and related stresses for the patient. Over the past 15 years, study after study has documented patient satisfaction and support for telehealth services.

With all of the new opportunity in front of us and the incredible benefits it brings to our patients, I strongly believe PT’s should implement telerehab and redefine post-acute care. Let’s face it, healthcare is changing. But the more we engage and leverage these new technologies into our practice, the better our care delivery will be. And in the end, that is something we can all get excited about.

About The Author
Anang Chokshi is a licensed physical therapist with board certifications in orthopedics and sports medicine. He currently serves as the Lead PT and Head of Clinical Accounts for Reflexion Health, a San Diego-based startup creating software to help clinicians deliver digital medical therapy to patients. Anang also serves as an adjunct professor of physical therapy at Western University in Pomona, CA. He received his Doctor of Physical Therapy from the University of Michigan-Flint and has completed various yearlong postgraduate level courses, including Kaiser's Manual Residency & Sports fellowship programs.