- Telehealth has the potential to help many healthcare specialties, including occupational therapy. But the path to launching a connected health platform isn’t that easy.
That’s what Cynthia Abbott-Gaffney discovered. A practicing occupational therapist for 21 years and 2019 post-professional doctoral candidate at Boston University, where her doctoral focus is on the use of telehealth as a an occupational therapy delivery model, she sought to chart Medicaid guidelines for telehealth and telemedicine in OT in every state.
She only got information from seven states.
“It was like a treasure hunt in every single state,” says Abbott-Gaffney, who’s also a member of the American Occupational Therapy Association (AOTA) and the New Jersey Occupational Therapy Association (NJOTA). “With states seeing (physician) shortages, they should be embracing telehealth wherever they can. But that’s not the trend I’m seeing.”
Abbott-Gaffney’s report, Telehealth in Occupational Therapy Practice: Variations in Medicaid Reimbursement in Seven States, was recently published by the Robert J. Waters Center for Telehealth and e-Health Law (CTeL), for which she spent the past summer serving as a CTeL Policy Fellow. It paints a picture similar to that experienced by other healthcare specialties looking to embrace telehealth, in that each state is formulating its own guidelines, if there are any at all.
“Clearly, there’s some work to be done,” she says.
Telehealth adoption in healthcare is still a work in progress, due in part to restrictive federal guidelines and uncertain reimbursement. In this atmosphere, some specialties are embracing connected care faster and with more success than others. Telemental health, teledermatology, school-based primary care, telestroke, physical therapy and tele-ICU programs are seeing growth, and interstate licensure compacts have been launched for physicians, nurses and physical therapists to enable them to see patients in multiple states, thereby enabling them to use telehealth to expand their reach.
For other specialties, however, the going is slower. Ophthalmologists and vision specialists have clashed with online vendors and state agencies over how much of an eye exam can and should be handled through a virtual platform. Efforts to create licensing compacts for psychiatrists and social workers are moving slowly, and just recently a new group surfaced to advance telehealth for dentists and orthodontists.
According to Abbott-Gaffney’s research, the U.S. Bureau of Labor Statistics counted approximately 130,400 occupational therapy practitioners in 2016, employed in schools, community health centers, hospitals, psychiatric facilities, skilled nursing facilities, outpatient rehabilitation clinics and home health organizations.
And as far back as 2013, the field has had an interest in telehealth.
Defined by the AOTA as “the application of evaluative, consultative, preventative, and therapeutic services delivered through telecommunication and information technologies,” telehealth has the potential, Abbott-Gaffney writes, “to complement timing, frequency and duration of services, improve quality of care and afford the provision of services in a less restrictive environment that is context specific.”
“Telehealth may be used as a delivery method by an occupational therapy practitioner to facilitate various services including the following: evaluation of a client using informal or formal assessment tools; to observe a client’s performance in the context of daily activities or occupations; to facilitate direct treatment interventions; or to offer consultation to a client or the caregivers of a client,” she adds.
Yet the industry, as a whole, hasn’t caught on to telehealth yet. The AOTA cites a database of state-by-state telehealth laws on its website, but the data isn’t there.
In her research, Abbott-Gaffney gathered information from seven states – California, Florida, Idaho, Minnesota, Nevada, Washington and West Virginia – on how Medicaid programs are addressing telehealth use in occupational therapy. Some state programs, like Idaho, West Virginia and Minnesota, were helpful, while others were incomplete, confusing or simply non-existent. California, for instance, replied “no” or “not applicable” to each of her queries.
For Abbott-Gaffney, the benefits of telehealth platform are clear. She’s had a lot of experience with home- and community-based OT programs, and has spent a considerable amount of time on the road, visiting patients.
“You want to help patients in their own environment,” she says. “If you had a (telehealth platform) that you could just kind of swoop right in and see someone, that would be great.”
“But most of the practitioners are just not sure if they’re going to be reimbursed at all” for telehealth, she adds. “So they’re not doing it.”
Abbott-Gaffney now wants to create a national database of applicable telehealth guidelines for the occupational therapy profession, one that integrates data from every state Medicaid program. She’s received some backing from the AOTA, and hopes also to drum up support from the American Telemedicine Association.
“We need a user-friendly” database of best practices, she says. “I think step one is to get a collected resource, and then we’ll see where it goes.”