Telehealth is opening new areas of opportunity for chiropractic and care for musculoskeletal injuries
The ongoing pandemic has forced many non-tech-savvy Americans to change their habits and adopt technology in all aspects of their lives — from grocery shopping to health care.
And as we approach post-pandemic life, it’s clear telehealth is here to stay.[1] Members of the U.S. House Committee on Energy and Commerce’s Health subcommittee have expressed bipartisan support[2] for making the pandemic’s Medicare reimbursement for telehealth permanent, citing advancements and potential for health care technology. This extends to chiropractic and the use of the technology to care for musculoskeletal injuries.
Telehealth in medicine vs. chiropractic
While 76% of U.S. hospitals connect with patients and consulting practitioners at a distance through the use of video and other technology,[3] telehealth adoption in the chiropractic field has been slower than in traditional medicine.
Part of the reason is that online clinical practice is especially challenging for those professionals who routinely use their hands as a part of their assessment and treatment for managing patients.[4] However, telehealth has the potential to broaden the capability of chiropractors —beyond performing adjustments or spine manipulation — and allows us to care for musculoskeletal injuries and educate and empower patients more than we ever have before.
Evidence points to the validity of the telehealth examination for musculoskeletal concerns,[5] and with approximately 1.71 billion people worldwide suffering from musculoskeletal conditions[6] such as low-back pain, neck pain and joint pain, chiropractors would be remiss if they didn’t find a way to adapt and evolve to fit telehealth into their practices.
By adopting telehealth, practitioners of musculoskeletal care have the opportunity to expand their geographical reach, maintain and deepen contact with patients, and ultimately, help more people overcome pain and get back to doing what they love.
Telehealth care for musculoskeletal injuries and general wellness
The pandemic has provided an opportunity to broaden what it means to be a chiropractor with the injection of telehealth into the profession. The chiropractic field has always had a diverse array of doctors with various areas of focus — initial intensive care, rehab care for musculoskeletal injuries, and maintenance or wellness care.
As telehealth and other technologies such as motion capture and virtual reality continue to push the envelope of what an “in-person appointment” means, many of us find ourselves breaking down silos to not only integrate new tools into our practices, but also employing new techniques from outside of our comfort zones to ensure the best delivery and outcomes for our patients.
In-person health care of any type won’t ever completely go away, but these new access pathways may become the convention and the strategy upon which other points of care are built.[7] This could open an opportunity for chiropractors and other musculoskeletal experts to provide triage for musculoskeletal problems via telehealth and direct patients to the right care at the right time.
Getting started in telehealth
Telerehabilitation appears to be effective and comparable to conventional methods of health care delivery for the improvement of physical function and pain in a variety of musculoskeletal conditions. Chiropractors wanting to make the jump to telehealth should take implementation in three general phases: legal, technical and practical.
Phase 1: Legal — Make sure you are following the guidelines in your state and make sure you are covered legally in the virtual space. Key legal considerations include licenses required to practice telehealth in other states, stipulations on which platforms you and your staff can use to communicate with patients, reimbursement rates and HIPAA compliance.
Phase 2: Technical — What technology do you want to use to deliver virtual chiropractic care? You will have to decide what works best for you and the type of service you want to provide in the virtual space. Live video conferencing, mobile health apps, “store and forward” electronic transmission, and remote patient monitoring are examples of technologies used in telehealth.
Phase 3: Practical — Understand that the approach to a telehealth visit versus an in-person assessment is going to be different. You are going to need to break your own habits, and your communication skills will be put to the test. Small things like looking into the camera, being extra personable and animated with your patient so as to not come off as robotic, and being more descriptive when speaking, all play into the user experience for the virtual patient. It is also extremely important to define clear goals for each patient to help provide them with proper education and an effective treatment plan.
Adjustment-only providers who would like to adopt a digital model may consider using telehealth for follow-up visits and checkups or partnering with a technology that adds value to what they currently do in-clinic. Partnership offerings may include guided rehab sessions, nutritional advice or mental health support — anything educational that adds value to the patient’s life.
Adjusting to chiropractic telehealth
While the evaluation and diagnosis for a virtual patient are ultimately the same as with an in-person patient, telehealth takes more time. The communication is different, and you must spend more time educating the patient.
As the practitioner, you have to make sure your patient is comfortable doing the exercises or treatments on their own. This may mean speaking slowly, using analogies, or finding your own personal way to connect. It is important to remember you cannot use body language, so great verbal communication is key to make sure your patient understands what you’re talking about. Virtual patients must also be assured privacy and confidentiality are maintained and respected throughout the consultation.
Another aspect to consider is how particular and thoughtful you have to be in the rehab you are choosing to give patients to do. Since you cannot physically put your hands on the patient, it can be difficult for you as a provider, but if approached with the right mindset it makes you sharpen your skill set. Simpler but more effective techniques with more emphasis on rehab are where you will find the most success. Telehealth makes providers think.
Not every condition nor every patient is treatable via telehealth. Some issues are more severe and need a hands-on approach, such as trauma or a condition with dangerous comorbidities. Doctors should provide guidance on the appropriate next step, such as going in-person for further diagnosis or seeking the opinion of another specialist. Beyond the condition, sometimes it is the patient. There is a psychological element involved, where the patient needs hands-on guidance and the adherence to the routine that an in-clinic visit provides.
In today’s increasingly digital environment, chiropractors and other musculoskeletal care providers should seriously consider offering virtual appointments. Telehealth is a powerful tool that can enable providers to help as many people as possible. If you are amazing at what you do, joining the virtual world can further your reach, boost your revenue and expand convenience for patients.
STEPHEN OFFENBURGER, DC, is director of teleservices and digital solutions for Airrosti and a telehealth provider with Airrosti Remote Recovery. Before joining Airrosti in 2009 he earned his Doctor of Chiropractic degree from Texas Chiropractic College in Pasadena, Texas. He earned his undergraduate degree from San Jacinto College in his hometown of Houston, Texas.
REFERENCES
[1] Numerof, R., 2021. Telehealth Is Here To Stay – Once Payers And Providers Overcome These Hurdles. [online] Forbes. Available at: <https://www.forbes.com/sites/ritanumerof/2020/07/29/telehealth-is-here-to-stay–once-payers-and-providers-overcome-these-hurdles/?sh=12edf5674767> [Accessed 31 March 2021].
[1] Medpagetoday.com. 2021. Permanent Telehealth Expansion Gains Bipartisan Support. [online] Available at: <https://www.medpagetoday.com/practicemanagement/telehealth/91461?xid=nl_mpt_DHE_2021-03-04&eun=g1661889d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=Daily%20Headlines%20Top%20Cat%20HeC%20%202021-03-04&utm_term=NL_Daily_DHE_dual-gmail-definition> [Accessed 31 March 2021].
[1]American Hospital Association. 2021. Fact Sheet: Telehealth | AHA. [online] Available at: <https://www.aha.org/factsheet/telehealth> [Accessed 31 March 2021].
[1] Johnson CD, Green BN, Konarski-Hart KK, et al. Response of Practicing Chiropractors during the Early Phase of the COVID-19 Pandemic: A Descriptive Report. J Manipulative Physiol Ther. 2020;43(5):403.e1-403.e21. doi:10.1016/j.jmpt.2020.05.001
[1] Green BN, Pence TV, Kwan L, Rokicki-Parashar J. Rapid Deployment of Chiropractic Telehealth at 2 Worksite Health Centers in Response to the COVID-19 Pandemic: Observations from the Field. J Manipulative Physiol Ther. 2020;43(5):404.e1-404.e10. doi:10.1016/j.jmpt.2020.05.008
[1] Who.int. 2021. Musculoskeletal conditions. [online] Available at: <https://www.who.int/news-room/fact-sheets/detail/musculoskeletal-conditions#:~:text=Approximately%201.71%20billion%20people%20have,prevalence%20of%20568%20million%20people.> [Accessed 31 March 2021].
[1] Green BN, Pence TV, Kwan L, Rokicki-Parashar J. Rapid Deployment of Chiropractic Telehealth at 2 Worksite Health Centers in Response to the COVID-19 Pandemic: Observations from the Field. J Manipulative Physiol Ther. 2020;43(5):404.e1-404.e10. doi:10.1016/j.jmpt.2020.05.008
[1] Numerof, R., 2021. Telehealth Is Here To Stay – Once Payers And Providers Overcome These Hurdles. [online] Forbes. Available at: <https://www.forbes.com/sites/ritanumerof/2020/07/29/telehealth-is-here-to-stay–once-payers-and-providers-overcome-these-hurdles/?sh=12edf5674767> [Accessed 31 March 2021].
[2] Medpagetoday.com. 2021. Permanent Telehealth Expansion Gains Bipartisan Support. [online] Available at: <https://www.medpagetoday.com/practicemanagement/telehealth/91461?xid=nl_mpt_DHE_2021-03-04&eun=g1661889d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=Daily%20Headlines%20Top%20Cat%20HeC%20%202021-03-04&utm_term=NL_Daily_DHE_dual-gmail-definition> [Accessed 31 March 2021].
[3]American Hospital Association. 2021. Fact Sheet: Telehealth | AHA. [online] Available at: <https://www.aha.org/factsheet/telehealth> [Accessed 31 March 2021].
[4] Johnson CD, Green BN, Konarski-Hart KK, et al. Response of Practicing Chiropractors during the Early Phase of the COVID-19 Pandemic: A Descriptive Report. J Manipulative Physiol Ther. 2020;43(5):403.e1-403.e21. doi:10.1016/j.jmpt.2020.05.001
[5] Green BN, Pence TV, Kwan L, Rokicki-Parashar J. Rapid Deployment of Chiropractic Telehealth at 2 Worksite Health Centers in Response to the COVID-19 Pandemic: Observations from the Field. J Manipulative Physiol Ther. 2020;43(5):404.e1-404.e10. doi:10.1016/j.jmpt.2020.05.008
[6] Who.int. 2021. Musculoskeletal conditions. [online] Available at: <https://www.who.int/news-room/fact-sheets/detail/musculoskeletal-conditions#:~:text=Approximately%201.71%20billion%20people%20have,prevalence%20of%20568%20million%20people.> [Accessed 31 March 2021].
[7] Green BN, Pence TV, Kwan L, Rokicki-Parashar J. Rapid Deployment of Chiropractic Telehealth at 2 Worksite Health Centers in Response to the COVID-19 Pandemic: Observations from the Field. J Manipulative Physiol Ther. 2020;43(5):404.e1-404.e10. doi:10.1016/j.jmpt.2020.05.008
