HSS@Home, Physical Therapist-Led Telehealth Care Navigation for Arthroplasty Patients: A Retrospective Case Series

Abstract

BackgroundAs the rate of total joint arthroplasties performed in the USA continues to increase, so does the push for more value-based care. Bundled payments have encouraged organizations to be creative in limiting care overuse. Telehealth is one option for caring for arthroplasty patients post-surgery while limiting costs and improving communication with the surgical team.Questions/PurposesWe sought to determine the effects of the implementation of HSS@Home, a telehealth rehabilitation program that uses patients’ existing technology, in patients after they had undergone total knee or total hip arthroplasty.MethodsIn this retrospective case series, of 32 patients referred, 19 patients (nine men and ten women; average age, 69 years) were enrolled in HSS@Home after undergoing a pre- and post-operative screening process. Telehealth video visits were conducted, wherein a physical therapy navigator assisted patients in following exercise and mobility programs, addressing patients’ concerns while transitioning to outpatient therapy. Patients were seen within 24 h of hospital discharge, 3 times a week for 3 weeks, for an average of 11 sessions. Episodes of care were recorded in the patient’s electronic medical record.ResultsThere were no readmissions among the 19 patients. Nurse practitioners were consulted for all patients, predominantly for non-emergent reasons. Feedback from patients and physicians was positive, and no overutilization of care was found.ConclusionHSS@Home was a promising alternative to live, in-home physical therapy that was effective in monitoring this series of patients after hip or knee arthroplasty. This preliminary data sets the stage for further research into the use of telehealth technology to provide rehabilitative care to arthroplasty patients.Electronic supplementary materialThe online version of this article (10.1007/s11420-019-09714-x) contains supplementary material, which is available to authorized users.

Patient Satisfaction for Telehealth Physical Therapy Services was Comparable to that of In-Person Services during the COVID-19 Pandemic

“…Our findings of high patient satisfaction with telehealth PT are consistent with previous authors who have reported similar results for care delivered virtually, although the contributing factors may differ [4,5,7]. Kruse et al reported patient satisfaction with telemedicine to be correlated to a Age reported as mean and standard deviation improved outcomes, preferring telehealth for ease of use, low cost, improved communication, and decreased travel time [5].…”

“…Kruse et al reported patient satisfaction with telemedicine to be correlated to a Age reported as mean and standard deviation improved outcomes, preferring telehealth for ease of use, low cost, improved communication, and decreased travel time [5]. In a retrospective case series, Fisher et al described subjective reports of patient satisfaction with telehealth physical therapy following joint replacement surgery [4]. A study by Moffet et al found no difference in patient satisfaction between those receiving telehealth PT and those receiving in-person PT; furthermore, the researchers found that satisfaction strongly correlated with improvements in gait and stair climbing in patients after total knee arthroplasty [7].…”

Pivoting to Telehealth: The HSS Experience, Value Gained, and Lessons Learned

“…Historically, CMS did not recognize physical therapists as telehealth providers, thereby limiting the ability to expand to other patients and service lines. However, the viability of HSS@Home has been demonstrated wherein all patient concerns were addressed and zero patients readmitted [7]. Although HSS@Home was limited to scale, the infrastructure built during this time laid the groundwork for future telehealth programming.…”

“…Once admitted to the hospital, surgeons can perform remote rounding on patients to answer questions, improve patient-physician engagement, and save physicians time by not having to travel throughout the hospital to visit each patient. Post-operatively, HSS@Home has already improved access to care (patients are seen within 24 h of discharge), decreased unnecessary re-admissions, and improved patient satisfaction in total hip and total knee replacements [7]. Patients can also use telehealth as an adjunct with traditional in person therapy, decreasing the overcrowding of clinics.…”

“…HSS@Home provides virtual face-to-face visits with HSS physical therapists for coordinated care during the immediate post-acute stage (0 to 30 days) following total joint arthroplasty. Physical therapists provide education, monitor the progress of home exercises, and enhance communication between the patient and surgeon, with the goals of minimizing complications and reducing unnecessary re-admissions [ 7 ]. Yao and colleagues have shown that 60 to 70% of all re-admissions following a total hip or a total knee replacement occur within the first 2 weeks of surgery [ 22 ].…”