Post-COVID Rehabilitation Services Emphasizing Telemedicine

I found the May/June 2020 issue of Missouri Medicine featuring “Telehealth: The Post-COVID Era,” to be both informative and timely. As the COVID-19 pandemic has impacted society and made healthcare providers examine how healthcare is delivered, the use of telehealth seems to be here to stay. Due to some of the regulatory and reimbursement changes, many physicians in health systems have increased the use of some form of telehealth or telemedicine in their own practice.¹ As physicians, we tend to think of telemedicine as the provision of only our services; however, at the University of Missouri-Columbia, our therapy service department has initiated an interdisciplinary tele-therapy program to assist in both evaluation and therapeutic intervention after hospital discharge of patients with COVID-19. Early data on patients with COVID-19 who require ICU care reveals that sarcopenia, debilitation, and sometimes lung scaring can be causes of increased morbidity that can lead to readmission after discharge from the hospital. Many of our normal post-acute care (PAC) facility options (skilled nursing facilities, inpatient rehabilitation, and home health) have limited access to accept or care for patients post COVID-19 infection. Therefore, it is critical that we find other transition treatment options for patients who are discharged directly from the hospital to home.

As a result of these factors, a team of multi-disciplinary specialists from physical therapy (PT), occupational therapy (OT), speech therapy (ST), and respiratory therapy (RT) developed a post Covid-19 rehabilitation plan that could be provided to patients in their home via Zoom or Skype. Patients at home are initially evaluated using objective measures that include: respiratory rate, pain scale, Borg exertion test, sit to stand test, cognitive screening, and a fatigue scale. Based on each patient’s results, an individual program is developed geared toward respiratory mobility and activity of daily living (ADL) needs.

The program consists of two to four visits over a one to three week time frame based on each individual’s severity, needs, and clinician judgment. The visits are stratified as follows:

• Visit 1: 2–4 days post-discharge; evaluation and service needs.

• Visit 2: 2–4 days post Visit 1; evaluate progress and need to continue program.

• Visit 3: 7–10 days post Visit 1; assess tolerance and progress exercise recommendations.

• Visit 4: 3 weeks post initial evaluation; discharge to home wellness program or to outpatient therapy program.

By standardizing our treatment plan for delivering therapy services in the home setting, we hope to have a positive impact on readmission rates, costs, and satisfaction (provider and patients). Also, arranging therapy sessions during the first 10 to 14 days ensures that a medical professional has contact with patients soon after the transition home. This allows contact with the primary medical team if there are any acute concerns early in the patient’s post-hospital transition. Initial observations reveal that patients are in need of more OT and ST services than initially expected. However, just like physician services different, payors may or may not cover these services. While we are excited about further developing this and other teletherapy programs, it will be critical for physicians to understand options of treatment, to advocate for payment, and continue to push for innovation to help the patients that we serve.