Reimagining Rehabilitation: In-Home Physical Therapy Gets a Boost

This article was originally published November 7, 2023 by Medscape.

Partnerships between hospitals and home health companies are increasing access to rehabilitation services not only for older adults but also for people in rural areas, those without reliable transportation, and patients with injuries that hinder their driving abilities.

"We find more and more that physical therapy at their home, instead of coming to an outpatient facility, is something more and more folks are requesting," said Bill Benoit, MBA, chief operating officer of University Hospitals (UH) in Cleveland, Ohio. "In this post-COVID environment, people are getting all different types of services in their home when they're available, and this is one of them. The pandemic sped up the process of us moving away from the traditional brick and mortar hospital."

UH recently announced a partnership with Luna Physical Therapy, a company founded in 2018 that provides home services. Luna has teamed up with more than two dozen other hospitals in the United States to offer home-based rehabilitation, according to the company.

The process for arranging in-home therapies through hospital-clinic partnerships is like any other inpatient or outpatient rehabilitation, Benoit said: A patient meets with a specialist or primary care practitioner, they discuss options, and eventually the clinician recommends physical therapy. The only difference here, he said, is rather than going to a separate facility or a hospital, the patient logs onto a mobile app that matches them with a physical therapist on the basis of their location, needs, and the times they are available.

The prescribing physician oversees the patient's progress through notes provided by the therapist.

"For the primary care physician or surgeon, they're not going to see much of a difference," Benoit said. "This just adds to that list of options for patients."

Safer, More Productive PT

A 2021 study published in the journal Family Practice found that 76% of patients who are prescribed physical therapy do not initiate the services after it has been recommended.

Aside from the convenience and expanded accessibility for patients, the home therapy option can be more productive, said Denise Wagner, PT, DPT, a physical therapist with Johns Hopkins in Baltimore.

"Home is safer for many patients, but home is also more engaging and motivating," Wagner said. "Home health clinicians are experts in using whatever they find in the home environment as equipment; many people have stairs in their home, so we can use the rail as something to hold. If patient likes to walk their dog, we can use putting a leash on dog as balance activity."

Therapy in the home setting helps physical therapists customize programs to fit each patient's lifestyle, said Gira Shah, PT, a physical therapist with Providence Home Services in Seattle.

For example, patients generally want to know how to function within their own space ― navigate their kitchens to make food, or get in and out of their bathtubs. Staying in that space allows therapists to focus on those specific goals, Shah said.

"It's more of a functional therapy," she said. "The beauty of this, as therapists we're trying to assess what does the patient need to be independent."

The consulting firm McKinsey predicts that as much as $265 billion in healthcare services for Medicare recipients will be provided within the home by 2025.

The obvious question is: Why would hospitals partner with clinics rather than offer in-home services on their own?

The answer, like most things in healthcare, boils down to money.

The billing and documentation system that they use is more efficient than anything hospitals have, said John Brickley, PT, MA, vice president and physical therapist at MedStar Health, a healthcare system in Maryland and the Washington, DC, area. MedStar and Luna announced a partnership last June.

"We would financially fall on our face if we tried to use our own billing systems; it would take too much time," Brickley said. "Do we need them from a quality-of-care standpoint? No. They have the type of technology that's not at our disposal."

Patients should be aware of the difference between home-based PT and other health services for homebound patients, Brickley said. Medicare considers a patient homebound if they need the help of another person or medical equipment to leave their home or if their doctor believes their condition would worsen with greater mobility.

From the perspective of an insurance company, a home therapy session arranged by a hospital-clinic partnership is an ambulatory appointment and uses the same charging mechanism as most other visits. For a home healthcare visit, patients must qualify as homebound.

Home-based PT can be used for conditions including neurologic issues, bone and joint problems, balance, and fall deconditioning and prevention. But if a patient needs heavy equipment that cannot be transported, outpatient services are more practical.

That should be determined by the primary care practitioner or specialist evaluating each patient, said Palak Shah, PT, cofounder and head of clinical services at Luna.

"Primary care physicians play a huge role ― that's where patients express their initial concerns," she said. "It's up to them to make patients aware about all the options."