Viewpoints—Telehealth: A Q&A With Sherry Kolodziejczak

Sherry Kolodziejczak, MS, OTR/L, Director of the ALS Clinic/Cardiac Rehab/Therapy Services/Worker’s Program at the Crestwood Medical Center, Huntsville, Alabama, is conducting a pilot telehealth program at her center to serve clients from across Alabama with amyotrophic lateral sclerosis (ALS). She recently spoke with Jana Cason, DHSc, OTR/L, FAOTA, a Professor at Spalding University’s Auerbach School of Occupational Therapy, in Louisville, Kentucky, about how telehealth helps her serve clients.

What practice setting are you in?

Crestwood Medical Center’s ALS Clinic is an outpatient clinic designated as an ALS Association Treatment Center of Excellence. Transportation and travel are difficult for our patients and their caregivers. With the advances in technology and the recognition of telehealth as a viable service delivery model, we launched a pilot telehealth program to supplement our in-person services.

How many occupational therapy practitioners are involved in delivering services in your telehealth program?

Currently, I’m the only occupational therapist involved in the pilot telehealth program.

What type of occupational therapy services do you provide through telehealth?

Initially, the main service provided through telehealth was the initial intake interviews. Then, it branched into providing consultation and case management services through telehealth. I commonly address care issue concerns, such as transfers and self-care. I can also follow up on durable medical equipment orders, help the caregiver with set up, and provide guidance on safe use.

What type of technology do you use?

The hardware used in the pilot telehealth program include a desktop, laptop, tablet, and external USB camera. No specific videoconference software has been selected for the program; I am continuing to explore options. No peripheral devices (e.g., blood pressure cuff, O2 monitor) are connected to the telehealth platform; however, data from devices in the home (e.g., suction machine, blood pressure cuff, O2 monitor) can be obtained from the caregiver and relayed to [health care providers] remotely.

How are services provided through your telehealth program reimbursed?

The ALS Clinic telehealth program is currently a pilot program; third-party payers are not billed. The services provided through telehealth promote health and wellness and may prevent hospitalizations. They are a value-added benefit to our patients.

Why did you begin providing services through telehealth?

Telehealth is the best avenue to provide comprehensive case management for patients with ALS who are in crisis, and for those who can no longer physically come to the ALS clinic at Crestwood Medical Center.

What benefits have you observed from using telehealth?

Using telehealth within the ALS clinic has enabled me to be proactive and provide comprehensive care management. Through telehealth, I have prevented visits to the emergency room (ER), and likely prevented hospitalizations and re-hospitalizations. For example, with the use of the feeding tube, it is critical to get any air out of the tube before commencing tube feeding. When this step has not been performed properly, the patient’s stomach becomes distended, which can be alarming to caregivers, and often results in an ER visit. Telehealth enables the patient to be managed safely at home with professional support from myself and other health care professionals on the team (e.g., physician, nurse, dietician, respiratory therapist). Another area where telehealth has averted ER visits is in the area of medication management. I frequently collaborate with nursing to support the occupation of medication management. With telehealth, I have observed that patients have received forms of medication that are not compatible with a feeding tube (e.g., oral, time-release forms of a medication). If this form of a prescribed medication is used with a feeding tube, it will block the tube.

What challenges have you encountered?

The two primary challenges encountered are lack of high speed Internet in portions of the state and reimbursement. Some of our patients are still on dial-up Internet service. In this event, I use the telephone to provide case management and care coordination. Reimbursement has proven to be a key challenge. One of Alabama’s largest insurers does not currently reimburse occupational therapy services provided through telehealth. I have been actively involved in advocating with this insurer, as well as others, to expand reimbursement of occupational therapy services provided through telehealth. We are also exploring reimbursement through Alabama’s Integrated Care Network (ICN)/Medicaid program. The hospital system is evaluating how the telehealth pilot may fit into the Accountable Care Organization model, in which physicians, hospitals, and health care providers work as a team to provide high quality care. Although not direct reimbursement, for Medicare patients, the return on investment may occur through the prevention of re-hospitalization within the 30-day period set by Medicare.

What recommendations or lessons learned would you like to share with other occupational therapy practitioners interested in telehealth?

Administrators and practitioners should complete a system review before implementing telehealth, which may include a needs assessment, technology-readiness assessment, and requirements of reimbursement entities. In addition, practitioners should understand HIPAA requirements and any telehealth-related state laws, regulations, and/or policies, including occupational therapy licensure requirements and scope of practice (e.g., practitioners may not be able to provide telehealth services to clients in another state). Patients should conduct a telehealth-readiness assessment to assure that they have adequate Internet bandwidth, can access (or have a caregiver who can access) the technology, and that they are good candidates for using telehealth (e.g., their needs can be met through telehealth or a hybrid model, where some services are provided through telehealth and others in-person at the ALS clinic).

Jana Cason, DHSc, OTR/L, FAOTA, is a Professor at Spalding University’s Auerbach School of Occupational Therapy, in Louisville, Kentucky. Explore AOTA's resources on telehealth. To be considered for inclusion in a future telehealth Q&A, email jcason@spalding.edu.