May 22, 2019 at 5:00 am ET
American seniors are facing an epidemic.
It’s an epidemic that strips away their ability to live and function independently, presenting staggering costs to Medicare and America’s broader health care system. I’m not talking about a complex disease befuddling clinical researchers, but the well-known but poorly addressed problem of elderly Americans falling in their homes.
Falling is the number-one cause of injury for older Americans. Every 11 seconds, a senior citizen goes to the emergency room after a fall, resulting in roughly 300,000 hip fractures and 800,000 hospitalizations every year. Worst of all, it’s estimated that falls kill an estimated 27,000 seniors each year in the United States.
Unfortunately, this problem is only expected to worsen. According to the Centers for Disease Control and Prevention, fall death rates among the elderly increased by 30 percent between 2007 and 2016, a trend that will result in seven fall deaths every hour by 2030.
This is an epidemic that, while substantial, is not without ready solutions. According to the National Institute on Aging, physical activity and regular exercise regimens are simple solutions that can reduce the risk of an accidental fall. As a physical therapist with 19 years of experience treating Medicare-age individuals, I can attest to these assertions.
Over the years, I have helped hundreds of older patients undergo balance training and patient-specific exercises that strengthen their body and reduce the risk of a fall. But despite the fact that physical therapists are well-equipped to assist patients with these fall-prevention strategies, a significant gap still exists in both access and compliance to such strategies — something that prevents us from making significant headway in reducing falls among American seniors.
For older adults who are given home exercise regimens during a physical therapy appointment, compliance with such regimens becomes increasingly difficult as time passes. These compliance challenges, in turn, can eventually reduce the overall effectiveness of the exercise program in preventing unwanted slips. With more seniors dying every year from falls, addressing this compliance problem will become increasingly relevant — a reality that has caused a growing number of physical therapists to promote a solution that, while by no means novel, has the potential to greatly improve the effectiveness of traditional in-person therapy sessions: PT telehealth.
By giving patients the option to consult their physical therapist through virtual telehealth appointments, the limiting factors of mobility and age-induced disability are removed. Better still, ready access to existing telehealth technology can make it easier for physical therapists to see inside their patients’ home and make specific recommendations on how to remove physical hazards that may cause unwanted falls. Compliance is also improved, as physical therapists can more easily monitor the progress of patients through routine telehealth checkups.
A growing wealth of evidence shows the effectiveness of virtual PT in reducing the frequency of fall-related injuries among seniors. One recent program, for example, heavily utilized virtual PT to improve the endurance, balance and strength of patients, successfully reducing falls by 35 to 40 percent among seniors.
By strengthening seniors to avoid devastating accidents, telehealth-based PT can prevent much of the exorbitant spending on treatments for fall-related injuries. An estimated $50 billion in total medical costs was incurred to treat senior falls in 2015, $29 billion of which was paid by Medicare. If PT telehealth initiatives are expanded on a broader scale, more seniors might access these services, thus reducing the possibility of a fall and avoiding the subsequent medical expenses associated with it.
Telehealth-based PT, though not a silver bullet, has the potential to significantly reduce both the risk of fall-induced injury and associated treatment costs for participating patients. With that said, one significant coverage obstacle remains for Medicare beneficiaries seeking to utilize virtual PT.
Although the Centers for Medicare and Medicaid Services recently announced that Medicare Advantage will soon be able to offer a whole host of telehealth services within its basic benefits package, physical therapy was unfortunately not among these services. While this is a frustrating setback for physical therapists who recognize the value of virtual PT in preventing fall-related injuries, future opportunities still remain to expand coverage for elderly beneficiaries.
In early March, the Congressional Telehealth Caucus released a letter requesting “suggestions, recommendations or relevant experiences” in an attempt to gauge public opinion before creating new telehealth legislation for the 116th Congress. By soliciting comments, the caucus has shown an important willingness to consider patient and provider opinion in the policymaking process, which should be applauded.
History has shown public persistence is the best way to move the legislative needle in Congress. By making our voices heard on Capitol Hill, we can take an important step in ensuring that seniors have virtual access to services that can significantly reduce the risk of devastating and costly falls.
Nikesh Patel, PT, DPT, is a physical therapist and executive director of Alliance for Physical Therapy Quality and Innovation.
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