Objective To keep patients healthy and safe during the pandemic, payers and the Federal Government temporarily relaxed restrictions, expanded the eligible provider list for providing telehealth services, and developed a reimbursement structure. Physical therapists were uniquely challenged during the pandemic, requiring a reassessment of techniques and strategies in order to best support patients. The purpose of this case report is to describe a musculoskeletal institution’s experience with implementing telehealth physical therapy. Methods (Case Description) Previous telehealth experience enabled the infrastructure of a wide-scale adoption across institutions response to the Covid-19 pandemic. However, to fill in training gaps for HSS outpatient physical therapists, HSS Rehabilitation developed a robust education and implementation program. This training was influenced by clinician and patient surveys as well as the development of a published HSS Rehabilitation telehealth guide. Prior to performing telehealth physical therapist visits, clinicians were required to complete all training material to ensure comfortability and confidence. Results The adoption of telehealth among clinicians was born out of necessaity, however the speed in which HSS rehabilitation pivoted was critical to avoid lapses in care. In a four week period after the NYC shelter in-place orders, 173 therapists were trained and performing virtual visits. HSS rehabilitation determined telehealth physical therapy had quicker access to care, similar patient satisifaction, and increase geographical outreach when compared to in-person care. Conclusions The tranisition to telehealth physical therapy included a multi-step process that provided clinician training, establishment of protocols and guidelines, and obtaining a better understanding of the patient experience. Telehealth physical therapy has shown early benefits such as improving patient access to care, and better continuity of care for patients traveling. Even after the current public health emergency, there is a place for high value telehealth physical therapy in caring for patients with musculoskeletal conditions.

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.

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