Using This Can Boost Revenues, Increase Patient Engagement, Improve Collections, & Implement RTM With Vikram Sethuraman Of PT Wired

Leveraging technology is not easy for many PT clinics. It requires a change in flow, mindsets, and protocols that can make life difficult in a busy clinic. However, embracing technological options can, in time, generate better results for patients, providers, and the business. Vikram Sethuraman of PT Wired , a patient engagement app, share with us how apps like his can improve revenues in a physical therapy clinic by increasing patient engagement, improving collections, and implementing new remote therapeutic monitoring (RTM) codes.

—

I got a return guest, Vikram Sethuraman . He is the CEO of PT Wired and coming to us from Spain, which is awesome. I’m impressed. He is working remotely. Thanks for joining us again. We had you on several years ago. It is cool to have you back, catch up with you and see what you guys are doing nowadays. For those who might not have been reading several years ago, and might be reading this for the first time, tell us a little bit about you and where you are coming from.

Thanks so much again for having me back on. I had a lot of fun last time. I’m excited for this time. I am the CEO of PT Wired. PT Wired is a patient engagement and RTM solution for physical therapy clinics. What we offer is a branded application. Every clinic has its own custom branded app, clinic name, clinic logo, and color scheme on the App Store and Google Play Store.

That app is intended to be a full-service patient engagement experience so they get their home exercises. They can message the provider and track their progress. They have gamification, achievements, awards, appointments, and bill pay. On the therapist side, they can track everything for RTM automatically through our dashboard and generate a new stream of revenue from RTM.

PT Wired is not the only player in this space. If you go to the PPS convention or CSM, you will see a number of those. The difficulty with many physical therapists is they don’t like to change their way of doing things. You try to implement new things. You were like, “This is better for the business. This is better for the patient.” If it is going to make me do some extra clicks and change my flow, I’m not that interested.

We have to recognize that there is a benefit from the technology and digitization of some of these things. What are some of the issues that owners are still bringing up that keep them from doing some digital home exercise program applications? I know that is only a small portion of what you guys provide, but moving away from the stock photos of cards that they put on the copier machine to do a home exercise program, what is keeping them from switching over?

We have been at this a long time in the space. It has been interesting seeing that now. The answer to that question has changed over the course of the time that we have been around. There are a couple of things. Earlier on, we would get a lot more concerns about the older populations, which are typically the people going to physical therapy, being those populations that would engage with digital devices for this purpose. Even back several years ago, that trend was already starting to occur, but it is even more so the case now.

Nowadays, 83% of people above the age of 50 to 64 have a smartphone device and engage with it every day. That is 61% for people 65 and older. That is continuing to go up over the years. As far as computer and internet access, it is 96% for 50 to 64-year-olds and 75% for 65-plus. That used to be more of a question people asked.

Most people nowadays have a grandparent or parent that has a device. That is a bit less of a concern. What we are seeing is PTs and clinic owners are busy. If it is not broken, don’t fix it. People have been doing their cards. They have their papers. They have been doing that for a long time. Any change, even if it is something that will ultimately be more efficient down the road, there will be a learning curve. Knowing that people are busy already and also up until there were other reasons to make the switch like RTM, there was less of an incentive on their side to do it because they have a system that works and that is comfortable. There are a million other things on the to-do list. That is what we have seen.

You talk about patient engagement. What are some of the benefits to the therapists and owners of having this system in place? It makes it easier for patients to access their home exercise program. The first thing that went off my mind was, “If you can do some bill pay through the app, that is awesome. Helping with billion collections. There is got to be a return on that.” What are some of the things like that that you recognize are helpful and make this a benefit not just the patients but the patients, the therapists, and the owners?”

The main stat that we want to focus on, because it is the easiest one for everybody, is revenue. When you are not engaging patients, there are a lot of ways that lead to a loss of revenue. The primary one is a patient dropout. When patients aren’t engaged in between visits, the number one time when they drop out is when they fail to adhere to their home exercise program. At home, they have less support, motivation, or instruction. They don’t have the reminders they need or the proper instruction by medium, whether it is a video, an image, or a text that is something written on a piece of paper. That is what leads to the dropout rates that we see.

When you're not engaging patients, there are a lot of ways that lead to a loss of revenue, the primary one being patient dropout.
Click To Tweet

Seventy percent of patients don’t finish their course of care and 20% drop out in the first three visits. One survey found that retention was as low as 7% in practices with more than one physical therapist. A small bump to that retention number can have a big increase in profit. That is a good starting point. As far as what we can do to tweak that, going back to the old methods of paper, postcards, and things with the exercises, a while ago, clinic owners didn’t have much that they could do to impact that.

It was phone calls and some texts.

That was the extent of it. Those phone calls and text messages weren’t billable time. That is another barrier to that. Nowadays, everybody got a smartphone in their pocket. We have access to the patient in between visits more than we did in the past. That is not only for something like home exercise programs. That is for something like sending a message and making it easy, where they can go on the app to book their next appointment versus having to call the clinic or the clinic call them to get that scheduled.

As you mentioned with bill pay, it’s making everything a lot easier. In between these visits, collecting data on what the patient is engaging with. We can detect dropout earlier before it happens. The biggest thing with this switch to digital patient engagement is that there is more power in the hands of the providers because they have access to the patient in between visits in a way that they never did in the past.

Do PT Wired and some of the other apps collect statistics in terms of whether the patient is doing the exercise this many times a day? Do they have some compliance statistics that are easily pushed to you, where you can easily go to a dashboard?

We certainly do. Most digital apps do. What is going to be a big help is having a clear picture of what patients are doing. If you look at the factors that affect behavioral change for patients, accountability is the number one thing. Not only is it beneficial to the provider to be able to see what the patient is doing. It is beneficial to the patient because the number one thing that will impact their level of engagement is knowing that the provider can keep tabs on them. It goes both ways.

This might be from the left field, but do you see how or if AI is going to affect it? Are you leveraging some AI at this point or looking for ways to do that? The hot topic now is how AI is going to affect many things, but it could affect healthcare. Are you noticing anything where it might be affecting you?

Yes, AI is the biggest buzzword of the day. The applications of it in this digital patient engagement space are endless. As I said, we have been around for several years. We have had hundreds of thousands of patients use the system. Some have done their full plan of care. We have a lot of data on the levels of engagement of patients and the outcomes of that patient.

The way we are looking at it is, what can we see in terms of behavior on the app that is indicative of different outcomes, whether it is a dropout, a successful discharge, an instance where a patient has a high percentage of RTM eligibility for billing based on their engagement or a situation where a patient has a low percentage of RTM engagement? The earlier we can detect that based on the data, the more effectively we can intervene earlier and make the adjustments we need to get them on the right track. That is how we do it on the patient side.

On the provider side, with the exercise search, we have 7,000 exercises in our library to pick from. You can add your own, but that is what we provide. That is a lot, and people still want more. They always will want more, but one thing we can do there is to create a more effective search system to give people the results which are more relevant to them based on what we have learned over time. It gets progressively better and more useful to the provider.

Tell me a little bit about RTM, Remote Therapeutic Monitoring, if people don’t know about it. I have done a couple of episodes in the past several months. Look in the show library to learn about RTM if you don’t know about it. Did it come out in January 2022 or 2021?

Yes, 2022.

Some therapists might still be getting used to it. Maybe they have heard the word, but they know nothing about it. What can you share about RTM because you have made it easier with the implementation of RTM opportunities within your app? Tell us a little bit about it from there.

Another barrier in the past for people making the switch to digital is the cost element of going digital versus going paper. It is going to be more expensive to go digital. A new way that can be addressed is through RTM. It is not only going to help you cover the cost. It will help you view it as more of an investment than a cost in the first place because you are getting a return on the investment that well exceeds the cost.

In the past, a barrier for people making the switch to digital was the cost element of going digital versus going paper.
Click To Tweet

Some of the things we talked about in terms of patient engagement, patient retention, how that impacts outcomes, and the bottom line of the clinic are why RTM exists. Data from these types of digital platforms being used with patients was indicative of the fact that it leads to better outcomes, better retention, and less need for surgery or medication and, instead, a successful result in physical therapy. That is why these codes were brought into existence. It adds extra incentive for clinics to use these types of systems and engage with patients more in-between visits because that is what is going to lead to successful outcomes.

There are four codes in RTM. The way I try and break it down in the simplest terms is there are codes that are based on the patient’s level of engagement with the system you are using. For example, with our app or whatever system you may be using. There are codes for the provider’s time. The provider is monitoring the patient, engaging with the patient, setting up the patient’s care plans, and editing the care plans. We talked about in the past, the only thing that a provider could do was shoot a call or a text to a patient if they didn’t have a digital system and how that time wasn’t billable in the past, but now that time is billable through RTM if it is done as part of one of these.

Yes, if you can document it to share what you discussed.

That is a quick high-level summary. A lot of people are a bit more familiar now. For all of 2022, a lot of people were waiting to see what other people did and what happened with RTM. Now it has been getting a bit more mainstream. A lot more people are adopting it or at least planning to adopt it. In part, that is because in 2022, CMS proposed a couple of changes, and they didn’t get implemented in the final rule. People have a bit more confidence that RTM is here to stay. If they make the investment into implementing an RTM strategy at their clinic, it is going to be worth it in the long run.

If people are looking into taking advantage of RTM and they don’t know where to start and are looking for software support, digital support, or an app that would guide them, what would you recommend they look for in an app or software to help them be able to do it, especially if they are starting from scratch?

For the RTM codes, the billing requirements are complicated at face value. You got some codes that are billed per 30-day period, some codes that are billed per calendar month, some codes that require data transmissions, and some codes that require time tracking. It gets complicated quickly. The number one thing is you would want to find a system that does all of the tracking for you and computing the billing side of things in terms of when a patient has met the requirements for billing a code. You want something that will do all of that for you.

You can track it yourself. That is possible, but at that point, it gets to how much you are getting in terms of the time you are spending on it. The ROI gets a bit dicey there. That is the number one thing. On our end, we have a smart timer that tracks time based on what you are doing. It is RTM-eligible. We will count it based on the requirements. Once you meet the code requirements, you will get a notification that a patient has met the requirements. We will give you the code and the supporting documentation.

Another thing is that the billing is a bit complicated for this because these codes are meant to be billed outside of visits. A lot of the EMR systems out there don’t allow for that. Having a system that assists with that, like getting the supporting documentation simple, a timely notification, and assisting in the whole billing side.

I mentioned some of the codes are billed per calendar month. It is getting towards the end of May 2023 here. If we had a code that was eligible to be billed at the end of the month, but you don’t bill it until June 2023, and you try to build a June code in June month, you could run into issues there. It can get complicated. You want a system that’ll help you with that side too.

It is one of those that will give you the bumper guards, like in bowling. You are like, “You can’t do that. You can do this. Here is the documentation you need to cut and paste into your EMR software for the appropriate documentation of it.” It says, “You haven’t met it. This is the code that you can use.” It sounds like it is what you are looking for in any support, but what you guys also provide is those guardrails to keep you compliant. It also tells you when you have met. It seems to be teaching you when you can use those codes and when not.

Another part in itself is the initial training. You want a system where they help get you up to speed at the beginning and give you the training on RTM strategy. One thing we do is we will have a kickoff call. We have questions for the clinic to make recommendations on different strategies they can implement based on how they already do things.

The last thing I would add there is I mentioned notifications when a patient’s eligible for billing. That is at the end of the billing period, whether it is a calendar month or a 30-day period. What you also will want is something that, in the middle of the billing period, tells you how you are progressing and forge the code to meet the code. You can prioritize your time.

If you see these patients are on track, they are going to meet the code requirement for 98977. I don’t have to do much more engaging to get them to use the app more. They are good to go. These ones are on the fence. If I have fifteen minutes between a patient visit to do some RTM, I want to focus on these ones to optimize my time and get the most revenue from RTM.

I had an interview with Matt Jurek about RTM. Are there payers outside of Medicare that are reimbursing for RTM codes?

There are, and it is complicated. We have heard of over 30 payers that are reimbursing, but it depends on the state and plan. The lawyer answer I always get is, “You got to try it and verify with your payers in your area.” Unfortunately, it is like that. There are instances of payers who haven’t released anything stating that they are reimbursing, but they are. We see payments from them. It is worth looking into, especially if you have a big non-Medicare patient population. It is worth seeing payers that are now reimbursing.

If all payers were paying for RTM, it is something that should be part of the routine for almost every patient.

We have the patient engagement app. For all clinics that use our system for RTM, they use the app for all their patients. Whether they are RTM-eligible patients or not, that doesn’t necessarily mean that they do the extra phone call and twenty minutes of time per calendar month for the patients that are not RTM. They will still set the patient up on the app and have a lot of the same engagement that they would with an RTM patient. The idea here is related to the other stats that we talked about earlier in terms of patient dropout and outcomes. That is what it is about for Medicare. That is why Medicare approves these codes. They saw the value there.

What have you found has been the most successful strategy for implementing RTM? Let’s start before RTM. What is the most important strategy to make this a successful transition from whatever the system was before for patient engagement to a digital app like this? After that, what has been successful in the implementation of an RTM program? Let’s start with the first one. If they are going, “I did my paper copies on the copier. We are switching all over to this digital app.” What have been some of the most successful actions to make sure that happens?

The most important is the provider adoption at the beginning. If the providers aren’t using it, the patients won’t ever get set up to use it. The biggest thing we found indicative of a successful implementation are the providers having the initial setup on their end of templates and favorites for their exercises.

With the paper printouts that you mentioned, a lot of people have a hip printout that they use for a lot of their hip replacement patients. Getting that same template that they know and use into the digital system as a template with the videos associated with the exercises. Everybody has the same 15 to 20 exercises they use a lot more than another provider, necessarily having those flagged in the system. Those are always the first ones popping up.

That is when we track implementation at the beginning to ensure that things are going well. We are looking at every provider’s favorites and templates. We are flagging the people that don’t have any. We are trying to engage with them to say, “How can we help you here?” We know how much easier it is and how indicative of a successful implementation.

I can see what you are talking about because we used to have file folders next to the documentation station. There was the hand, shoulder, knee, and hip file folder. They had the printouts for us. We could always grab that and hand it to the patient. It made it simple. You got to make it as simple as that for the providers.

Do you recognize that the owners who are engaging with the providers prior to landing on the app that they choose have a little bit more success? I’m assuming if an owner comes in and says, “We are going to switch over to this app.” They are blindsided. I would assume that is not best for successful implementation. If you get the providers engaged, on the other hand, there might be some buy-in earlier on.

It depends on the clinic and the therapist population. If they are younger therapists, it is easy to implement. They are more ready to use a new tech system like that. The biggest thing is getting the therapist’s buy-in. We do demos for everybody as if they are implementing our system. Some clinic owners will bring therapists on the demo and get their take on how it will work for them.

The biggest thing we always focus on is the time spent that the therapist would have to engage with the system because you got your file cabinet with the wrist PDFs. How much time does it take to start the stopwatch, reach in, grab one, and hand it to the patient? It is not much. That is what you are competing with. If that is the system they are using, it has to be approached from that way to say, “Can I open up PT Wired, hit wrist, and hit send.”

In the same amount of time, the patient has an engaging app with videos, reminders, gamification, appointment scheduling, and bill pay that in the same amount of time that it would’ve taken me to give them the piece of paper. We need to have the templates and the favorites to get us there. You had to have the file cabinet prepped over a lot of time. It got to be that easy and quick. You have to have the therapist buying for it to be a successful implementation.

The same question for RTM, for those who haven’t used it, maybe they are already using PT Wired at this point, but implementing RTM, what have you found that clinics are doing to make that a successful implementation?

There are a couple of different approaches to RTM. What we have seen some groups do is they have a dedicated RTM provider. It might be one PT or PTA who is the RTM provider. Let’s take an example here. Let’s say it is a two-location practice, eight PTs, and you have one PT who is the RTM PT for that practice. That PT will do the interactive communication needed for 98980 and 98981 for all of the patients in the clinic, even not the ones they are seeing.

The advantage to that is only one person needs to know the ins and outs of RTM. We have seen this work in some clinics, and everybody for themselves works in some clinics. This is why I mentioned earlier that one of the things we do is, on our calls, have discussions with the clinic, ask them some questions to make a recommendation based on how they do things, and also give the pros and cons of each approach.

Another thing that works well with strategy is if you have a dedicated RTM provider, you can even block out time for them to do the RTM. One creative way we have seen people do this is, let’s say you have somebody who is on maternity leave and they want to spend an extra day or two at home after they come back, but they still want to get hours in. They can do RTM and be the dedicated RTM provider. We have seen that implemented a lot.

Another thing is everybody has cancellations. In the past, cancellations have been lost revenue. You have an hour block that you are going to be billing codes, and now you are not. What a lot of people are doing with us is they are using that as an opportunity to do RTM. If you have a cancellation, you can do 30 to 40 minutes of RTM during that hour slot. That could be for your patients and other patients in practice for a provider who doesn’t have any cancellations this week. That way, everybody can hit the RTM requirements.

It is important how you position it to the patient. What we found is that you want to position the app as a monitoring tool versus an instructional tool. I mentioned that some of the codes are billed based on the patient’s level of engagement. If the patient engages more, you hit the requirements more and build a code more. What we found is if you position it as purely an instructional tool, we have videos for the exercises. Patients might need to watch the videos for the first 3 to 4 days. If they have the same HEP, they might not need to on the fifth day because they now have learned the exercise.

If they view it as an instructional tool, they might not open the app and mark it as complete. If they view it as a monitoring tool, they know that somebody is checking in on them and looking at how they are engaging. They will still take that extra step, which is what we need to build RTM. Another thing we will chat about on our implementation and onboarding calls is small things you can do, from how you position the app with different languages that you can use to get the best outcomes with RTM.

Being a PT owner in a place where there was definite seasonality, you can see where, during the slower seasons, pushing RTM instead of sending people home early. It maybe makes a few calls for us. You said PTs or PTAs could do it. With Medicare making the 15% cuts to PTAs, does that take place with RTM? If a PTA made the calls, do you know if they would decrease the reimbursement rate if a PTA did it versus a PT?

Yes, it does for some codes. There are four codes for RTM. 98977 is the data transmission code for the 30-day billing period. That is not subject to the de minimis standard, that reduction. The other codes are if more than 10% is completed by the PTA.

I’m thinking about that from a PT owner mindset. I love the idea of having a single provider making some of those calls. They become specialists. They could also be the person that heads out and trains the other people on RTM stuff, even though they are doing it most of the time because you always want to have some backup. I like the idea of having someone lead the program. Do you have someone like that? Do you recommend someone like that simply for going to the digital HEP? Maybe there is a provider that is not the owner but the lead person to get this pushed and implemented into the programs. Have you seen success with that?

It is mainly at bigger organizations like five-plus location clinics. The bigger you get, the more we find it helpful to have an internal champion. We have also found out that as the clinics get big, there gets to a point where a subgroup of providers will ask a question to somebody internally, but they wouldn’t send it to us. It is helpful to have an internal expert who works more with us and gets up to speed, whether it is on RTM or general patient engagement and HEP to help make sure that that clinic is working well.

The bigger your company gets, the more it's helpful to have an internal champion.
Click To Tweet

I can see that as being an opportunity for the PT owner. This is conjecture, but if it wasn’t the clinic director that is going to champion the digital HEP or RTM program, maybe there is someone else within the group that wants to take on some leadership role in the future in a clinic. This could be an easy way for them to develop, show leadership skills, and put them on the path to leadership training. If they were to head this up, become the specialist, make sure everyone does it, follow the dashboard, and keep the KPIs, it could be a great opportunity for them.

We talked about hiring that one person. For some clinics, if they are big enough, they can be a full-time thing. We have had that happen. We have multiple clinics that we work with where they have a single dedicated RTM provider for everybody who is full-time RTM. We have the full-service model, where on our end, PT Wired, we employ providers. They can help the clinics fulfill those requirements.

Something we always chat about on a call is what RTM approach will make the most sense. If it is a group with a higher cancellation rate or they brought on a new PT and are not fully booked out on their schedule, that makes more sense to manage it themselves. Whereas if it is a group that is fully slammed in five locations and has a waitlist, you might want to hire a full-time dedicated RTM provider to take advantage of all the revenue for all the patients that are already coming in. There is a lot to it.

If people have more questions, how can they get in touch with you and ask you about digital HEPs and RTMs and how they can work with their clinics?

You could go to our website, PTWired.com. We have a lot of information on RTM generally there. If you want to book a time to chat with us, you can. Whether you decide to implement with us or have another system you want to implement, we are happy to be a resource in making strategic recommendations or answering questions on RTM. That is where you can find more information and go from there.

It has been several years. We need to follow up again in a couple of years and see what is happening with PT Wired.

Hopefully, we will have a coffee at PPS in 2023.

Thanks for coming back and joining me again, Vikram. I appreciate it.

Thanks, Nathan.

Love the show?  Subscribe, rate, review, and share!  https://ptoclub.com/

The post Using This Can Boost Revenues, Increase Patient Engagement, Improve Collections, & Implement RTM With Vikram Sethuraman Of PT Wired appeared first on Physical Therapy Owners Club.