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Embracing Telehealth Changes to Deliver the Otago Exercise Program for Fall Prevention by Lee Karlsson, PT, DPT, MScPH; Daniel Barry, SPT; Astrida Griswold, SPT; Carolyn Snell, SPT; Sadie Thompson, SPT; and Nancy Gell, PT, PhD, MPH The year 2020 brought many telehealth policy changes at the national, state, and payer level spurred by the COVID-19 pandemic. These policy changes present an opportunity to more flexibly implement clinical fall prevention programs, including the Otago Exercise Program (OEP), through telehealth. The OEP is a personalized balance and strength fall prevention program that is delivered by a physical therapist (PT) over 52 weeks.1 Originally developed by researchers at the University of Otago in New Zealand, the OEP has since been modified and adapted by the National Centers for Injury Prevention and Control (NCPIC) for use in the United States. Certification is available online for U.S. clinicians through the Center for Aging and Health and the University of North Carolina School of Medicine.2 The program is effective to reduce falls and fall-related injuries among individuals at high risk, particularly adults over 80 years of age and those who have fallen within the past year. The OEP has been shown to reduce falls by 35% in these populations.1 The program is typically delivered through a combination of in-person and telephone visits with the initial evaluation, first few visits, and re-evaluations occurring in the patient’s home and subsequent follow-ups taking place by phone. Home and phone visits, as originally designed, can be a potential barrier to implementation under traditional clinic-based fee-for-service models of outpatient physical therapy care. Many national and state emergency orders, originating or retroactive to March 2020, enable PTs to provide services via a telehealth platform. In particular, the Coronavirus Aid, Relief, and Economic Security Act (CARES Act)3 and Centers for Medicare and Medicaid Services (CMS) waivers4 allowed for the use of telehealth including video and audio with some exceptions for telephone. Such mixed care delivery methods increased the flexibility for OEP program implementations when many other insurance payors adopted the waivers. Current Procedural Terminology (CPT) codes eligible to be billed via telehealth include: Evaluations of Low, Moderate, or High Complexity (97161- 97163), Re-Evaluations (97164), Therapeutic Exercise (97110), Neuromuscular Re-Education (97112), Gait (97116), Therapeutic Activities (97530), and Self Care (97535). Additionally, many payers allow for the use of telephone evaluation and management services (G2061, G2062, G2063). Medicare also allows Self Care (97535) to be delivered via telephone
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call. Patients may be located in any geographic area, not just those designated as rural, in any health care facility, or in their home. These policy and telehealth changes allowed changes in delivery of health promotion learning experiences for DPT students at the University of Vermont as well. The pandemic forced a format shift from traditional in-person student-paired community experiences with practicing clinicians to online projects that could reach beyond local community. Led by community partner Lee Karlsson, PT, DPT, MScPH and faculty Nancy Gell, PT, PhD, MPH, students sought to create a resource that could provide guidance on how to continue the OEP through telehealth, allowing older adults in need of fall prevention to continue rehabilitation even if they were quarantined in their homes. While some guidance had been offered,5,6 no comprehensive resource existed for how to navigate the quickly changing realm of telehealth. To address this need, students compiled resources gathered by their community partner to provide an all-in-one package for delivering the OEP via telehealth. This OEP telehealth resource includes 2 documents: one for clinicians delivering the program and the other for patients receiving it. Prior to document assembly, students interviewed practicing clinicians to determine needs, concerns, and fears about leading a fall prevention program online. These findings informed the clinician resource which begins with a brief introduction for a telehealth format of the OEP. Guidance on completing evaluations, reevaluations, and follow-up visits, including billing codes approved for use with telehealth during each stage of the program is outlined. The clinician resource includes an updated Visit Chart which includes meeting types and references billing information options for telehealth. An appendix includes online resources for exercise demonstrations, exercise calendars, and useful links to guide patients. The participant resource is designed as a guide for patients who are unfamiliar with the Otago Exercise Program and/or the use of telehealth services. Similar to the clinician resource, the participant version was informed by findings from interviews between the students and older adults at risk for falls. The guide contains an introduction to the OEP and numerous program resources, including hyperlinks to a comprehensive exercise booklet with pictures and written descriptions of each exercise,
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