Getting a physical therapist to visit a recovering patient's home can be tough. Ditto for getting the patient to a clinic or office. So, as is the trend these days, Dr. Joe Smith and his team are going digital with a virtual physical therapy platform for patients at home as they prepare for and recover from surgery.
"The platform serves as a link to clinicians," said Smith, CEO of the San Diego-based company that makes the platform. "They get an unprecedented amount of transparency into the post-acute care process."
The platform, called VERA—Virtual Exercise Rehabilitation Assistant—uses Kinect, a motion-sensor technology developed by Microsoft. Physical therapists and physicians can track patients' progress in their physical therapy exercises thanks to a 3D camera. Patients, meanwhile, interact with an avatar on a touchscreen and have virtual visits with real therapists.
"There's no rocket science in this," Smith said.
One goal is to increase compliance with physical therapy. Others are to reduce costs and to extend clinicians' reach beyond their offices. "They can use the technology as people extenders," Smith said.
For Smith and his partner, that technology is provided by Reflexion Health.
The company, which is now owned by Digital Health Corp. and has 55 employees, received clearance for VERA from the Food and Drug Administration in 2015.
In a study of VERA conducted by Cleveland Clinic researchers, patients' adherence rate to at-home therapy was almost 80%, compared with rates between 35% and 70% for traditional therapy.
Clinicians can be dubious at first because the system is so different from the norm. That was the case with Greensboro (N.C.) Orthopaedics when the provider group participated in a research study looking at virtual physical therapy compared with standard treatment for people with knee replacements. But they were convinced when the results rolled in, showing, for Greensboro Orthopaedics specifically, increased patient satisfaction and better or equivalent outcomes with virtual physical therapy.
Now, the health system is using virtual physical therapy for some Medicare bundled-payment patients.
"I was skeptical going in, thinking patient compliance would be an issue and that not having hands-on therapy, they would not progress as quickly," said Dr. Frank Aluisio, an orthopedic surgeon at Greensboro whose patients use the platform. But compliance has been "phenomenal," he said. "The patients said they felt accountable because they knew someone was watching, and that made them do the exercises more."
Right now, Reflexion's customers include only providers; the company is in talks with self-insured employers and payers.
"Once the data is out there, this technology is going to explode, because it works well and it's way more convenient for the patients," Aluisio said. "It's going to be more cost effective and something that the patients are going to enjoy doing."
But until reimbursement is worked out, there's going to be "friction" in adoption, said John Gardner, a partner with NGP Capital. That's despite the fact that telemedicine has been shown to be effective, he said. "Across the board, it's been demonstrated over and over again that when you can do things on a remote basis, it increases compliance due to the fact that when people have to go to the office, they don't show up."
Compliance is especially important in rehab, he added. "Because compliance with rehab has such a big impact on success, being able to do some parts remotely would be attractive."
It's attractive to patients, too, Smith said. "Patients love it," he said. "I'm not sure whether they love it because it's cool technology or because it's a cute avatar or because it saves them time."