By Dr. Michael P. Ast
Hospital for Special Surgery
Medicare pays for about 8 million surgeries each year, from joint replacements and spinal fusions to open-heart bypasses. To ensure that seniors get the best follow-up care possible — and thus avoid expensive complications — Medicare officials are about to roll out a new payment model.
In essence, the reform puts hospitals on the hook for medical expenses patients incur within 30 days after they are discharged. This will give hospitals skin in the game, incentivizing them to not only perform the surgeries well but also provide patients with all the wound care, pain management and physical therapy needed to ensure a healthy recovery.
But in practice, this proposal will only succeed if Congress intervenes and gives hospitals permission to continue using one of their most effective tools — virtual physical therapy.
Medicare coverage for telehealth physical therapy — or tele-PT — is currently set to expire at the end of September. Unless Congress extends this coverage, hospitals like mine will soon find it much harder to give patients the top-notch post-surgical care they deserve.
Until relatively recently, physical therapy was something that happened almost exclusively in person. That all changed in 2020, when the COVID-19 pandemic led to a wave of telehealth adoption, including a greater use of tele-PT.
But what largely started as a COVID-era workaround soon proved a highly effective post-surgical intervention.
I’ve seen this first-hand with my patients.
An analysis by the Hospital for Special Surgery, where I practice, found that surgical patients treated through a program known as HSS@Home — which incorporates tele-PT — reported higher satisfaction scores than those treated through a leading home health agency that uses traditional in-person physical therapy. These patients also required fewer hospital re-admissions, fewer emergency room visits and experienced fewer complications.
Plus post-surgical costs were substantially lower for HSS@Home patients than for their counterparts in a traditional home health arrangement.
That might sound counterintuitive, but it makes sense.
Modern digital technology allows physical therapists to provide the same coaching, with the same level of precision, to patients at home as in a traditional office.
But hospitals can’t offer tele-PT if Medicare won’t cover it. Patients, hospitals and taxpayers will all suffer if coverage expires in September.
In the 2026 physician payment rule, Medicare officials are proposing to transition codes with temporary status on the Medicare telehealth list to permanent status. This is the right thing to do.
But ultimately, only Congress can permanently allow providers to bill Medicare for telehealth services. The bipartisan CONNECT for Health Act, which is currently under consideration in the Senate, would make coverage for many telehealth services permanent.
As CMS further develops post-surgical payment models, it must also urge Congress to recognize the true value of tele-PT. It’s not a temporary fix reserved for pandemics, but a major technological advance in how we rehabilitate patients following surgery.
Without permanent coverage for tele-PT, Medicare officials’ best efforts to support discharged patients are destined to fall short.
Michael P. Ast, MD, is Chief of the Knee Service, Chief Medical Innovation Officer, and Director of Ambulatory Surgery Center Strategy at Hospital for Special Surgery. This piece originally ran in The Well News.