Beyond the Visit: Patient Engagement & RTM

LifeLine Partners started small. One physical therapist evaluated patients and built their plans of care, while Justin, a PTA, monitored and managed those patients in EverEx. The team began in one of its four offices and enrolled patients one at a time. Once both clinicians were comfortable and had a working system, the practice expanded office by office, visiting each clinic to teach the onboarding procedure while Justin continued to manage monitoring centrally. Justin estimates it took four to six months before every clinic was signing patients up. The practice later added its occupational therapists, beginning with women's health patients.

Justin describes the first few months as the hardest stretch, comparable to moving from paper charts to an EMR, before the new process became second nature for staff. Early on, some providers forgot to enroll patients during busy clinic days. Some patients, often because of their demographics or lack of a smartphone, were not going to use an app, and Justin learned not to get hung up on them. Billing also had early hiccups, such as learning the timing rules different payers apply between billing periods.

Instead of a paper home exercise program the care team cannot see, patients follow their exercises in the app while a clinician monitors activity and messages them directly. Justin uses that channel to check in after an evaluation, answer practical questions between visits, follow up when a patient has missed appointments, and add or adjust exercises as patients progress so the next in-clinic visit builds on what happened at home. Some patients also stayed on the platform after discharge, which kept the line of communication open.

Justin sets aside about an hour to an hour and a half at the start of his day. He answers unread patient messages, reviews requests clinicians have sent by email, text, or phone, and spends a few minutes with each patient to see whether anything needs adjusting. The team updates plans of care in EverEx, often weekly. Because monitoring time accrues across the month, he can shift the work later in the day when his schedule changes. For other practices, Justin suggests giving an in-house PTA or COTA who understands documentation and billing protected time for RTM, such as time freed up by cancellations.

LifeLine found that the most reliable approach is for clinicians to walk patients through app setup while they are still in the clinic. Patients leave with the app working, can start their exercises the same day, and hear from Justin right away. For pediatric patients, having a parent present helps with sign-up. The practice also added a yes or no RTM enrollment question to its evaluation intake paperwork, with a reason recorded for each no, so the team can spot patterns it can address internally. Enrolling patients at the start of care, rather than near discharge, lets the team monitor the home program across the whole plan of care.

Justin bills RTM once a month, usually on the second, third, or fourth, which keeps billing on a predictable cycle. EverEx stores the month's patient communication, exercise activity, and symptom information, which he pulls into the daily note in the practice's EMR, and a monthly report shows which codes are billable for each patient. Because Justin is a PTA, he gives the treating physical therapists notice before billing day so they can set aside time to review and co-sign those notes. When he started, he followed a documentation template shared by the EverEx team.