Should clinics temporarily close or should outpatient physical therapy be halted? What treatments should not be postponed? How can clinics determine the risks for patients and their staff? How can patients be served if clinics are closed?
At the local level with “shelter-in-place” rules, physical therapy providers may be among the exceptions for health care services. The CDChasn’t released guidelines for physical therapists, but the Centers for Medicare and Medicaid Serviceshas urged that all “non-essential” health care services be postponed.
What does that mean for most physical therapists today? The American Physical Therapy Association (APTA) urgesthat PTs and PTAs “flatten the curve of the outbreak … by minimizing exposure in the clinic”, evaluating “when the risk of exposure to COVID-19 outweighs the benefits of immediate treatment, and “rescheduling non-urgent care.”
However, other APTA members have suggested the need to go further by shutting down outpatient clinics entirely. Some physical therapist clinics around the country have closed their practices and now facing the economic losses as other businesses.
For clinics that choose to continue to work, proper screenings of staff, patients, and anyone accompanying patients is the first critical step, followed of course, by working under safe protocols. In California, which has aggressively managed the coronavirus outbreak, the California Physical Therapy Association has stressed the importance putting patients before concerns about “how you will be paid”. The state has actively encouraged Teleheath, or e-Visits, as a substitute for visiting clinics. However, insurance coverage varies between insurance companies and federal programs.
In New York City under the Governor’s PAUSE order, most physical therapy clinics and programs are closed. For many of those clinics and their patients, Telehealth service has quickly emerged as the way to continue exercise and recovery work in real time with a PT or PTA. Recognizing the need for e-Visits, the CMS, for the first time will allow PTs to bill Medicare for online assessments and therapy management services. However, there is currently a limited seven-day period for treatment and beyond that, the patient may be able to pay for continued service.
Because physical therapy services range from sports rehab to post-surgical therapy, the decision to continue treatment begins with the PTs and PTAs. But it also requires patients to make decisions about the risk of receiving treatment now or waiting until the it’s considered safe to visit their clinics again.