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  • Coronavirus Update: March 19, 2020

    AHCA and NCAL release guidelines for PTs, OTs, and SLPs in long-term care facilities; Aetna expands telehealth and e-visit coverage; APTA to host e-visit Facebook Live event, and more.

    Practice Guidance

    March 19: Guidelines Issued on the Role of PTs, OTs, and SLPs in Long-Term Care Facilities During Pandemic
    The American Health Care Association and the National Center for Assisted Living released a joint document focused on changes to physical therapy, occupational therapy, and speech-language pathology to reduce the spread of COVID-19. Recommended changes to be considered by LTC facilities include discontinuation of group and concurrent therapy, delivery of therapy in resident rooms rather than therapy gyms, and the use of social distancing "as practicable." AHCA and NCAL also advise against therapists moving between buildings if COVID-19 is discovered in one building.

    The statement is part of a broad coronavirus education effort for LTC facilities created by AHCA that's centered on an extensive and frequently updated webpage containing more detailed AHCA recommendations as well as links to resources from CMS, the CDC, and other organizations.

    March 19: Aetna Expands Telehealth and Remote Visit Coverage, Allows PTs to Bill for E-Visits
    Major commercial insurer Aetna announced that it would require no co-pay on telemedicine visits for any reason for 90 days—and would allow PTs to bill for e-visits consistent with the recent e-visit waiver policy announced by CMS. Collaborative efforts between APTA and Aetna led to the change and inclusion of PTs. All Aetna policy changes are retroactive to March 9.

    The Aetna e-visit approach is slightly different expanded from the CMS system, in that it allows PTs to bill for either codes associated with evaluation and management (98970, 98971, 98972) or as well as for assessment and management (G2061, G062, and G2063). CMS only allows PTs to bill for the G codes. Providers should check with Aetna's provider page for updates and changes.

    March 19: E-Visit Facebook Live Event to be Held March 20 at 2 pm
    Join APTA regulatory affairs experts on Friday, March 20 at 2 pm ET, for a Facebook Live townhall and Q&A session on the e-visit waivers for PTs recently announced by CMS. The event is open to members and nonmembers, but seats are limited. The Facebook Live event will repeat information shared in an APTA webinar set for March 19 at 8 p.m. ET. Recordings of both events will be available afterwards.

    March 18: WHO Begins Massive Open Online COVID Courses
    The World Health Organization has developed OpenWHO Massive Online Open Courses for COVID-19 to provide real-time training for health professionals, decision-makers and the public. The courses will be offered in several languages.

    From CMS

    March 18: CMS Publishes Revised Guidance on Fee-for-Service Response That Includes E-Visit Waiver Information
    CMS has revised its recent MLN Matters publication on its blanket waivers (1135 waivers) of various requirements to include more information on telehealth-related changes—and specifically for the physical therapy profession, waivers that would allow PTs to conduct digital communications with patients by way of "e-visits." Revised and additional language is indicated in red.

    March 17: CMS Says That Elective and Non-Essential Surgeries Should be Delayed
    The agency issued a statement pressing for facilities to carefully evaluate risk factors for the spread of COVID-19, and postpone—or consider postponing—a number of different types of surgeries. Carpal tunnel release, colonoscopy, cataract, and endoscopies are among the procedures CMS believes should be postponed; hip and knee replacements, elective spine surgeries, and procedures related to low-risk cancers are listed as surgeries that hospitals should "consider postponing."

    From the CDC

    March 15: CDC Offers "Get Your Practice Ready" Resources
    The Centers for Disease Control and Prevention's COVID-19 offerings now include a set of printable resources designed to be posted at clinics and other facilities to help providers and patients understand the symptoms of COVID-19, the steps that should be taken to minimize the risk of spreading the virus, and ways to manage respiratory symptoms at home. The materials include a sign providers can post outdoors.

    In The Media

    March 19: Scientists Say "Flattening the Curve" is Possible, but the Fight May Continue for Months
    Health researchers point out that reducing the rate of coronavirus infection will help steer the world away from a calamitous "peak," but doing so will mean that duration of the outbreak will be longer.

    March 18: White House Invokes Defense Production Act
    President Trump has invoked the World War II-era act to ramp up production of much-needed medical equipment such as N95 masks and ventilators.

    Visit APTA's Coronavirus webpage for more information and updates.


    • I work in the Home Health setting. I am concerned as leadership has said we may have to see patients who have had COVID-19. We have no assist he surfaces in the homes have been properly cleaned. We have no assistances that caregivers have not been infected. This leads to the potential of infecting other patients. Does the APTA have a position on this issue?

      Posted by Marilyn McClain on 3/19/2020 7:23 PM

    • Is there any guidance regarding outpatient pt clinics and whether or not they are considered "essential"? There is likely to be a shelter-in-place order for my area and I would like to know whether the outpatient clinic should stay open or not. Thank you.

      Posted by Anne on 3/19/2020 7:50 PM

    • After days of your peers clamoring for guidance and responsible recommendations especially for the outpatient setting, this is what we get??!! So disappointed...I'm sure we'll get shut down by state or local authorities sooner rather than later, but not before we get to make the problem worse, with the best intentions. Our care is important, it is NOT essential, we're dangerously arrogant thinking otherwise.

      Posted by David on 3/19/2020 10:53 PM

    • The only lever that can be acted upon is the spread. Courage, friends. Stay at Home, CLEAN and DISINFECT everything that comes INTO your HOME. The next rare commodity will be the Household Cleaners : https://amzn.to/2U5w4WH

      Posted by Kimm Byon on 3/20/2020 12:31 AM

    • PLEASE, PLEASE, PLEASE APTA ... put out a statement regarding essential vs non-essential as it pertains to outpatient rehabilitation in a hospital setting. We all need the guidance and the written word to back us. Thank you!!!

      Posted by Carolyn Winuk on 3/20/2020 7:57 AM

    • PLEASE advise that outpatient clinics be closed! Our therapists and their patients are being put at risk!!

      Posted by Jamie on 3/20/2020 9:43 AM

    • KY Governor has shut down all out patient clinics, 3/20/20. Great, have a total knee done on Monday and then no out patient Physical Therapy

      Posted by Terry Randall -> @MXZ? on 3/20/2020 11:57 AM

    • Where can one see the responses to the above posts on guidance of staying open vs. closing an outpatient PT facility. We are one on one and it my patient's eyes - we are an essential service.

      Posted by Dr Miri Ingwer-Jarecki on 3/20/2020 12:54 PM

    • I really can’t believe PT offices are not shutting down. There is no possible way we can abide by the guidelines being set out to us by the government and other organizations working on this crisis. The PT’S have to touch patients all day to provide manual labor and other various modalities. I as an aide have tried hard to follow the guidelines of social distancing but as I already mentioned it is very difficult to follow these guidelines in the work setting we are in. I think it is hugely irresponsible to stay open, there’s a lot of cancellations every day but still people continue to come in and especially the elderly, who we all as a society are trying to protect in this time of crisis. I truly believe that it is our responsibility to close PT clinics in order to lessen the spread of the virus and help protect our patients as well as our staff because unless we do so people will continue to come in and the situation will just proceed to be more and more risky. The only people that PT should be considered essential for are post op patients. For these patients I understand the necessity of having access to physical therapy, but at the same time we live in a world where there are so many solutions to our problems. PT’S can have electronic consultations with these patients and home exercise programs can be administered via email. As for patients with less serious cases, they can continue with their HEP’S at home as well as connect with their Therapists through email and or video calls. I truly believe this is an issue that needs to be addressed, and the sooner that it is the sooner we can join our neighbors and peers in participating in social distancing and staying at home and we can all unite in fighting against the spread of this virus. We as healthcare providers are responsible for our patients’ well being, and generally speaking it is our duty to help society as a whole get through this crisis because we are all in this together, and it is truly and greatly irresponsible that these facilities remain open knowing the high risk of the situation and then all the employees as well as patients go home to their loved ones who they can potentially be infecting without knowing. ALL OUTPATIENT FACILITIES SHOULD SHUT DOWN IMMEDIATELY, IT IS HIGHLY IRRESPONSIBLE TO REMAIN OPEN AND ALLOW THIS RISK TO PERSIST OR PERHAPS EVEN GROW.

      Posted by Stanley on 3/20/2020 2:24 PM

    • While APTA has been a valuable resource to PT profession in many ways - having COVID info that is only accessible to members, lack of clear direction, lack of guidelines, no videos, nothing, has been very disturbing and the leadership has been almost non existent in my mind.

      Posted by Konrad Siemek on 3/20/2020 3:56 PM

    • This is not about physical therapy at this point. This is a matter of life and death. What value are we putting on peoples lives now

      Posted by Ben Chong on 3/20/2020 4:29 PM

    • There are essential and nonessential PT services, which makes it difficult to mandate a conclusive decision! Encourage nonessential outpatient clinics to shut! This is irresponsible! We cannot provide service 6 ft away! Everyone is at risk with negligible reward!

      Posted by Kaitlin on 3/20/2020 4:47 PM

    • Home health physical therapists are putting the patients, themselves, and all families involved that they are in contact with at risk. This is not a life saving healthcare service. We should be mandated to cease operation to avoid the spread of this virus! Stop home health care physical therapy until this is over!

      Posted by Amanda on 3/20/2020 6:36 PM

    • APTA, please strongly suggest/mandate outpatient facilities close in this time. It is understandable to say we are essential but also to say the opposite. Post op PT is extremely crucial in returning to a prior level of function. However, most health insurances do not afford patients the opportunity to attend PT sessions 5 out of 5 days thus still making CONSISTENT home exercise performance crucial to recovery. We are a nation and a world full of capable professionals that will be able to solve, what has been deemed, a national emergency such as COVID 19. Please strongly consider the suggestions brought out by me and my peers as we can beat this and make the return the normalcy faster than what is vaguely projected.

      Posted by Joe on 3/20/2020 11:01 PM

    • No one is talking about the huge loss of income this is causing for us. If it lasts over 2 months I will have to file bankruptcy.

      Posted by Phillip Bass on 3/21/2020 8:16 AM

    • People who have post operative cases are essential. They need direction for their care. If we are going to close we need MUCH BETTER telehealth options in ALL states. We want to help our patients be safe from the virus and return to their health and function. Push for better telehealth if we can’t see our patients who need us and deserve to be functional.

      Posted by Meaghan on 3/21/2020 8:52 AM

    • I have been a PT working for 37 years. Currently I work in home health care. There is absolutely no reason for me or any other therapist to be going into someone's home. I am risking my health, the health of the patient and family members. Often family members are in and out of the home, going back and forth to work and their families. There is no containing the spread here. The APTA must make a statement regarding PT services. No one is having elective surgeries now. There is no need for most PT services to continue right now. Make a decision!

      Posted by LeeAnn on 3/21/2020 8:21 PM

    • People do not die from missing physical therapy. They do, however, die from COVID19. As much as this is financially devastating for my family, its better then the loss of life. Rehab unit and Nursing home residents and staff are particularly "sitting ducks", waiting for just one staff member to bring in the virus. Staff are not allowed to wear N95 masks yet spend up to an hour and a half touching patients, who are hacking on them. Is it COPD or COVID19? This is the time for the APTA to actually stand up for physical therapist. Enough with the passiveness. Its time to put the wallets aside a and help save all lives. Act now!!

      Posted by PT on 3/22/2020 1:00 PM

    • With regard to outpatient physical therapy we continue to see calls for "sanitizing surfaces" and proper use of gloves. I find great difficulty in understanding how it is possible that so many fail to understand what an -airborne- virus is. Working one on one with patients in a manual therapy capacity places clinicians directly within range of a virus that can be transmitted up to two weeks before an individual even shows symptoms. This is like clicking a zippo next to a gas can and claiming "well, it hasn't ignited yet". By the time a potentially infected patient coughs or sneezes, there is nothing that can be done. Further, should that clinician contract the virus, how many patients will they inadvertently pass it on to before they show symptoms sufficient to warrant staying home themselves. There will indeed be fiscal consequences from a shut down of outpatient services across the board, though I take issue with the notion that any of my fellow clinicians would put the bottom line over someone's life. Our patients, for the most part, have devices that can receive links to a patient specific HEP to be implemented until normal office visits may resume. While this is less than ideal, and certainly does not replace the often essential manual therapy some patients may require, a contracture (in most cases) is a significantly less complex issue to resolve than death. While some may consider these statements a bit dramatic, I would argue that view does not take into consideration the insidious nature of this disease. I hope each of you continue to keep yourselves, your families, and your patients safe.

      Posted by PTA on 3/23/2020 3:34 AM

    • I was fired from a nursing home for self quarantining my self when my Supervisor was possibly exposed to the virus . He was told to quarantine for two weeks he returned after 5 days then had to quarantine again when he became symptomatic. what rights do I have in this situation?

      Posted by Wendy Anderson on 4/3/2020 4:28 PM

    • How long will PT, OT , ST do home visits WITHOUT MASKS! Spitting sll over pediatric patients who can't speak for themselves! Dallas texas therapists performing visits during this time STILL come from HOUSE to HOUSE and do not use a mask ! They speak up close and LOUDLY to the patients because thry are babies..yes Playing and talking to them us important ...but WEAR A MASK! TOTAL DISREGARD. for patient safety! I hope EACH COMPANY WILL ADDRESS THIS!

      Posted by Delorisp24@gmail.com on 4/15/2020 12:48 PM

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