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  • Coronavirus Update: March 20, 2020

    APTA's President issues a statement, updated e-visit Q&A and webinar recording available, telehealth grassroots advocacy, and more.

    Practice Guidance

    March 20: Letter From President Dunn on COVID-19 Impact
    APTA President Sharon Dunn, PT, PhD, released a statement on the coronavirus pandemic that calls on the physical therapy profession to rely on its unique ability to help society through a troubling period.

    March 20: E-Visit Q and A Resource Updated and Expanded; Recording and Slides Available
    Many questions from PTs and PTAs have arisen since the CMS announcement of waivers that would allow for limited digital communication by PTs. APTA regulatory affairs staff continue to expand and update the relevant questions and answers. In addition, APTA offers a recording of a March 19 webinar on the e-visit waiver, as well as the slide deck from the presentation.

    March 20: Members Send More than 53,000 Communications to Congress Over Telehealth (and Growing)
    A grassroots campaign to urge members of Congress to waive restrictions on the use of telehealth for physical therapy services has sparked more than 50,000 communications in less than week—one of the most impressive APTA advocacy efforts to date. A second grassroots campaign focused on congressional action to provide additional relief to physical therapists has generated more than 2,000 emails. Both initiatives continue to gain momentum.

    March 20: APTA Offers More Template Letters to Advocate for Telehealth to Payers, State Officials
    APTA has developed two template letters to use in advocating to states — your governor, state representatives, and Medicaid office director — for coverage by private payers and Medicaid of telehealth furnished by PTs and PTAs to ensure that patients continue to have access to the rehabilitative care they need amid the COVID-19 pandemic. One letter is for individual PTs and PTAs; the other letter is for state chapters. Instructions are included at the top of each letter. Also available: a template letter on telehealth designed to be sent to payers.

    March 18: TRICARE Expands Telemedicine Benefit
    A new announcement from TRICARE Humana Military states: "If a beneficiary meets all other criteria for a covered service for speech therapy and for continuation of PT/OT, (but not initiation of PT/OT), it is covered using telemedicine, using any coding modifiers as you would for a TRICARE network provider office visit."

    From OSHA

    March 19: OSHA Releases Guidance on Preparing Workplaces for COVID-19
    A recently released guide from OSHA covers topics including steps employers can take to reduce exposure, how to classify worker exposure to SARS-C0V-2, and contact information for OSHA regional offices.

    From the CDC

    March 16: NIOSH Publishes Guidelines on Proper N95 Respirator Use
    The Centers for Disease Control and Prevention's National Institute for Occupational Safety and Health has released an illustrated guide to safe use of the N95 respirator. Topics include filtration, fit, and proper use, as well as situational strategies to achieve the best fit during serious outbreak conditions.

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

    Comments

    • How selfish of us physical therapists to think of our reputation in the medical world over the wellbeing of our patients. I’ve never been more ashamed to be a physical therapist. We have an ethical responsibility. Does anyone remember that?

      Posted by Kaitlin on 3/20/2020 6:16 PM

    • Will you be providing masks and gowns as protection to outpatient clinics? This will take down our industry.

      Posted by Kaitlin on 3/20/2020 6:24 PM

    • Kudos again APTA for again for not helping out your fellow physical therapy professionals in a time of crisis and leaving us exposed. What essential function are we currently providing that is a matter of life or death?? I will tell you that answer to that is unequivocally none. However, we are putting our lives and possibly the lives of our patients in jeopardy by keeping our doors open. I have patients coming in because the "gym is closed" or they are "bored stuck at home" or "I am in the population that is least likely to get Covid" and finally "Covid is a hoax". These are the patients that are currently coming to outpatient PT when we're on a lockdown! The only necessity would be post surgical emergency care, and that should only be done in a controlled one on one environment. All other care is not necessary and should be deemed so by our profession organization. To not do so is an epic failure and a travesty that will have serious repercussions. Even the orthopedic office are closed out of an abundance of caution for their employees! Way to have our back APTA.

      Posted by Steven on 3/20/2020 10:47 PM

    • Really APTA? Again with the gray area context "rely on the professional judgment of physical therapists — because care decisions should be based on a specific person's needs and a risk/benefit analysis for the individual, not simply by the setting in which the care is provided. The COVID-19 outbreak changes the factors we must consider in our professional evaluation, but it does not change our basic responsibility to do what is best for our patients." We are not providing a life saving service here. The "risk" is clear, potentially contract or spread Covid19. How can we possibly social or physically distance ourselves? I don't know of any physical therapy's in the Outpatient setting that currently have PPE. Why can you not support us with a concrete decision to CLOSE OUTPATIENT PHYSICAL THERAPY AND LIMIT TREATMENT TO EMERGENCY ONLY? I am saddened by your callous attitude, your decisions are putting not only patients but also healthcare workers in harms way and for what? So we can say we are essential? Human life is what is important, both that of our patients and our own. This is an opportunity to rise up and lead us in a time of crisis and you are not. It is simple, only emergent care is necessary at this time. PERIOD! This is what orthopedic doctors are doing, and they are our referral sources.

      Posted by Ally on 3/21/2020 10:30 AM

    • Wow, I am amazed to hear that some folks think physical therapy is not an essential service. It makes me grateful for a career in acute care. Did you know that physical therapist services in the intensive care unit reduces the average length of ICU stay by 1.5 days? Given the anticipated burden on ICUs, improving the rate of turnover will save lives. I am glad APTA appreciates that physical therapists are essential.

      Posted by James Smith -> @LS\ on 3/21/2020 5:44 PM

    • No one is saying PT in the acute care/ICU settings is not essential. Outpatient PT seems non urgent during this crisis.

      Posted by Amy Powell on 3/22/2020 1:15 PM

    • APTA please help us. Define essential PT? Outpatient PT is not essential during a pandemic. Allowing us to be open and see patients is putting us and our patients in grave danger. We took an oath to do no harm yet this is clearly a serious hazard to all. Acute care/ICU care is understandable for emergencies in a controlled environment with PPE but that should be it. Please make a statement about outpatient PT. Even other medical professional think it's absurd that we are allowed to continue to see patients. This is awful and you have the power to help! We don't even have PPE and we are in close contact, this isn't right, please help us Ms Dunn.

      Posted by Kayla on 3/22/2020 11:12 PM

    • why are people not understanding context of this situation? ICU/Acute for sure is more urgent and should continue. But if surgeons aren't doing hip or knee replacements, Rotator cuff or ACL repairs, we are treating minor injuries in outpatient. Many referring doctors are even telling post op patients not to come in for PT now!! Doing your hep for 2 weeks is not life threatening like it might be for someone who had stroke to lie in bed for several days without PT. I would not say ankle sprain treatment is un necessary under normal circumstances. THESE ARE NOT NORMAL CIRCUMSTANCES!! Many outpatient centers are big corporations. Not having them told by someone in power to close and leaving it to each therapist leaves us in a bad position. Do I do what I want to protect myself and my patients and trust using PTO if doing so means I risk being called "not a team player" and being penalized or possibly even laid off for it further down the line?? Most of us can't afford to take that financial risk!! So we go in and feel completely guilt ridden and ethically conflicted. I really hope I am wrong that the risk of people coming to see us for non life threatening issues is worth than the risk of getting this virus. Otherwise it can spell lots more ethical trouble for our profession when people find out they were exposed in an OP clinic. Thank God I stopped my membership in this organization that does nothing to help actual clinicians in the field right after graduation.

      Posted by anon so i don't get penalized. on 3/23/2020 12:03 AM

    • Came here expecting to see a statement about what the APTA position statement is regarding the critical PPE shortage and acute care based PT and PTAs. Found a generic link to proper fit for an N95 mask I can't find anywhere right now anyway. Hospital administration is forbidding us from wearing a surgical mask to avoid potential transmission from asymptomatic positive PTs to our frail and comorbid patients. We WILL be charged with evaluating and treating COVID + patients and we WILL be confronted with an absence of vital PPE. We WILL fall ill and we need guidance and protections set in place now. Where is my APTA ?

      Posted by Acute CarePT on 3/23/2020 10:33 AM

    • I'm sorry for all of you outpatient PTs who feel powerless to influence the closure of your clinics. Blasting the APTA for that is not helpful, however. As noted above, acute care and home health PTs are dealing with fragile individuals for which, in the grand scheme of things, are the definition of the "gray area" you are demanding the APTA eliminate. Please use your powers of persuasion for good! Educate your individual patients on the DL, and don't continue to work for bosses who put profits over people.

      Posted by Travis on 3/23/2020 12:25 PM

    • I'm a pta in outpatient pt facility to keep us in a limbo and make us essential is ludicrous. We r not home,rehab,or acute care. Our offices are not supplying us w equipment the CDC recommends. How are we to do manual therapy if we r supposed to adhere to the CDC regulations of 6 foot distancing .it's s disgrace that greed is outweigh the ethical code to protect both clinician and patient. Disgusting!!!!!

      Posted by Clare k on 3/23/2020 4:34 PM

    • The Department of Homeland Security defines PT as essential primary care providers for musculoskeletal conditions. Why? If we can manage post-op patients, acute injuries, and those with high pain levels (>5/10) then we can keep these patients from clogging up the ER, Urgent Care, and PCP's who need to be managing patients that need their care and attention the most. This is a chance for PT's to prove their worth to the medical community. We wanted open access and autonomy - now we need to prove it. https://ppsapta.org/sl_files/BFC419ED-9B9A-A69F-DDCCAA8F5688CF5C.pdf

      Posted by Mark K on 3/24/2020 10:23 AM

    • I am a Canadian PT. I want to way in on physio in the icu and the comment above that ICU physio is essential and that it reduces patient stay by 1.5 days. I worked in the ICU 20 years ago. This is one population that I feel physio does very little to help patients. Simply getting patients out of bed can be done by anyone. Nurses are required to do ICU training courses and are specialized. I never received any training or was required to pass any test. In my time in the ICU, I was a people mover. It's true getting people out of bed decreases their stay in the ICU not passive ROM or chest physio that we know has little impact on improving respiratory health. However you don't need a physio to get people out of bed. Patients with covid 19 are incredibly ill in the ICU. The risk of infection to to physio's has to be weighed against the benefit to the patient. I believe physio's would serve a greater good to help patients recover once out ot the ICU and not in the ICU.

      Posted by Ronan on 3/24/2020 1:04 PM

    • Working in a specialty orthopedic hospital in the outpatient clinic has been very confusing and trying. As healthcare/medical professionals, the general public will see us as essential. I am not trying to down play the role of outpatient therapists, but specifically outpatient orthopedic therapy at this time is NOT essential. In non-COVID-19 times, I had patients who would go out of town or on vacation for 2 weeks or more ALL the time. They would continue their HEP, sometimes even just using a hotel or guest room (not the gym), and were able to maintain if not progress in their absence from PT. Why is a "2 Week COVID-19 Hiatus" any different? My patient population is mostly 65 and older, and many have some sort of underlying condition. Many continue to come because "you are open." As someone mentioned earlier, patients see this as "essential" IF you remain open. They feel YOU are making the decision for them, and it is a SAFE decision because YOU are the medical professional. When, in all actuality... Most of us therapists are NOT making the decision to remain open; our employer is. And, unfortunately, because of the good ol' dollar; not for the "better good" of the patients...much less the employees. With all these "lockdowns," "stay at home orders" and social distancing, patients will also be looking for an excuse to get out of the house, have some human contact, and get in a workout because their gym is closed. That is NOT what we (orthopedic) outpatient physical therapists/physical therapist assistants are for. We are suppose to make the hard decisions FOR our patients at times, and if that is to actually STAY AWAY from PT, then so be it. I feel some backing from our governing body, the APTA, would be nice. Patients with non-orthopedic diagnoses seeking outpatient physical therapy could be referred to home health therapists, or be offered tele-health? Maybe a statement stating orthopedic be limited to tele-health only, and any clinics specializing in orthopedics need to closed? Something needs to be said... Leaving the judgment up to the therapist is correct to a point, but sometimes the therapist's judgment is muffled by big corp...

      Posted by L.Y. on 3/25/2020 3:52 PM

    • Outpatient IS nonurgent. All nonemergency doc appts are canceled...we are NONemergent services. No elective surgeries are being done..TKA, Total shoulders, etc. People can do their HEP, if a therapist feels like they need to do it on their dime they can tele conference with them. For goodness sake, STAY HOME! We need you in the future.

      Posted by lala on 3/27/2020 8:04 AM

    • I concur that PT should be considered non urgent, even acute care/ICU. As Ronan stated, patients can be mobilized by nursing, further transmission by the virus by the physical therapist isn't worth the benefit of PT. The only setting i could understand PT being essential is acute rehab in which these patients have a very short window to regain mobility and independence (such as after a stroke). I work in outpatient physical therapy and I definitely feel like my employers are putting profits over the safety of staff and our patients.

      Posted by Anonymous on 4/5/2020 1:57 PM

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