• News New Blog Banner

  • Win: CMS Says SNFs, Hospitals, HHAs, Rehab Agencies, Other Institutional Settings Can Bill Telehealth Outpatient Therapy Claims

    The clarification from CMS applies to settings that use institutional claims such as UB-04.

    It's settled: Medicare Part B institutional claims for outpatient therapy services furnished through telehealth are permitted for hospitals, skilled nursing facilities, critical-access hospitals, comprehensive outpatient rehab facilities, rehabilitation agencies, and home health agencies. APTA pressed CMS for recognition of institutional settings that provide outpatient therapy for months; CMS' May 27 answer is a clear win for PTs, PTAs, and their patients.

    News of the clarification came by way of an update to CMS' lengthy Frequently Asked Questions resource on fee-for-service billing, a document with a particular focus on so-called 1135 waivers that CMS adopted in response to the COVID-19 public health emergency. Those waivers included allowances for telehealth by PTs, occupational therapists, and speech-language pathologists in certain circumstances, but details of exactly who could do what vis a vis remote care have only emerged over time.

    The specific answer to the institutional setting question appears near the end of the document (page 70 at the time of this article, but citing a specific page number isn't always helpful as CMS updates the FAQs on a regular basis).

    In CMS' own words, "Outpatient therapy services that are furnished via telehealth, and are separately paid and not included as part of a bundled institutional payment, can be reported on institutional claims with the "-95" modifier applied to the service line." The guidance goes on to say that this applies to hospitals for outpatient therapy services (bill type 12X or 13X), SNFs (bill type 22X or 23X), CAHs (bill type 85X), CORFs (bill type 75X), ORFs (rehabilitation agencies) (bill type 74X), and HHAs (bill type 34X).

    When use of the waivers were announced in mid-March, it was unclear to what extent remote services would be permitted for PTs and PTAs. Over the following months, CMS clarified its interpretation of the waivers, first by permitting therapy "e-visits," then clarifying that PTs and PTAs in private practices could engage in real-time video telehealth with patients. In early May, the agency acknowledged a pathway for hospital outpatient department PTs and PTAs to furnish remote services under Medicare. However, the ability of institutional settings to bill outpatient therapy furnished via telehealth was not directly addressed — until this week.

    "Until now, CMS did not specifically address a major area of care that encompasses a large number of PTs and PTAs, so we're grateful that we were able to help spark these clarifications," said Kara Gainer, APTA director of regulatory affairs. "The answer CMS provided is good news for PTs and PTAs in these settings whose primary concern is to be able to safely deliver effective, high-quality services to Medicare beneficiaries."

    The waivers are temporary and will be withdrawn when the public health emergency is officially ended. In the meantime, APTA is advocating to HHS and CMS about the importance of extending the telehealth policy flexibilities after the emergency declaration ends. Supporters can lend their voices to this effort by submitting comments on CMS’ additional policy revisions in response to the COVID-19 public health emergency interim final rule.

    In addition, APTA also continues press Congress for permanent telehealth allowances for PTs and PTAs. That effort includes grassroots opportunities to add your voice to calls for lasting change.

    U.S. Reps Urge House Leadership to Stop Proposed 2021 Payment Cuts

    A letter from 46 U.S. representatives calls the cuts "reckless."

    The push to avoid a proposed 8% cut to therapy payment under Medicare in 2021 has gained significant momentum: Thanks to strong grassroots efforts and advocacy from organizations including APTA, the American Occupational Therapy Association, and the American Speech Language Hearing Association, 46 bipartisan members of the U.S. House of Representatives have signed on to a letter urging House leadership to create a path that would allow CMS to drop the potentially devastating proposed cuts.

    On May 28, Reps. Bobby Rush (D-IL) and Susan Brooks (R-IN) submitted a bipartisan letter to Speaker of the House Nancy Pelosi and Minority Leader Kevin McCarthy decrying the January 1, 2021, proposed cuts to the Medicare Physician Fee Schedule and urging action by the House to prevent them.

    "If these cuts are allowed to go into effect, they will be devastating and will limit access to care for patients, including seniors, who rely on these services," the letter states. "Ultimately, these cuts will force physical and occupational clinics to close, resulting in thousands of qualified professional clinicians, especially those in rural and urban areas in our districts, to lose their jobs." The results, authors write, could lead to large-scale losses in access to care, including "the over 50 million Americans who suffer from acute and chronic pain conditions [that] will be unable to access these important, non-opioid services."

    The letter also points out that the effects of the COVID-19 pandemic "could be felt for years" in the health care system, adding, "Now is not the time to implement these reckless cuts when our health care system is under such tremendous financial strain."

    The proposed cuts are an attempt by CMS to maintain "budget neutrality" while increasing payment for primary care provider evaluation and management codes, referred to as E/M codes. To find the money to pay for the increase without exceeding budget limits, CMS proposed to reduce reimbursement for codes commonly used by more that three dozen health care provider types. Reimbursement cuts to codes associated with physical therapy are estimated to result in an 8% payment drop.

    The letter to House leadership urges enactment of a legislative proposal that would waive budget neutrality requirements so that CMS could move ahead with the E/M increases without putting payment to other professions on the chopping block.

    Since the CMS announcement of the proposed cuts that accompanied the 2020 physician fee schedule, more than 60 health care provider organizations launched advocacy efforts to block or blunt the damage. Those efforts are ongoing at APTA, which offers members and other stakeholders online opportunities to make their voices heard in pushing for elimination of the cuts.

    “We are grateful for the leadership of Representative Rush and Representative Brooks on this important issue,” said Justin Elliott, APTA's vice president of government affairs.“When therapists, clinics, and rehabilitation facilities are struggling, particularly in rural and underserved areas, it's clear that this is no time to implement payment cuts that will negatively hurt patient access to care and exacerbate the instability of health care providers' practices."

    Be sure to check out APTA’s resources on this issue.

    UnitedHealthcare, Aetna Temporarily Drop 2% Cuts in Medicare Advantage Plans

    The insurers are mirroring CARES Act provisions that suspended the sequestration cut in Medicare payments.

    Two of the nation's largest commercial insurers — Aetna and UnitedHealthcare — are following CMS' lead and temporarily suspending this year's 2% sequestration cuts to provider payments in Medicare Advantage plans. For both companies, the suspension applies to payments made between May 1 and December 31.

    The shift comes in the wake of changes brought about through CARES Act COVID-19 relief provisions that temporarily halted a 2% cut in Medicare provider payments. Those annual cuts, mandated through the 2011 Budget Control Act, often have been passed along to providers participating in private insurers' Medicare Advantage plans. Now at least two insurers are following in kind by suspending the reductions for a limited time.

    This isn't the first time commercial payers have mirrored — and even expanded on — CMS coverage and payment changes related to the COVID-19 pandemic. Most major insurers now accept claims for therapy delivered via telehealth, and BlueCross BlueShield Tennessee recently became the first major payer to include telehealth by PTs as a permanent benefit.

    Carmen Elliott, APTA's vice president of payment and practice management, says that continued communications between professional organizations such as APTA and the insurers are helping the payers make informed decisions about coverage during the pandemic and beyond.

    "APTA and other provider associations have continued to share information with insurers to work toward collaborative approaches such as therapy via telehealth, and how the pandemic has impacted individual providers," Elliott said. "We certainly appreciate the ways in which these payers are closely following federal guidelines."

    APTA Advisory: TRICARE Reimbursement for TENS Treatment for LBP Stops on June 1

    The health program used throughout the U.S. Department of Defense announced that it would make the change after questioning the effectiveness of the treatment.

    Are you a provider in the TRICARE system? Don't forget that beginning June 1, the program will no longer pay for transcutaneous electrical nerve stimulation as a treatment for low back pain. The changes are reflected in TRICARE's policy manual.

    This March 6 PT in Motion News story provides more details on TRICARE's stated reasons for the change.

    APTA Report: 44% of PTs, 54% of PTAs Say They Lost Income During Pandemic

    Results of a nationwide APTA survey show how the COVID-19 pandemic is impacting the profession — and sparking changes in care delivery.

    The physical therapy profession has experienced some significant setbacks during the COVID-19 pandemic — many of them on a personal level. But results of a new nationwide survey conducted by APTA also reveal how PTs and PTAs are using their resilience to adapt to a changed professional landscape.

    APTA summarized results of the survey conducted April 24-May 11 in a new report titled "Impact of COVID-19 on the Physical Therapy Profession." The report is also the first resource to be released using APTA’s new logo and brand, which will be officially adopted in June.

    The report, based on a survey results from 6,500 PTs and PTAs across the country, makes it clear that the COVID-19 pandemic has exacted a literal cost on PTs and PTAs, with 44% of PTs and 54% of PTAs reporting decreased income during the health crisis. Furloughs also were disturbingly high, affecting 17% of PTs and 27% of PTAs. Layoffs were less frequent — though no less troubling — with 5% of PTs and 13% of PTAs reporting job loss.

    Although much of the survey was focused on income and employment, respondents also were asked to provide information on the reasons behind clinic closures, use of PPE, telehealth adoption, clinic revenue, and other topics.

    Among the Findings

    Setting made a difference in reduction in work hours and income.
    For PTs, work hour reductions were most common in private outpatient or group practice settings, with 68% of respondents reporting a drop, followed by PTs in home care (65%), and PTs working in hospital-based outpatient facilities or clinics (57%). As for actual income declines, PTAs in home care were hardest hit, with 81% reporting a reduction in income, followed by 66% of PTAs in private outpatient settings. The setting reporting the highest rate of income reduction among PTs was in private outpatient settings, with 65% of respondents reporting a drop.

    PTAs were most affected by furloughs — also depending on setting.
    PTAs reported furloughs in private outpatient or group practice settings at a rate of 37%, with hospital-based outpatient clinics not far behind at 35%. The private practice clinic setting was also the leading setting for PTs who experienced furloughs, at a rate of 23%.

    PTs generally felt they were providing essential treatment.
    Only 16% of PTs felt that their employers had asked them to provide PT services they considered nonessential.

    The use of telehealth rose dramatically.
    According to the report, use of telehealth by PTs was nearly nonexistent prior to the health emergency, with 98% of respondents reporting that they provided no live video consult with patients. The pandemic — and resultant changes to telehealth payment policies and regulations — changed all that. At the time of the survey, 50% of PTs reported using telehealth during the pandemic. The most dramatic change? School system PTs, whose use rose from near 0% levels to a 93% use rate.

    When facilities closed, professional judgment was the most common reason.
    Practice-owner respondents who closed their clinics during the pandemic overwhelmingly cited professional judgment as the primary reason for make the decision, at 76%. The next most-frequently cited reason was patient cancellations and no-shows, at 48%, followed by mandatory state orders, cited by 40% of practice owners as the top reason for the shutdown.

    “This report is a snapshot of a specific moment in time, starting about six weeks after a national emergency was declared,” said APTA CEO Justin Moore, PT, DPT. “We will continue to research this topic, both to measure how this health crisis is affecting our profession and to ensure that our association can respond to pressing needs to support the physical therapy community.” APTA will conduct a follow-up survey sometime in June or July.

    Recommendations

    The APTA report also makes recommendations for the profession, and recaps recommendations APTA made to Congress involving legislation related to the pandemic and beyond. The recommendations for the profession include:

    • A "better-leveraged" physical therapy workforce through improved patient access to PTs and PTAs.
    • Elimination of direct access restrictions.
    • Universal PT and PTA access to personal protective equipment.
    • Development of long-term strategies for use of telehealth.

    A New Look

    Readers also may notice something different about the way the report looks. That's because the document is the first to fully reflect APTA's new brand, including use of the association's new logo.

    The report provides a sneak peek into changes that will fully take effect in June, changes that will touch nearly every aspect of APTA's products, communications, and messaging.

    "This health crisis has put a spotlight on APTA's commitment to serving as the trusted leader for the physical therapy profession," Moore said. "Releasing this report under our new logo, ahead of formal adoption of our brand next month, not only helps us maintain consistency as we release more COVID-19 reports in the future but underscores our readiness to live out our brand promise."

    Coronavirus Update: May 26, 2020

    Expanded private payer telehealth coverage for physical therapy, employer tax credit, guidance for PT education programs, and more.

    From PT in Motion News

    May 15: BCBS of Tennessee Makes PT Telehealth Service Coverage Permanent
    BlueCross BlueShield of Tennessee announced that is making coverage of in-network telehealth service a permanent part of its benefit packages, including telehealth delivered by PTs. The change is the first time a major insurer has extended telehealth coverage beyond the length of the current public health emergency.

    May 19: Humana Adopts Telehealth for PTs, OTs, SLPs
    Humana announced that it has expanded its temporary telehealth provisions to include a wider range of providers — PTs, occupational therapists, and speech-language pathologists among them. The expansion applies to both participating/in-network providers and specialty providers, so long as the services don't violate state laws and regulations.

    From the U.S. Department of Internal Revenue Services

    May 8: U.S. CARES Act Provides Tax Credit to Help Employers Retain Staff
    The IRS recently shared information about the Employee Retention Credit authorized under the CARES Act. Designed to encourage employers to keep employees on their payroll, the credit allows an eligible employer whose business has been affected by COVID-19 to receive a refund for 50% of wages paid, up to $10,000.

    Guidance and Recommendations

    May 26: Considerations for Outpatient Physical Therapy Clinics During a COVID-19 Public Health Crisis
    APTA, the APTA Private Practice Section, and APTA Rhode Island created a guidance document aimed at helping outpatient physical therapy clinics minimize the risk of spreading the novel coronavirus. The resource contains more than 60 recommendations that impact nearly every area of operations, from treatment to office administration.

    May 13: ACC Sports Section Endorses "Game Plan" on Athlete Return to Play Post COVID-19
    Authors of a JAMA Viewpoint present a return-to-play algorithm for "competitive athletes and highly active people." The consensus document was endorsed by the American College of Cardiology Sports and Exercise Cardiology Section.

    May 14: CDC Issues Advisory on Inflammatory Syndrome in Children Associated With COVID-19
    The CDC Health Alert Network issued an official advisory on multisystem inflammatory syndrome in children (MIS-C) with background on the condition and reporting recommendation for any health care providers who have cared or are caring for patients younger than 21 years of age who meet criteria for MIS-C criteria. For additional information, providers can contact the CDC’s 24-hour Emergency Operations Center at 770-488-7100 or their state health department's after-hours hotline.

    May 18: ACAPT Offers Strategies for PT Education Program Classrooms and Labs
    The American Council of Academic Physical Therapy published a "living document" with strategies and considerations for managing safe in-person education programs.

    May 18: Trump Administration Issues Guidance to States for Safe Reopening of Nursing Homes
    A memorandum from CMS provides criteria to help state and local officials decide how and when to relax current restrictions for nursing homes, including factors such as number of new cases in the community and the facility, adequate staffing, and access to testing and personal protective equipment.

    In the Media

    May 15: COVID-19 Infection Rate Potentially 35 Times Greater in Areas Without Social Distancing Policies
    From Washington Post: Counties without mandatory social distancing policies experience 35 times more cases of COVID-19, according to a new study in the journal Health Affairs. Researchers found that the daily rate of infection decreased the longer a policy was in effect.

    May 15: World Health Organization: Coronavirus May Be Here for the Long Term
    From CBS News: WHO Emergencies Director Mike Ryan warns against trying to predict the end of the COVID-19 pandemic, saying "this virus may become just another endemic virus in our communities, and this virus may never go away."

    20: U.S. Nursing Homes "Plagued by Infection" Before COVID-19, Says GAO
    From Reuters: According to the U.S. Government Accountability Office, 82% of nursing homes were cited for an infection prevention and control deficiency between 2013 and 2017 — and 48% were cited more than once.

    Outpatient Clinic COVID-19 Recommendations Created Through Collaborative Effort

    APTA, the association's Private Practice Section, and APTA Rhode Island developed guidelines that could help clinics stay safe during the pandemic.

    Imagine you're a patient and it's time for your physical therapy appointment. You drive to the clinic, but instead of heading through the clinic doors, you text your arrival to staff, and then wait in your car until you receive a text telling you to come inside. Once inside, your temperature and oxygen saturation are checked, and as quickly as possible, you're taken from the (magazine-free) waiting area to the treatment area. Your PT and PTA are probably wearing masks (you, too, most likely), and should you be directed to use cardio equipment, you'll be at least 12 feet away from any other patient doing the same. Afterwards you'll be encouraged to leave as quickly as you came. You might not even need to stop to work out your copay because your credit card is on file already.

    Welcome to the PT clinic of the (very) near future — or, more precisely, the clinic as it might be today, according to APTA, the APTA Private Practice Section, and APTA Rhode Island. The association and its components collaborated on a new guidance document aimed at helping outpatient physical therapy clinics minimize the risk of spreading the novel coronavirus responsible for the COVID-19 pandemic. The scenario above is one possibility based on the recommendations.

    "Considerations for Outpatient Physical Therapy Clinics During the COVID-19 Public Health Crisis" envisions a clinic that takes infectious disease precautions that impact nearly every area of operations, from treatment to office administration. The resource is framed as a set of general recommendations, with the understanding that individual facility implementation may vary depending on mandated operational requirements, CDC guidance, and the clinic's own evaluation of cost vs. benefit.

    The guidance document contains more than 60 recommendations around six broad areas: scheduling and workflow, safe workspace distancing (including treatment areas, waiting areas, and front desk operations), patient screening (prior to and while in clinic), staff screenings, considerations on return-to-work after COVID-19, patient triage (in-clinic versus telehealth), and cleaning standards.

    Also recommended: reliance on important federal and APTA resources including CDC and OSHA guidelines, APTA online offerings, and information available through the APTA Private Practice Section. The pdf document includes hyperlinks to many of these additional sources of information.

    The clinic guidance document joins a wealth of other resources on APTA's webpage devoted to COVID-19 and the physical therapy profession. In addition to practical guidance and links to additional information, the webpage also includes news articles and opportunities to advocate on behalf of the profession and its patients.

    New Details Emerge on Delivery of Remote Services by Outpatient Department PTs and PTAs in Medicare

    In early May, PT in Motion News reported about CMS guidance on a way for hospital outpatient department PTs and PTAs to provide remote care delivery to Medicare beneficiaries. More details have surfaced since then.

    The original story is still worth a read, because it lays out the basics of how hospitals can use a patient's address as a "temporary expansion location." But since publication, additional information has come to light:

    If the department is "non-excepted": The CMS interim final rule doesn't change the status of any non-excepted off-campus departments — they are still considered to be non-excepted during the COVID-19 public health emergency, even if they relocate. That means these non-excepted departments will continue to be paid the physician fee schedule rate. It also means they don't need to apply for the relocation approval outlined in the earlier PT in Motion News story.

    If the department is "excepted": It doesn't matter whether the provider-based department — referred to as the PBD — is on or off campus: As long as the department is excepted, hospitals that opt to establish temporary expansion locations need to notify the relevant CMS Regional Office as outlined in the earlier PT in Motion News story.

    However, here's what CMS recently indicated during conference calls on May 19 and May 21: If the hospital outpatient department intends to bill for services under the hospital's outpatient prospective payment system, it must follow the guidance for establishing temporary expansion locations. If the only services that the department bills are paid under the physician fee schedule, such as PT, OT, and SLP furnished under a therapy plan of care, then the relocation process doesn't have to be followed.

    PO or PN Modifier

    Another question APTA has received recently is whether the PO or PN modifier is required on the hospital claim for therapy services furnished remotely but billed as if in person.

    The PO modifier is reported with every HCPCS code for all outpatient hospital items and services furnished in an excepted off-campus PBD of a hospital. CMS requires non-excepted off-campus provider-based departments of a hospital to report the PN modifier on each claim line with a HCPCS code for non-excepted items and services. The use of modifier PN will trigger a payment rate under the physician fee schedule. CMS expects the PN modifier to be reported with each non-excepted line item and service, including those for which payment will not be adjusted, such as therapy services.

    Bottom line: If your excepted or non-excepted off-campus hospital PBD was billing with the applicable modifier before the COVID-19 health emergency, the off-campus PBD continues to bill with the same modifier, whether or not the services are furnished in person or remotely. Hospital outpatient therapy services furnished under a therapy plan of care will continue to be reimbursed under the physician fee schedule.

    Other Modifiers

    In addition to adding the GP modifier when care is furnished by PTs and PTAs under a physical therapy plan of care, hospitals must use the DR condition code and CR modifier. Because the allowances are part of an official response to the public health emergency, both the "Disaster-Related" condition code and the "Catastrophe/Disaster-Related" modifier are required on claims. Details are available in this CMS guidance document.

    APTA also continues to advocate for the recognition of hospital outpatient departments and other facility-based providers as eligible providers that can furnish and bill for services furnished via telehealth under the physician fee schedule. Add your voice by visiting APTA's regulatory take-action webpage and using APTA's unique template letter to comment on the COVID-19 public health emergency interim final rule.

    Labels: None

    PTJ Virtual Issue Puts COVID Research and Perspectives on the Fast-Track

    The association's journal launched a project that brings new rehab-related information to readers as quickly as possible.

    The COVID-19 pandemic demands that PTs, PTAs, and other rehabilitation professionals stay on top of what's being learned about the disease and how the role of physical therapy is evolving because of it. PTJ, APTA's scientific journal, is doing its part to deliver the latest research with minimal delays. In fact, says PTJ editor-in-chief Alan Jette, PT, PhD, FAPTA, the journal's latest project is offering information in ways that are about as "real-time" as you can get.

    Now available on the PTJ website: the PTJ COVID-19 Virtual Issue, a platform that allows the journal to share its latest COVID-19-related research and perspectives at a rate not possible through the normal PTJ publication process. The journal is free to members, and the virtual issue contains open-access work, free to everyone.

    The virtual issue isn't a static resource. Instead, PTJ will add new manuscripts on a regular basis. The result is a collection of articles that, while not in final copyedited form, are as fresh from authors as possible.

    Bookmark the site to keep up with its growth. Here's what's available now:

    APTA Advisory: Humana Adopts Telehealth for PTs, OTs, SLPs

    PTs can now bill the insurer for common therapy codes, delivered via telehealth, for the duration of the public health emergency.

    Another major commercial payer has acknowledged the value of telehealth provided by PTs: this time, it's insurance giant Humana, which is now reimbursing PTs for services delivered via real-time video-based telehealth. Humana is among the last large national payers to make the shift.

    In a May 15 update, Humana announced that it has expanded its temporary telehealth provisions to include a wider range of providers — PTs, occupational therapists, and speech-language pathologists among them. The expansion applies to both participating/in-network providers and specialty providers, so long as the services don't violate state laws and regulations.

    Similar to CMS, Humana previously had adopted many of the CPT codes commonly used by therapists as billable through telehealth, but didn't include PTs, OTs, and SLPs among the providers able to bill for telehealth services using the codes. That's no longer the case — even for Medicare — and PTs are now able to bill for telehealth services.

    For Humana, the affected codes are 97161-97164, 97110, 97112, 97116, 97535, 97750, 97755, 97760, and 97761. The codes should be accompanied by a place-of-service code — 11, or where services would normally have been furnished — as well as the 95 modifier.

    Humana joins Cigna, UnitedHealth, and Aetna among the payers allowing telehealth by PTs for the duration of the public health emergency. Recently, BlueCross Blue Shield Tennessee became the first large insurer to make physical therapy delivered via telehealth a permanent part of its benefits package.

    Sourcing PPE, Spotting Scams, and Evaluating Need: Six Resources

    PPE remains in short supply during the COVID-19 pandemic. These resources may help you find the right equipment — and avoid counterfeits.

    As the COVID-19 pandemic wears on, providers continue to struggle with sourcing the personal protective equipment they need. And now there's an increasing danger that some of the PPE being offered for sale is counterfeit — nearly identical to the real thing but not up to performance standards. On top of that, limited supplies of PPE mean that providers have to be well-versed in the usage life of various pieces of equipment. In other words, when it comes to use of PPE, it can be easier said than done.

    Note: there's been some confusion about where PTs and PTAs stand in terms of establishing Amazon Business accounts to purchase PPE (when available) through the mega-retailer. Here's where things stand: Currently PTs and PTAs can sign up for an Amazon Business account; however they are not yet included in the "Medical Professionals" category for supply ordering. APTA is working to change this Amazon policy.

    While there are no all-encompassing solutions, there are resources that can help you not only access the PPE you need, but better understand proper use and ensure that the PPE you're able to acquire is the real thing. Here are six recommended resources.

    A PPE supplier list.
    The American Health Care Association and National Center for Assisted Living collaborated on a regularly updated list of PPE supplies that have recently served long term care providers. The organizations caution that the list is not an endorsement, but a list of suggested suppliers that may be useful "when PPE is not available through [a provider's] ordinary supply chains." As of May 8, the resource included six providers of PPE including N95 and KN95 facemasks, and three providers offering disposable face shields. Note: PPE among even these providers is in short supply, and backorders are common.

    A brief information sheet on identifying scam PPE.
    Also from AHCA and NCAL: This two-page resource includes 25 questions that can help you weed out the legit from the non-legit PPE vendors — and there are plenty of the latter out there.

    A free webinar from the CDC on making informed decisions about buying PPE from another country.
    This 90-minute webinar helps you understand the federal standards used to evaluate PPE, and what to look for in order to avoid ordering equipment that is being passed off as compliant when it's in fact a counterfeit.

    Strategies for optimizing the supply of N95 respirators.
    Another offering from the CDC, this website includes strategies to get the most use out of the N95 masks on hand, which are often in short supply.

    A "burn rate calculator" to help you calculate the rate at which your facility uses PPE and estimate how many days your PPE supply will last.
    The CDC created a tool, in form of an Excel spreadsheet, that helps you match PPE inventory against patient numbers to help determine current and future needs. The calculator is also available as a mobile app.

    Information on addressing PPE needs in non-health care settings.
    The Federal Emergency Management Agency offers a fact sheet on what settings outside health care should be thinking about and doing when it comes to acquiring and using PPE. The resource includes five key questions that should be asked before making a PPE request to a local emergency management agency.

    Coronavirus Update: May 15, 2020

    A possible blueprint for telehealth exercise programs, pediatric COVID-related illness, CDC guidance on reopening, and more.

    From PTJ

    May 5: "COVID-19 Pandemic and Beyond: Considerations and Costs of Telehealth Exercise Programs for Older Adults With Functional Impairments Living at Home—Lessons Learned from a Pilot Case Study"
    Authors of a recent open-access PTJ article published ahead of print developed what they hope is a “blueprint” for developing and implementing new telehealth exercise programs for older adults with functional impairments — or for transitioning traditional in-person visits to telehealth during a pandemic such as COVID-19. The case study findings include a list of steps taken, participant and provider considerations, resources used, and cost analyses.

    May 8: "Musculoskeletal Physical Therapy During the COVID-19 Pandemic: Is Telerehabilitation the Answer?"
    In a PTJ Point of View published ahead of print, authors examine the clinical evidence on telerehabilitation for musculoskeletal conditions, discuss the evidence for telerehabilitation's feasibility and acceptability, and address potential benefits and challenges for physical therapists.

    From PT in Motion News

    May 11: FSBPT to Host May 18 Webinar on National Physical Therapy Exam
    On Monday, May 18, the Federation of State Boards of Physical Therapy is hosting a free webinar for students and others, COVID-19 and the Impact on the Physical Therapy Community, to answer common questions about the national health emergency’s impact on the National Physical Therapy Examination.

    May 11: TRICARE Allows Audio-Only Services, Waives Copays for Telehealth
    As of May 12, TRICARE, the health insurance used throughout the military, temporarily allows for the use of audio-only remote services for office visits when audiovisual communication is not possible — with documentation for that clinical decision. The rule, which will remain in effect until the COVID-19 public health emergency ends, also eliminates copays and copayments for telehealth services and relaxes provisions around licensing requirements for providers.

    In the Media

    May 8: Worldwide Increase in Reports of COVID-19-related Pediatric Multi-System Inflammatory Syndrome
    From MedPage Today [free account required]: "In the NYC health department report, the 15 cases in children ages 2 to 15 years were hospitalized with typical or incomplete Kawasaki disease, some with shock. All had fever and more than half had rash, abdominal pain, vomiting, or diarrhea. However, less than half have had respiratory symptoms."

    May 8: Health Care Sector "Hemorrhages" 1.4 Million Jobs in April
    From HealthLeaders: "With the COVID-19 pandemic steamrolling much of the nation during April, new federal data show the healthcare sector shed 1.4 million jobs for the month, as hospitals and outpatient care venues shuttered money-making elective services and slashed payrolls to stem the red ink."

    May 13: As States Begin to Reopen, 19 States Are Seeing Rise in COVID-19 Infections
    From Reuters: "Nationally, new cases of COVID-19, caused by the new coronavirus SARS-CoV-2, are down 11% in the last week, according to the Reuters analysis. However, hot spots are emerging in some southern and western states, while the Northeast has seen new infections plunge."

    May 14: CDC Issues Guidance on Reopening Schools, Workplaces
    From NPR: "The Centers for Disease Control and Prevention released a set of documents on Thursday designed to provide guidance on how child care centers, schools, restaurants and bars, and other establishments could begin the process of reopening in the face of the coronavirus. The direction comes after calls from lawmakers and state officials mounted for the CDC to weigh in on how regions should reopen their economies."

    Evidence Reports

    May 7: People of Color and Low-Income Patients in General Are at Higher Risk of Serious Illness if Infected With COVID-19
    According to a new report from Kaiser Family Foundation, national and state-level data "suggest that serious illness resulting from coronavirus disproportionately affects people in communities of color, due to the underlying health and economic challenges that they face. Similarly, adults with low incomes are more likely to have higher rates of chronic conditions compared to adults with high incomes, which could increase their risk of serious illness if infected with coronavirus."

    May 13: Infrared Temp Assessment Ineffective, Research Indicates
    According to Clinical Evidence Assessment by ECRI, infrared temperature screening programs to detect people infected with coronavirus are ineffective. Simulation studies, authors write, "suggest such screening will miss more than half of infected individuals," because many infected individuals do not have fever at the time of screening and because screeners may be inconsistent in their technique.

    From U.S. Department of Labor

    May 9: U.S. CARES Act Authorizes Additional $600 Per Week for Individuals Receiving Unemployment Compensation
    The U.S. Department of Labor published a series of responses to specific inquiries and questions raised by states regarding the Federal Pandemic Unemployment Compensation program. The CARES Act authorizes the FPUC program, and provides an additional $600 weekly payment boost to certain eligible individuals who are receiving other qualifying benefits.

    May 14: OSHA Issues Safety Guidance for Nursing Home and Long-Term Care Facility Workers
    The U.S. Department of Labor’s Occupational Safety and Health Administration has issued an alert listing safety measures employers can follow to help protect nursing home and long-term care facility workers from exposure to the coronavirus. The agency also has issued more general workplace guidance for keeping employees safe from infection.

    From the U.S. Department of the Treasury

    May 13: Small Business Administration, Treasury Department Publish FAQ on Paycheck Protection Program
    The Small Business Administration, in consultation with the Department of the Treasury, issued additional guidance to address borrower and lender questions concerning the implementation of the Paycheck Protection Program established by the CARES Act.

    From the Centers for Medicare & Medicaid Services

    May: CMS Issues Toolkit to Help Nursing Homes Mitigate COVID-19 Prevalence
    CMS released a compilation of actions employed by organizations, including state governments and outlying U.S. territories, to help nursing homes meet the needs of their residents since the onset of the COVID-19 pandemic. CMS notes that the document is not intended as guidance and does not replace or serve as a substitute for CMS requirements and policy. The agency has not evaluated the actions outlined in this document for effectiveness.

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

    First Major Insurer Adopts a Permanent Telehealth Benefit

    BCBS of Tennessee will now include telehealth services — including telehealth provided by PTs — among benefits in place even after the COVID-19 health emergency ends.

    An isolated change or a glimpse into the post-COVID health care environment? BlueCross BlueShield of Tennessee announced that is making coverage of in-network telehealth service a permanent part of its benefit packages, including telehealth delivered by PTs. The change is the first time a major insurer has extended telehealth coverage beyond the length of the current public health emergency.

    According to a press release from BCBS Tennessee, the expansion began in March, when it began covering telephone and video visits with in-network primary care providers, specialists, and behavioral health providers. That coverage was later extended to PTs, occupational therapists, and speech-language pathologists.

    The now-permanent benefit includes member-to-provider and provider-to-provider consultations.

    BCBS Tennessee is the latest development in a trend among many commercial insurers to cover telehealth services delivered by PTs. Aetna, UnitedHealthcare, and Cigna are among the payers that have adopted telehealth — but until now, all insurers limited the benefit to the duration of the COVID-19 public health emergency.

    "Providers and patients have indicated that they believe telehealth provided for therapy and many other services is not only efficient but effective — and not just during a public health crisis," said Carmen Elliott, APTA's vice president of payment and practice management. "This innovative step by BlueCross BlueShield of Tennessee is encouraging, and hopefully other payers will see the same promise in telehealth as a permanent offering."

    As for Medicare, CMS has adopted waivers that allow for telehealth by PTs and PTAs that are set to expire when the public health emergency ends (the current federal emergency declaration doesn't include a set end date). APTA urges its members to advocate that CMS make those changes permanent.

    Visit APTA's Telehealth webpage for regularly updated information on payment, information on coding, and general guidance on what to consider when evaluating whether telehealth is right for you.

    APTA, AOTA, ASHA Alert Patients, Physicians to Misuse of SNF and HHA Payment Systems

    In addition to providing CMS with reports of inappropriate practices by HHAs and SNFs, the organizations are now taking concerns about PDPM and PDGM misapplication directly to physician and consumer groups.

    From the moment new payment rules governing skilled nursing facilities and home health agencies were rolled out, APTA, and the professional associations representing occupational therapists and OTAs and speech-language pathologists have been battling some employers' willful misapplication of the rules. Now the organizations are taking that mythbusting effort directly to physicians and consumers.

    This week, APTA, the American Occupational Therapy Association, and the American Speech-Language-Hearing Association released two joint letters and a consumer "fact sheet" that exposes how some SNFs and HHAs inappropriately use the new systems — known as PDPM for SNFs and PDGM for HHAs — to reduce patient care, cut therapist hours, and sometimes eliminate entire jobs. "PDPM" stands for "Patient-Driven Payment Model"; "PDGM" stands for "Patient-Driven Groupings Model."

    In a joint statement announcing release of the letters, the organizations write that "Preserving access to therapy services is critical, particularly as postacute care organizations prepare for the expected surge in patients recovering from COVID-19."

    The consumer-focused letter, sent to numerous patient and consumer advocacy groups, cites examples of HHAs and SNFs reducing therapist hours, requiring therapists to perform services outside their scopes of practice, ignoring or modifying physician orders and plans of care, misinforming therapists about which treatments are allowed under the payment systems, and failing to provide maintenance therapy, among other practices.

    "Our associations stand committed to ensuring all patients retain access to medically necessary therapy services and ensuring all stakeholders understand the impact these business-driven decisions can have on patient outcomes," the organizations write, adding that "Medicare beneficiaries and their caregivers deserve to know the facts about Medicare coverage in SNFs and HHAs to address the inappropriate practices."

    To that end, APTA, AOTA, and ASHA created an accompanying fact sheet that explains, in easy-to-understand language, the most common mistruths patients and caregivers are being told. Among the messages that the organizations point out as false:

    • Medicare limits the amount of therapy that can be received.
    • Medicare dictates what forms of therapy a therapist can deliver.
    • A portion of SNF therapy treatment must be provided in a group setting.
    • Medicare only pays for therapy services that improve a patient's condition.
    • Medicare does not pay for certain diagnoses.
    • Medicare does not cover home health services unless the patient is discharged from the hospital or institutional setting.
    • Medicare won't reimburse for any home health care services that exceed a total of 30 days of service.

    "Many SNFs and HHAs are using these payment systems in ways that support patient access to necessary care, but some are purposefully providing misinformation," said Kara Gainer, APTA's director of regulatory affairs. "We believe the facilities and agencies misusing the systems are outliers, but it's still important that all patients are aware of their rights."

    The fact sheet includes steps patients can take if they believe a SNF or HHA has inappropriately restricted access to therapy services, including links to consumer advocacy groups that can help pursue the issue.

    The letter directed at physician groups is aimed primarily at home health and warns that "some HHAs are making care choices for patients based on the perceived financial incentives … rather than the actual needs of patients of patients or the plan of care."

    "We recognize that CMS only implemented PDGM on January 1, 2020," the letter continues. "However, we anticipate that as patients raise concerns with their physicians and outcomes data becomes available, the failure of some HHAs to provide the care that has been ordered as medically necessary for the patient will require your attention."

    APTA, AOTA, and ASHA have been supplying CMS with a steady stream of examples of inappropriate practices by SNFs and HHAs since the new payment plans were introduced. For its part, CMS says it has been tracking SNF and HHA utilization and outcomes data, but has yet to release any findings, describing any release as "premature" at this stage.

    APTA's webpage devoted to PDPM and PDGM includes resources to better understand the rules, as well as links to materials that can help PTs and PTAs advocate for proper application of the systems.

    APTA MIPS Reporting Update, Registry Enrollment Deadline May 31

    Practices thinking about or planning to report 2020 MIPS data to CMS via APTA’s Registry need to enroll by the end of this month.

    Physical therapists who are participating in the Merit-based Incentive Reporting System for 2020 should be aware of important changes in reporting requirements and some key deadlines.

    MIPS Changes for 2020

    • Clinicians and groups must now earn a minimum of 45 points in order to avoid a negative payment adjustment. This is up from 30 points in 2019.
    • Data must be collected on at least 70% of all patients, rather than last year's 60%.
    • Groups must now complete and document Improvement Activities for at least 50% of clinicians on staff.
    • Two Improvement Activities have been removed from the Centers for Medicare & Medicaid Services’ approved list.
    • A COVID-19 Improvement Activity has been added for 2020. Learn more at the CMS Quality Payment Program Measures and Activities webpage.

    If you don’t hit all three thresholds for reporting, you could be eligible to opt-in for potential payment adjustments or voluntarily report to receive feedback directly from CMS.

    2020 Deadlines

    • The deadline for collecting data for the MIPS 2020 reporting year is December 31, 2020.
    • If you are considering participating in MIPS via the APTA Physical Therapy Outcomes Registry for the 2020 reporting year, you must enroll by May 31. Contact registry@apta.org for more information or to enroll.

    With more than 20 MIPS measures, including 11 qualified clinical data registry (QCDR) measures and two electronic clinical quality measures (eCQMS), APTA's Registry makes it easy for PTs to participate in MIPS and maximize payment. The Registry is an ONC-Certified Electronic Health Records Technology Registry and contains more than 1 million unique patient visits for benchmarking outcomes.

    Virtual NEXT Provides APTA Members More Than 20 Programming Hours for $20

    Nonmembers can access Virtual NEXT for $40, as APTA supports the physical therapy community during COVID-19.

    The COVID-19 pandemic forced APTA to cancel the NEXT Conference & Exposition in Phoenix this June, but it isn’t keeping APTA from delivering outstanding continuing education content.

    This week APTA unveiled Virtual NEXT, which will launch on June 3 with more than 20 on-demand sessions offering CEUs. Additional live online events will be announced soon, giving the physical therapy community more opportunities to connect and learn in a time when mass gatherings are unsafe.

    APTA priced the special event with the challenges of the health crisis in mind: APTA members get access to the Virtual NEXT bundle for $20, and nonmembers pay a similarly low $40. Those who were registered for NEXT in Phoenix at the time of its cancelation are receiving Virtual NEXT for free, as are Life members and members in the first year of the Career Starter Dues program, who were eligible for a free NEXT registration.

    Virtual NEXT is made possible through the support of GEICO, HPSO, and Rusk Rehabilitation.

    “Virtual NEXT is symbolic of our commitment to supporting the physical therapy community, in good times and bad,” said APTA CEO Justin Moore, PT, DPT. “We are grateful to our sponsors for helping us offer this programming at low prices, and to our speakers who enthusiastically stepped forward to deliver their presentations in a virtual environment.”

    Topics for the on-demand sessions include COVID-19, leadership, pain management, disaster management, diversity education, and telehealth.

    Special sessions include the John H.P. Maley Lecture by Nicole Stout, PT, DPT, FAPTA, and a townhall with APTA President Sharon Dunn, PT, PhD. Additional special sessions are yet to be announced.

    Virtual NEXT is available for purchase through the end of July. Those who purchase Virtual NEXT can begin their online sessions at any time after June 3, 2020, and before the end of the year, and have 90 days to complete any individual course to earn related CEUs.

    See the list of sessions at the Virtual NEXT webpage.

    The Good Stuff: Members and the Profession in the Media, May 2020

    "The Good Stuff" is an occasional series that highlights recent media coverage of physical therapy and APTA members, with an emphasis on stories of how individual PTs and PTAs are transforming health care and society every day. Enjoy!

    Home sweat home: Jill Michelle Henderzahs-Mason, PT, DPT, and Ninia Eliza Agustin, PT, DPT, describe how to avoid injury while working out at home during the pandemic. (Wall Street Journal)

    Hospital physical therapy during COVID-19: Jasmine Marcus, PT, DPT, Karl Arabian, PT, DPT, and Molly Smith PT, DPT, share their experiences as hospital-based PTs. (CovalentCareers blog)

    PT for heroes: Robert Fleming, PT, DPT, has launched a free service that provides telehealth-based physical therapy to COVID-19 front-line workers. (ABC News 10 Albany, New York)

    COVID-19 and health disparities research: Lisa VanHoose, PT, PhD, MPH, was appointed to a Louisiana state subcommittee that will look into how health disparities align with COVID-19 data. (Louisiana Office of the Governor press release)

    Men have pelvic floors, too: Rachel Tavel, PT, DPT, explains how pelvic floor dysfunction can affect men — and what to do about it. (Men's Health)

    Accessing physical therapy in a pandemic: Karen Litzy, PT, DPT, and Ryan Balmes, PT, DPT, share tips on what to expect and how to prepare when trying to receive physical therapy during the public health emergency. (Consumer Reports)

    Insight into Alex Smith's recovery: Stephania Bell, PT, talks about the harrowing injury and long rehabilitation road faced by Washington Redskins quarterback Alex Smith as presented in the ESPN documentary "Project 11." (Washington Post)

    The use of a dilator: Heather Jeffcoat, PT, DPT, explains the purpose and use of a vaginal dilator. (feminapt.com)

    The next challenge for COVID-19 patients: Maureen Boyle, PT, is helping to restore function and normalcy to the lives of patients who survive COVID-19. (Denver 7 News)

    Adjusting to a new world in athlete injury rehab: Edward Wilk, PT, DPT, FAPTA, and Mike Reinold, PT, DPT, ATC, outline their approaches to rehabilitation of elite athletes during COVID-19 restrictions.(Associated Press)

    You'll want to be sitting down for this: Bob Smetanka, PT, MS, offers tips on proper desk posture for people now working from home. (Argus Observer, Ontario, Oregon)

    A new normal for physical therapy? Jamie Dyson, PT, DPT, and Mary Pengelley, PT, DPT, offer perspectives on how the pandemic has changed physical therapy, and which of those changes might remain after the crisis ends. (Miami Herald)

    PTs turning up the creativity: Megan Berg, PT, DPT, Scott Rezac PT, DPT, Cameron MacDonald, PT, DPT, and Audrey Waldron PT, DPT, describe how they're using telehealth and other approaches to continue to provide care. (Denver Post)

    Working out at work: Brett Lynass, PT, shares simple exercises that can help alleviate discomfort caused by working from home in locations that encourage less-than-ideal posture. (KOTA TV, Rapid City, South Dakota)

    When pain hits home: Reid Gehring, PT, DPT, outlines ways to counteract stiffness and pain when working from home. (ABC7 News, Amarillo, Texas)

    Preparing for PICS: Patricia Ohtake, PT, PhD, is leading the way on research related to rehabilitation of COVID-19 patients who may experience post-intensive care syndrome. (University at Buffalo News Center)

    Managing pelvic physical therapy during a pandemic: Carrie Pagliano, PT, DPT, describes how she's approaching pelvic physical therapy during social distancing. (WUSA9 News, Washington, DC)

    Zooming in on care: Deanna Proimos, PT, DPT, shows how she conducts pediatric physical therapy over Zoom. (WTHR13 News, Indianapolis)

    The setting for sitting: Grace Lancaster, PT, DPT, provides ideas on how to reconfigure a home office to minimize pain. (Fox 5 News, Atlanta)

    Balance in all things: Sara Mikulsky, PT, adds her take on how to improve balance while walking. (myfitnesspal blog)

    Running 56 miles in two days: Ken Vinacco, SPT, logged 56 miles in a 48-hour period to help bring awareness to a local food bank and multiple sclerosis center. (WJAR 10 News, Cranston, Rhode Island)

    Squat's going on: William Suits, PT, DPT, elaborates on proper squat technique.(USA Today)

    Got some good stuff? Let us know. Send a link to troyelliott@apta.org.

    Education Leadership Partnership Annual Report Now Available

    The review reflects the evolution of a comprehensive, collaborative approach to physical therapy education issues.

    The Education Leadership Partnership's 2019 annual report, now available, tracks a year in which the group moved its agenda forward on multiple fronts — and did so with a commitment to inclusion and empowerment.

    In its report, ELP outlines work done as a whole and by way of five strategy groups focused on education research, educational outcomes, academic-clinical partnerships, essential resources for education programs, and clinical education. The review also describes the development of the ELP's report on student debt released in April.

    ELP comprises representatives from the three founding member organizations as well as ex-officio nonvoting members representing the American Board of Physical Therapy Residency and Fellowship Education, the American Board of Physical Therapy Specialties, the Commission on Accreditation in Physical Therapy Education, and the Federation of State Boards of Physical Therapy. Representatives from various areas of the clinical community — private practice, veterans, acute care, and health systems — also participate in the partnership.

    Want more information on the ELP, its history, and resources as they develop? Check out APTA's ELP webpage.

    Updated OA 'Agenda' Emphasizes Importance of Physical Activity

    APTA contributed to the development of an eight-point strategy to address a highly prevalent but "under-recognized" condition.

    A revised "public health agenda" for addressing osteoarthritis couldn't make it any clearer: The impact of OA could be blunted through greater emphasis on nondrug interventions, physical activity, weight management, and a stronger embrace of evidence-based approaches and policies.

    Developed through a collaborative effort between the U.S. Centers for Disease Control and Prevention, the Arthritis Foundation, and the Osteoarthritis Action Alliance, the 2020 update of the National Public Health Agenda for Osteoarthritis describes OA as "still an under-recognized chronic condition." Currently, the report states, OA is estimated to affect one in seven Americans; given growing obesity rates and an aging population, prevalence is likely to increase in the coming years.

    And yet, "OA is not the inevitable result of aging, and there are public health strategies that can help to prevent and manage it," according to the report. Those strategies — eight in all — are at the heart of the OA agenda. Staff and volunteers from APTA, which is a member of the action alliance, contributed to the development of the strategies.

    The eight strategies outlined in the report are:

    1. Promotion of evidence-based, self-management programs and behaviors as nondrug interventions.
    2. Expansion of access to self-management education and physical activity programs.
    3. Promotion of low-impact, moderate-intensity physical activity for adults with OA.
    4. Promotion of weight management for prevention and treatment of OA.
    5. Promotion and implementation of policies and interventions that reduce falls and OA-related joint injuries.
    6. Expansion of systems for referral and delivery of evidence-based interventions.
    7. Assurance of equity in access and delivery of interventions.
    8. Implementation of a public health policy agenda for OA.
    9. Pursuit of more OA research and evaluation.

    "Tackling the complex challenges of OA requires a concerted effort among multiple and diverse public and private sector partners," the report states, describing the OA Action Alliance as "uniquely positioned to coordinate the [agenda] into action."

    In addition to being a member of the OA Action Alliance, APTA is a strong supporter of the importance of physical activity in the treatment of OA. The association offers resources on encouraging healthy, active lifestyles at APTA's Prevention, Wellness, and Disease Management webpage as well as information on arthritis management through community programs. Members also can dive deeper into the issues by joining APTA's Council on Prevention, Health Promotion, and Wellness in Physical Therapy. Patient-focused resources are available through APTA's ChoosePT.com website; the Osteoarthritis Action Alliance also offers a free booklet to help consumers participate in its "Walk With Ease" program.

    Ernest A. Burch Jr. Dies at 91

    Ernest Burch, PT

    The former APTA vice president helped lead the way in the establishment of autonomous physical therapist practice in Maryland.

    Ernest A. Burch Jr., PT, FAPTA, considered a pioneer in physical therapy, died April 28 at age 91.

    Originally from Swedesboro, New Jersey, Burch received his undergraduate degree from Western Maryland College (now McDaniel College) in 1950. He began his career in physical therapy after serving time in the U.S. Army during the Korean War and then completing his PT education in 1956 from the University of Pennsylvania on a G.I. bill that paid his tuition.

    He spent 10 years as chief therapist at Union Memorial Hospital in Baltimore before leaving to open a private practice, Burch, Rhoads & Loomis, focusing on orthopedic and home health services. The practice eventually expanded to 10 offices. While at Union Memorial, Burch spent an afternoon each week observing Henry O. and Florence P. Kendall perform muscle testing and posture analysis with nurses at Johns Hopkins.

    As successful as Burch’s career was, he was equally well-known for the depth and breadth of his service to APTA. Notably, he and Florence Kendall helped push for autonomous practice legislation in Maryland in the 1970s. Among the long list of positions Burch held are APTA vice president, chair of the APTA Nominating Committee, secretary and then president of the Maryland Chapter, president of the Private Practice Section, and chair of the Maryland State Board of Physical Therapy Examiners. He was named a Catherine Worthingham Fellow, APTA’s highest member category, and he earned several awards, including APTA’s Lucy Blair Service Award and the Private Practice Section’s Robert G. Dicus Award.

    "Ernie was a stalwart for physical therapy advocacy," said APTA CEO Justin Moore, PT, DPT. "In one of my first presentations for APTA more than 20 years ago, I was at a chapter meeting being drilled with questions about direct access, referral for profit, and incident-to billing. After 30 minutes, Ernie stood up and said if everyone in the room was as aggressive on Capitol Hill as in the conference room we’d have solved those problems already. The crowd applauded and my presentation was over. I hadn’t met Ernie yet, but he supported me and I never forgot that. Over the years I got to know him a bit better. He was a gem and a gentleman. APTA is fortunate for having had his leadership."

    New TRICARE Rule Allows for Telephone-Delivered Services, Drops Copays

    Audio-only visits will be allowed when necessary, cost-sharing is lifted, and TRICARE licensing requirements relaxed.

    In this review: TRICARE Coverage and Payment for Certain Services in Response to the COVID-19 Pandemic (interim final rule with comment period)
    Effective date: May 12, 2020

    The big picture: TRICARE is expanding the range of remote services it will allow—and is temporarily waiving copays for telehealth.
    TRICARE, the health insurance used throughout the military, will function under a new interim rule that will allow for the use of audio-only remote services for office visits "when appropriate," and eliminate copays and copayments for beneficiaries who receive services delivered via telehealth. The rule, set to go into effect May 12, also relaxes provisions around licensing requirements for providers. The new rule will remain in effect until the COVID-19 public health emergency ends.

    Important to note: The changes — especially the new provisions around the use of audio-only services — come with requirements and shouldn't be seen as blanket permissions.

    Yes, it's possible for TRICARE beneficiaries to receive care through audio-only (telephone) services, but only when appropriate — and documentation is important.
    The U.S. Department of Defense Office of the Secretary (author of the interim rule) has lifted TRICARE's prohibition on telephonic services to enable beneficiaries to have their symptoms evaluated by a provider over the phone. The change applies to any covered illness or injury, including COVID-19 symptoms, for all beneficiaries, but the services must be medically necessary and rendered by an authorized TRICARE provider within the scope of the provider's license.

    The interim rule is clear that the use of audio and visual two-way platforms is preferred, and that audio-only services should only be used when necessary — for instance, when access to broadband may be impossible. TRICARE is counting on its providers to use clinical judgment in deciding when the audio-only option is appropriate, and to carefully document their reasons for choosing the platform used.

    DoD also points out that there are circumstances under which audio-only telehealth is not appropriate — namely, any visit that requires a physical examination.

    Cost-sharing and copays for telehealth service are (temporarily) out.
    To incentivize TRICARE beneficiaries to reduce in-person visits to TRICARE providers, the rule eliminates cost-sharing, including deductibles, for all in-network authorized telehealth services. The waiver applies to TRICARE Prime and Select beneficiaries in all geographic areas but will remain only as long as the national public health emergency is in place.

    Interstate practice in TRICARE will be a little easier — and there could be international implications, too.
    For the duration of the emergency, the TRICARE system will lift its mandate that providers must be licensed in the state in which they're practicing (which could be different from the state in which they reside), even if that license isn't otherwise required. Providers still need to have an equivalent license to practice, however, and DoD acknowledges that individual states retain the authority to manage the licensing of all providers in that state's jurisdiction. The change allows TRICARE providers to make full use of relaxed interstate licensing requirements adopted by state or federal government.

    The interim rule around licensing also has implications beyond the U.S.: According to DoD, the change could also allow TRICARE providers in other countries to practice beyond that nation's borders, so long as permitted by the host nation.

    The change applies to services delivered both in person and via telehealth.

    FSBPT to Host Webinar on NPTE Amid COVID-19

    Testing center closures are preventing administration of the National Physical Therapy Examination.

    [Editor's note: an earlier version of this story reported the webinar date as May 15; that session is intended for faculty only. The May 18 session is open to students and others.]

    For thousands of would-be PTs and PTAs, the National Physical Therapy Examination stands between them and licensure. Amid COVID-19, the hardest part isn’t passing the exam – it’s having the opportunity to take it.

    The Federation of State Boards of Physical Therapy, which oversees the NPTE process, uses Prometric to administer the exam in testing facilities across the country. In normal circumstances, Prometric supports millions of test takers annually around the world. But the COVID-19 pandemic has closed buildings where exams are usually conducted and made it unsafe for test-takers to sit near each other – problems not unique to the NPTE.

    Aware of the challenge, FSBPT is hosting a free webinar on Monday, May 18, at 3:10 pm ET, to provide updates and answer questions. Advance registration is required.

    Last week Prometric sent a letter acknowledging the challenges and confusion: “We recognize that our communications to your test takers and other stakeholders has at times been inadequate and may have caused unnecessary confusion and frustration,” the letter said. Prometric also includes status information on a special COVID-19 webpage.

    Coronavirus Update: May 8, 2020

    Insurance premium rebates, cyberattacks related to COVID-19, resources from APTA components, and more.

    In the Media

    May 7: UnitedHealth Commits to Premium Rebates, Cost-Sharing Waivers
    From CNBC: "UnitedHealth Group announced Thursday it will provide $1.5 billion in direct financial relief for its customers in the form of premium rebates for consumers on individual and small group employer plans, and cost-sharing waivers for seniors on its Medicare Advantage plans." A subsequent announcement from UHC clarifies that the waivers apply to physical therapy visits.

    May 7: Inflammatory Syndrome in Children May be Linked to COVID-19
    From NPR: "The new condition associated with COVID-19 is called Pediatric Multi-System Inflammatory Syndrome. Symptoms include persistent fever, extreme inflammation, and evidence of one or more organs that are not functioning properly."

    May 5: Humana CEO Predicts Permanent Changes to Health Care System Post-Pandemic
    From CNBC: "Humana CEO Bruce Broussard said Tuesday that he expects telehealth and other changes embraced by the health-care sector during the coronavirus pandemic to have a lasting impact on how people go to the doctor."

    May 5: U.S., U.K. Warn of Cyberattacks to Coronavirus Response Efforts
    From CNN: "The United States and United Kingdom issued a new advisory Tuesday warning of ongoing cyberattacks against organizations involved in the coronavirus response, including health care bodies, pharmaceutical companies, academics, medical research organizations, and local government."

    Practice Guidance

    May 5: APTA Collects COVID-19 Webinars and Event Recordings
    APTA, in partnership with its components and other organizations, has amassed a collection of learning opportunities — all free to members and nonmembers.

    May 6: APTA Components Recommend Resources
    APTA's sections and academies have been creating resources and curating offerings from other agencies and organizations.

    COVID-19 Relief Programs

    May 7: HHS Extends Deadline for Attestation
    Providers now have 45 days to sign an attestation that they received relief money and will comply with terms and conditions. The previous deadline had been 30 days.

    From U.S. Department of Labor

    May 4, 2020: Employers May Not Have to Contribute to Workshare Benefits During Emergency
    From Law360: "Employers that opt in to 'workshare programs' letting workers collect partial unemployment while working a reduced schedule may not have to chip in during the COVID-19 pandemic, the U.S. Department of Labor said in new guidance."

    From the Centers for Disease Control and Prevention

    May 8: CDC Updates Guidance on Purchasing Respirators From Other Countries
    The CDC acknowledges that providers may be forced to source respirators that are not approved by the National Institute for Occupational Safety and Health, and offers guidance on how to evaluate devices and warning signs of potentially substandard equipment.

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

    APTA Advisory: Providers Given More Time to Comply With Relief Money Requirements

    Providers now have 45 days to sign the required attestation instead of 30.

    The COVID-19 relief money that the U.S Department of Health and Human Services is making available to providers requires that each provider sign an attestation acknowledging receipt and agreeing to the terms and conditions of the program. Providers had 30 days to meet that requirement, but now HHS is allowing more time.

    On May 7, HHS announced that it has extended the deadline for attestation from 30 days to 45 days after a provider has received a payment. The expanded deadline applies to all provider relief distributed through the CARES Act Provider Relief Fund.

    This PT in Motion News story explains some of the eligibility and other details of the relief fund. But note: HHS continues to update information on the program, so be sure to closely monitor the HHS Cares Act provider relief fund webpage for additional information as HHS makes it available.

    Think you may be eligible for relief but didn't receive any? First, call UnitedHealth Group at 866-569-3522 (UHG is handling the payments for HHS). If you're unable to find an answer, email COVID-19@cms.hhs.gov, contact your members of Congress, and notify APTA at advocacy@apta.org.

    APTA Continues Strategic Investments to Support Diversity, Equity, and Inclusion

    A new standing committee and staff position align with expanded fundraising efforts to advance this strategic plan objective.

    One of the nine objectives in APTA’s 2019-2021 strategic plan is to foster the long-term sustainability of the physical therapy profession by making APTA an inclusive organization that reflects the diversity of the society the profession serves.

    To advance that objective, APTA has recently taken the following steps:

    • Established a standing committee on DEI. Joining other standing committees to the Board of Directors (Ethics & Judicial, Finance & Audit, Public Policy and Advocacy, and Scientific and Practice Affairs), this committee will provide the Board with strategic counsel and recommendations for advancing diversity, equity, and inclusion in the association and profession. APTA will open its call for volunteers for this 14-person committee in February 2021.
    • Expanded fundraising efforts. Building on APTA’s fundraising for the Minority Scholarship Fund, headlined each year by the Celebration of Diversity Gala, earlier this year APTA announced the creation of the Campaign for Future Generations. The purpose of the campaign is to leverage any net proceeds from the association’s upcoming centennial activities and the sale of naming rights in APTA’s new headquarters to invest in DEI. (In light of COVID-19, APTA has temporarily suspended active fundraising, but the opportunity to contribute remains open. The first 10,000 people to donate at least $10 to the campaign will have their name included on the Community Wall at APTA’s new building.)
    • Created the Dimensions of Diversity Fund. Since 1988, APTA has provided more than $1 million in awards to racial and ethnic minority students and faculty through the Minority Scholarship Fund. The new Dimensions of Diversity Fund will expand on APTA’s efforts to improve DEI. Both funds are organized within the Physical Therapy Fund, an APTA-controlled subsidiary 501(c)(3), which will be overseen by a new board of trustees to strengthen ongoing stewardship. Since the beginning of 2020, the Physical Therapy Fund has generated over $250,000 in new pledges as part of APTA’s goal to double the fund by the end of 2021.
    • Outlined a new APTA staff position to begin in 2021. Later this year, APTA will begin recruiting for a new director of inclusion, which will lead organizational support of DEI and serve as the executive director of the Physical Therapy Fund. This position will continue and expand the work led by APTA’s previous director of minority affairs and women’s initiatives position, which was vacated earlier this year when Johnette Meadows, PT, MS, retired from APTA after more than three decades of pioneering leadership that included establishing and growing the Minority Scholarship Fund.

    The efforts expand on other actions taken by APTA in recent years, ranging from the addition of mothers' rooms at the Combined Sections Meeting to the expansion of student recruitment efforts meant to inspire a more diverse applicant pool for physical therapy education programs.

    In alignment with the strategic plan theme of stewardship, the Board is committed to positioning the association to head into its next century with expanded support to improve diversity, equity, and inclusion throughout the physical therapy community.

    Want to connect on APTA’s DEI activities? Email dei@apta.org.

    CMS Officially Recognizes Compacts

    A new online resource clearly states that providers who are members of compacts — including the compact system for PTs and PTAs — can be recognized as eligible Medicare providers.

    The U.S. Centers for Medicare & Medicaid Services let it be known in February that PTs and PTAs with physical therapy compact privileges can qualify as Medicare providers, but only by way of an email to APTA and the Physical Therapy Compact Commission. In that email CMS said that official notice would be forthcoming: That notice is now here.

    Now available: a CMS MLN Matters resource verifying the agency’s recognition of interstate license compacts as "valid and full licenses for purposes of meeting federal license requirements." The statement is aimed at settling confusion over compacts that led to some providers experiencing problems enrolling in Medicare with a compact privilege.

    The CMS position is good news for PTs and PTAs in the Physical Therapy Compact, the system that allows PTs and PTAs licensed in one compact state to obtain practice privileges in other compact states. CMS specifically mentions the physical therapy profession's compact in its acknowledgment of what it calls "a new trend in medicine."

    According to CMS, Medicare Administrative Contractors will accept enrollment applications from providers in compacts and will attempt to verify the applicant's license — or request documentation directly from the provider. Additionally, CMS says MACs will reopen any applications that were previously denied and continue processing them, establishing the effective billing date as the date the MAC received the original application.

    CMS: Potential Flexibility for Hospital Outpatient Department PTs and PTAs in Care Delivery; PTAs can Furnish Telehealth in Private Practices

    CMS representatives say hospitals could opt for a process to designate outpatients' homes as "temporary expansion locations" to allow for remote care.

     

    [Note: This story was updated with new information on May 11.]

     

     The U.S. Centers for Medicare & Medicaid Services provided more clarity on recent guidance related to COVID-19 waivers, and the new details are mostly good news for PTs, PTAs, and patients. Among the answers provided by CMS representatives: PTAs working in private practices can furnish telehealth under Medicare Part B with services billed by the supervising PT, and hospitals could choose a pathway that would allow their outpatient department PTs and PTAs to provide care remotely.

    The clarifications were provided in a May 5 conference call with APTA and other stakeholders about recent guidance from CMS that, among other provisions, established a private practice PT's ability to provide services delivered via real-time, face-to-face telehealth technology under Medicare Part B. That guidance was issued to better articulate CMS' interpretation of an interim rule that includes multiple waivers to respond to the COVID-19 public health emergency.

    Not surprisingly, even after the interim rule was released and subsequent guidance issued, APTA and providers had questions. CMS has now provided some — but not all —of the answers. A recording of the call and a transcript will be posted on the CMS Podcasts and Transcripts webpage.

    [Editor's note: Need an even deeper dive into the CMS guidance and interim rule? Join APTA regulatory affairs and practice staff for a Facebook Live Q&A session at 2 p.m. ET on May 7.]

    PTAs, Telehealth, and Direct Supervision

    PTAs can furnish telehealth. According to CMS representatives, PTAs are included among the providers who can furnish services by way of telehealth, with the supervising therapist able to bill for those services. The allowance only applies to professional services under Medicare Part B, meaning that only PTs and PTAs in private practice can make use of the telehealth provision.

    Virtual direct supervision of PTAs may be allowed under certain circumstances. CMS reps acknowledged that during the public health emergency, "direct supervision" includes real-time interactive audio and visual communications "when use of such technology is indicated to reduce exposure risks for the beneficiary or health care provider" (that's the language from the April 6 interim final rule). During the May 5 conference call, CMS said this flexibility could be applied in the context of the PT directly supervising the PTA in private practice.

    APTA's advice: Until CMS provides written confirmation and more details, don't make a switch to virtual direct supervision. And regardless of policy, PTs and PTAs must still comply with state supervision requirements.

     UPDATE, May 11, 2020: Since the May 5 conference call, CMS clarified that virtual direct supervision is possible. During a May 7 conference call, the agency confirmed that the supervision changes explained in an earlierFAQ did in fact apply to PTs and PTAs in private practices. 

    Remote Care Provided by Hospital-Employed PTs and PTAs to Hospital Outpatients

    Hospitals could choose to follow a process that would enable PTs and PTAs who furnish therapy in the hospital outpatient department and whose services are billed by the hospital through the UB-04 claim form to furnish remote care to registered outpatients — provided the hospital registers the patient's address as a temporary expansion location. It's up to each hospital to determine whether it's necessary and feasible to add a temporary expansion location to its provider-based department, but if it's within scope of practice and doesn't run counter to state laws and regulations, hospital-employed PTs and PTAs could be eligible to provide remote therapy to patients registered as hospital outpatients, and the hospital would bill as if the services were provided in person. But the hospital first must register the patient’s home as a temporary expansion location of the hospital’s outpatient department, referred to as the provider-based department or PBD, during the public health emergency. Registration includes justifying the need to add a relocation site such as a patient’s home.

    This shouldn't be interpreted as a green light for hospital-based PTs and PTAs to engage in remote therapy. While CMS says it is providing this flexibility to allow hospitals to maintain treatment capacity and deliver needed care for patients, a hospital may choose to maintain the status quo.

    CMS needs to be notified if a hospital chooses to add patients’ homes as temporary expansion locations. According to guidance that can be found on page 41 of the CMS interim final rule released on April 30, the hospital must notify its CMS regional office by email of the addresses it plans to identify as temporary expansion locations. That notification should be made within 120 days of beginning to furnish and bill for services at the relocation, and should include:

    • Hospital's CMS certification number.
    • Address of the current PBD.
    • Addresses of the temporary expansion locations (referred to as relocated PBDs in the interim rule).
    • Date on which services began at the relocated PBD.
    • Brief justification for the relocation and role it plays in the hospital's response to the public health emergency.
    • Attestation that the relocation is consistent with the relevant state's emergency preparedness or pandemic plan.

    APTA will ask CMS if the hospital must submit a unique request each time it registers a hospital outpatient’s home as a PBD. Until a definitive answer is provided, we suggest hospitals pose this question to their CMS regional offices.

     

    UPDATE, May 11, 2020: Since the May 5 conference call, CMS clarified that hospitals have flexibility in how they send the emails to CMS regional offices — as a single email with all patient addresses, or separate emails with each patient's address. The important thing is to send in the patients' addresses.

    Use the DR condition code and CR modifier. Because the allowances are part of an official response to the public health emergency, hospitals must use both the "Disaster-Related" condition code and the "Catastrophe/Disaster-Related" modifier on claims. Details are available in this CMS guidance document.

    SNFs, HHAs, Rehab Agencies, and Telehealth

    SNFs and HHAs can't bill for telehealth services provided by PTs or PTAs. CMS was clear that for Medicare Parts A and B, SNFs and HHAs are not included among the providers with new, albeit temporary, telehealth flexibility. The new flexibilities apply only to professional services on a professional claim, or by way of the hospital rules involving PBD expansion sites (see above).

    Rehab agency use of telehealth will be discussed, but for now the answer is no. During the call CMS representatives said the agency would consider the possibility of telehealth for rehab agencies and will provide clarification in the future. APTA recommends that for the time being, rehab agencies assume that telehealth is not billable.

    APTA and other stakeholders are advocating for the expansion of telehealth provisions to SNFs, HHAs, rehab agencies, and other institutional settings. The association continues to press for changes and expansions, including a call for CMS to make its telehealth allowances permanent.

    'Don't Miss' COVID-19 Resources, Recommendations From APTA Components

    The association's sections and academies have been creating invaluable resources and curating offerings from other agencies and organizations. Here's what they recommend.

    The COVID-19 pandemic triggered an unprecedented effort among APTA components to provide resources that deliver expert perspectives and insights on a wide variety of topics. Sometimes from a single component and at other times through collaboration like never before, the offerings are proof that the physical therapy profession is committed to responding to the health emergency with tenacity and compassion, through a unique set of skills and expertise.

    Here's a sampling of what's available, as recommended by the components themselves. All are free and open access.

    [Editor's note: Components are continually adding resources, including notices of upcoming online events such as this webinar titled "Overview of Prone Positioning: Why It Works" a collaborative effort from the Academy of Acute Care Physical Therapy, the Cardiovascular and Pulmonary Section, and the Academy of Clinical Electorphysiology and Wound Management set for May 9 from 3 p.m.- 5 p.m. CT, and "How COVID-19 Has Exposed Our Nation's Structural Inequities," an online townhall on May 9, 11 a.m-1 p.m. ET, sponsored by the APTA Section on Health Policy and Administration.]

    Collaborations

    COVID-19: Minimizing the Impact of Social Distancing for the Older Adult
    Recorded webinar
    Representatives from the APTA Home Health Section, APTA Academy of Acute Care Physical Therapy, the APTA Section on Health Policy and Administration, and APTA Geriatrics and its Cognitive and Mental Health Special Interest Group discuss ways individuals, their families, caregivers, and PTs and PTAs can help minimize the impact of isolation being experienced by many older adults.

    Post-Acute Exercise and Rehabilitation (PACER) Series
    Webinar Series
    This continually growing series of webinars is an initiative shared by multiple APTA sections and academies to increase practitioner proficiency in cardiovascular and pulmonary physical therapy. Currently available modules include information on examination, geriatric considerations, pediatric considerations, cardiovascular anatomy and physiology, pulmonary rehabilitation, and COVID-19-specific considerations. See information on specific modules under the component headings.

    Academy of Acute Care Physical Therapy

    Laboratory Values Interpretation Guide
    Online resource
    The academy's Practice Committee updated the Laboratory Values Interpretation Resource to better align with emerging evidence, current practice, and practitioners’ clinical decision-making needs.

    Clinical Best Practices in Physical Therapy Management
    Recorded webinar
    Highlights current insight into pathophysiology and medical management of COVID-19, including its widespread acute inflammatory microvascular changes resulting in multisystem effects.

    Academy of Clinical Electrophysiology and Wound Management

    Statement on Wound Care as an Essential Service
    Position statement
    This statement from the Alliance of Wound Care Stakeholders supports wound care as essential to help prevent worsening of complicated wounds and reduce the influx of patients in EDs and inpatient admissions.

    Statement on Preventing Injury With N95 Masks
    Position statement
    From the National Pressure Injury Advisory Panel are position statements and review of current evidence regarding facial pressure injuries associated with N95 mask use.

    Protecting Facial Skin Under PPE N95 Face Masks
    Infographic
    An easy-to-understand guide from NPIAP on protecting facial skin is suitable for printing out and displaying.

    Academy of Aquatic Physical Therapy

    Is COVID-19 Spread Through Water?
    Blog post
    The Academy of Aquatic Physical Therapy is referencing the CDC for the most-up-to date information on the question of whether or not COVID-19 is spread through swimming pools.

    Cardiovascular and Pulmonary Section

    PACER Series: Cardiovascular and Pulmonary Examination
    Recorded webinar
    This course will explain how to conduct an examination of the cardiovascular and pulmonary systems, including the four components of a chest examination.

    PACER Series: Cardiovascular and Pulmonary Anatomy and Physiology
    Recorded webinar
    This course describes the anatomy, histophysiology, and pathology of COVID-19.

    PACER Series: Pulmonary Rehabilitation
    Recorded webinar
    This course examines pulmonary rehabilitation for people with COVID-19 in the postacute setting, with a look toward outpatient pulmonary rehab.

    APTA Geriatrics

    PACER Series: Geriatric Considerations, COVID-19
    Recorded webinar
    This one-hour course will provide clinicians with an overview of how and why COVID-19 has had such a significant impact on older adults.

    Resources for PTs and PTAs Teaching Online Geriatric Content in Academic Programs
    Recorded webinar
    For PTs and PTAs working in academic settings who teach geriatric content and are affected by campus shutdowns related to the COVID-19 pandemic: sharing of knowledge and resources to promote immediate and effective online teaching resources and strategies.

    Home Health Section

    OSHA Guidance on Preparing Workplaces for COVID-19
    Guidance document
    These OSHA guidelines include information on personal protective equipment and protection of workers with high risk of exposure.

    Home Health Agencies: CMS Flexibilities to Fight COVID-19
    Guidance document
    A CMS roundup of the ways in which recent COVID-19-related waivers apply to home health agencies.

    American Council of Academic Physical Therapy

    Lessons from the Trenches: The Nuts and Bolds of Implementing a Lab Immersion Webinar
    Live webinar, May 21, 1 p.m.-2 p.m. ET
    Dr. Casey Unverzagt and Dr. Brian Young share the nuts and bolts of hybrid learning and immersive lab instruction developed by the Baylor University DPT Program.

    Open Forum for Clinical Education
    Discussion board
    The discussion board does not require ACAPT membership, but you will need to register with the ACAPT database to access the discussion.

    Clinical Education Communication Tips During COVID-19
    Guidance document
    Tips on being mindful in your approach to conversing with various clinical education stakeholders.

    Academy of Pediatric Physical Therapy

    PACER Series: Pediatric Considerations
    Recorded webinar
    This course explores the statistics of pediatric COVID-19, sequela of the disease including heart and lung function, how lung development plays a role in disease’s course, and appropriate outcome measures and interventions following the acute phase of the disease.

    Section on Health Policy and Administration

    Telehealth PT Patient Satisfaction Survey (scroll down on HPA's COVID-19 page and look for "Complete the Telehealth PT Patient Satisfaction Survey" header)
    Patient resource
    This patient satisfaction survey was developed to capture the voice of the customer related to their telehealth experience.

    Acute Care Physical Therapy and COVID-19: How Can We Add the Greatest Value? (part one)
    Recorded webinar
    A recording and handouts that provide considerations and tips for navigating health care in the acute care setting during the pandemic. Resources and links for additional information are included.

    Audio and Video Telecommunications Systems (scroll down on HPA's COVID-19 page to find)
    Blog post and related resources
    Resources and points to consider prior to engaging in telehealth, including a link to a spreadsheet of vendors that provide audio and video telecommunications services that could be used for telehealth.

    APTA Private Practice Section

    Managing Your Practice Through the Pandemic — Next Steps
    Recorded webinar
    A panel discussion looking at how five practices, from small to large and with varying situations, are each responding to keep their practices going through this crisis, especially as many states begin the early stages of lifting bans.

    Your Guide to Free COVID-19 Webinars and Facebook Live Recordings From APTA and Others

    The association, in partnership with its components and other organizations, has amassed a great collection of learning opportunities — all free to members and nonmembers.

    The COVID-19 pandemic has challenged the physical therapy profession on several fronts — not just in terms of providing needed care, but in keeping up with continually evolving practice, payment, health care delivery, and advocacy issues.

    As the pandemic began taking hold across the country, APTA and its components were there with timely, insightful webinars and Facebook Live events that connect viewers with peers and experts. We've been learning from and listening to each other in historic and important ways, and leveraging the power of our community, together.

    The result: a lot of very relevant content in a very short amount of time, which means it's entirely possible that you may have missed something of interest along the way. Fortunately, nearly everything has been recorded. Here's a rundown of most of what's available to date — all free to members and nonmembers.

    Clinical Guidance: A Multi-Module Collaborative Effort

    The APTA Academy of Acute Care Physical Therapy, the APTA Section on Health Policy and Administration (HPA the Catalyst), and the APTA Cardiovascular and Pulmonary Section combined forces with to create a multi-module series that connects you with the experts. You can download the sessions separately or in a bundled package.

    Acute Care Physical Therapy and COVID 19: How Can We Add the Greatest Value? Part One. Clinical practice considerations and trends including assessing lab values and imaging results, differentiating ventilator versus non-ventilator patients, positioning.

    Acute Care Physical Therapy and COVID-19: How Can We Add the Greatest Value? Part 2. A deeper dive into the concept of thoughtful triaging and targeting PT resources to add the greatest value, including leveraging real-time audiovisual technology.

    COVID-19: Clinical Best Practices in Physical Therapy Management. This edition focuses on clinical practice considerations.

    COVID-19: Minimizing the Impact of Social Distancing for the Older Adult. A session aimed primarily at older adults, caregivers, and therapists looking for ideas on how to minimize the impact of isolation among older adults.

    Physical Therapy Considerations of COVID-19 in the Post-Acute Setting. A follow-up webinar to the "How Can We Add the Greatest Value" webinars presented in March that provides updates and a deeper exploration of clinical issues.

    Physical Therapy Considerations of Neurologic Presentations in COVID-19. A review of emerging evidence of neurologic impairments found in patients with COVID-19, including discussions on physiology and anatomy, neurological vital sign considerations, impact of medications, and assessment and treatment considerations when evaluating this population.

    Meeting the Challenge of Postacute Care: The PACER Series

    PACER stands for Post-Acute Exercise and Rehabilitation Project, a training program aimed at helping PTs from any training or experience background to better understand the needs of the patient in the postacute care phase. It's an understanding that will be crucial as the profession begins to treat survivors of COVID-19. The PACER series offered by the APTA Learning Center is presented through a collaborative effort from the APTA Cardiovascular and Pulmonary Section, the APTA Academy of Acute Care Management, and the APTA Section on Health Policy and Administration. Courses may be downloaded separately or as part of a bundled package. Note: the series isn't over--new modules will be added over the coming weeks, so be sure to revisit.

    Telehealth

    Digital Telehealth Practice: Connect for Best Practice, Compliance, and Health Care. An exploration of the state of telehealth as of early April 2020. Topics include coverage status, APTA's advocacy efforts, and best practices.

    HIPAA and Telehealth. Information on how to comply with HIPAA and the professional code of ethics when providing telehealth.

    Implementing Telehealth in Your Practice STAT: Practical Guidance From Experienced Telehealth PTs. PTs with experience providing telehealth services discuss how they manage patients and deliver care, as well as share their perspectives on clinical decision making in digital care delivery.

    Implementing Telehealth in Your Practice STAT: Practical Guidance From Experienced Telehealth PTs (Q&A) (Facebook Live recorded event). This Q&A session is a follow-up to the recorded webinar of the same name.

    Increasing Physical Therapist Acceptance of Telehealth. APTA partnered with the Veterans Administration to create a course that explores why some clinicians are reluctant to embrace telehealth, and provides a model to improve adoption.

    Digital Telehealth Practice - Connect for Best Practice, Compliance, and Health Care (Facebook Live event recording). Topics include the status of PT telehealth coverage during COVID-19, as well as an update on coverage generally and where things stand on PTs’ ability to practice telehealth according to scope of practice acts (recorded April 7, 2020—some policies may have changed).

    Practice Management

    Managing Your Practice Through the Pandemic: Next Steps. A recording of a panel discussion focused on how five practices, from small to large and with varying situations, are each responding to keep their practices going through this crisis, especially as many states begin the early stages of lifting bans.

    Outpatient Physical Therapy During the COVID-19 Pandemic: A Clinician Discussion (Facebook Live event recording). Outpatient PTs from private practice, hospital, and pediatric settings discuss how they have maintained in-person practice while upholding CDC-recommended COVID-19 safety guidelines. Also available via YouTube.

    The Impact of COVID-19 on the Mental Health of the Patient and Clinician (Facebook Live event recording). Experts from physical therapy, psychology, and the Pan American Health Organization discuss the impact of COVID-19 on mental health and how physical therapists play an important role in the recovery of patients' mental and physical health. Presenters will share experiences from working on the frontlines of COVID-19.

    COVID-19: Adapting Your Practice (Facebook Live event recording). PTs who have changed their care models to adapt to the COVID-19 health crisis discuss how they modified their practices in response to the pandemic, and share innovative strategies to provide PT services to patients in need.

    Advocacy, Health Care Disparities, International Response

    Health Disparities Brought to the Forefront as COVID-19 Spreads: What the Physical Therapy Profession Can Do (Facebook Live event recording). Experts in physical therapy and public health discuss the impact COVID-19 has had on the United States, including how the pandemic interacts with existing geographic, economic, racial, and age-related health disparities.

    APTA Policy Priorities and COVID-19 – Q & A (Facebook Live event recording). APTA staff members Justin Elliott, vice president, government affairs, and Kara Gainer, JD, director of regulatory affairs, discuss what’s happening in Congress, what's to come, and what APTA is doing to advocate on behalf of the profession.

    International PT Response to COVID-19: Canada and the United Kingdom (Facebook Live recorded event). Presenters provide an overview of disaster phases and epidemiological information on COVID-19, experiences from past disasters, an overview of the response to COVID-19 in Canada and the UK, and global initiatives in the response and recovery phases COVID-19.

    International PT Response to COVID-19: Colombia and Peru (Facebook Live recorded event). This discussion features Nancy Molina, president of the Colombian Physical Therapy Association, Gabriela Mallma, president of the Peruvian Physical Therapy Association, and Ana Herrera, PT in Peru. Participants describe how the COVID-19 pandemic has affected their countries, the response of each government, and how PTs are challenged by insufficient PPE and other difficulties to providing services. They also describe how PTs are finding innovative ways to care for their communities.

    Movement is Life Health Disparities Podcast. This podcast series, from the organization whose mission is to decrease disparities by raising awareness of their impact on chronic disease management and quality of life, now includes episodes that look specifically at the COVID-19 pandemic. APTA is on the MIL steering committee.

    APTA Advisory: PTA, OTA Home Health Maintenance Therapy Codes Released for Use Beginning in October

    CMS MACs now have the G-Codes to allow HHAs to record the change that began on January 1. But don’t use them yet.

    Since January, a rule change long supported by APTA has been in place that allows PTAs and occupational therapy assistants to provide maintenance therapy for home health agencies under Medicare Part A, with certain restrictions. But something was missing — namely, the distinct codes that indicate when that type of service was being delivered.

    The codes are now identified, but it’s premature to start using them quite yet.

    Last week, CMS issued a change request to its Medicare Administrative Contractors with instructions for HHAs on the G-codes that indicate when maintenance therapy is provided by a PTA or OTA. The codes were introduced to help CMS more accurately track how much maintenance therapy is being provided by therapy assistants.

    The two new G-codes are:

    • G2168: "Services performed by a physical therapist assistant in the home health setting in the delivery of a safe and effective physical therapy maintenance program, each 15 minutes." (short descriptor: Svs by pt in home health)
    • G2169: "Services performed by an occupational therapist assistant in the home health setting in the delivery of a safe and effective occupational therapy maintenance program, each 15 minutes." (short descriptor: Svs by ot in home health)

    The change goes into effect on October 5, and applies to dates of service as far back as January 1, 2020. In the meantime, HHAs should continue to report G0157 and G0158 for PTA or OTA services provided in 2020.

    [Editor's note: While the rule change that started in January opens up the possibility for maintenance therapy provided by therapy assistants, certain requirements need to be met: the services must be provided by way of a maintenance program established by a qualified therapist under the Medicare home health benefit, and the services must be permitted by the relevant state practice act.]

    Fall Event Helps Sharpen Grant Writing, Research Proposal Skills

    The GAMER workshop offers a one-of-a-kind opportunity to learn from faculty experts and funding source representatives.

    The world of research funding and grant proposals is complex. Now you can acquire tools to help you thrive in this sometimes-daunting environment.

    Now open for registration: this year's Grantsmanship & Mentorship in Education Research workshop, a four-day event that connects physical therapy scholars with a nationally recognized group of PT mentors that includes faculty and representatives from potential funding sources. The GAMER workshop is sponsored by the American Council of Academic Physical Therapy, the APTA Academy of PT Education, and APTA.

    Scheduled for October 29-November 1 at the Medical University of South Carolina in Charleston, the workshop helps attendees develop grant-writing skills, polish proposals, understand funding options, and advance the science of physical therapy education and practice.

    Space is limited. Registration deadline is June 15.

    COVID-19 Research Updates and Perspectives

    Recent publications address home- and community-based care, post-intensive care syndrome, cardiac rehab, performance screening, neurologic effects of the virus, and the potential role of exercise as protection against organ system damage.

    The COVID-19 pandemic may be far from over, but clinicians and researchers already are evaluating lessons learned, attempting to identify factors related to poor outcomes, and proposing potential models of care as patients return home — and into rehab.

    The resulting articles, often put on a fast-track for publication and made available for free by journals — including APTA's scientific journal, PTJ — provide both research findings and clinical perspectives. Here's a collection of recently published studies and opinion pieces relevant to COVID-19 and physical therapy.

    PTJ Advance Access

    COVID-19 and the Advancement of Digital Physical Therapist Practice and Telehealth
    "The global pandemic has thrust the physical therapy profession and our society into digital physical therapist practice and telehealth," writes Alan C. W. Lee, PT, DPT, PhD, but many clinicians may lack competencies in this area. The author provides recommendations on digital physical therapist practice and poses critical questions the profession must answer as it looks toward the future of digital PT practice. Lee writes on behalf of the Digital Physical Therapy Practice Task Force of the World Confederation for Physical Therapy and the International Network of Physiotherapy Regulatory Authorities.

    Home and Community-Based Physical Therapist Management of Adults With Post-Intensive Care Syndrome
    In a perspective article, authors discuss the prevalence and clinical presentation of PICS and offer recommendations for physical therapist examination, developing plans of care, and intervention.

    According to authors, many PTs may not be aware of the syndrome, which involves both physical impairments, such as decreased muscle strength and pulmonary function, and cognitive impairments. Authors note that around half of patients who have experienced ARDS (acute respiratory distress syndrome) also have cognitive impairments that persist long after their release from the hospital. As part of an interprofessional team, home health and outpatient physical therapists are "ideally positioned to address the reduced functioning and participation associated with PICS," authors write.

    In a related PTJ Podcast, co-authors Patricia Ohtake, PT, PhD, and James Smith, PT, DPT, discuss how PICS can affect return to work, as well as the individual's family.

    The Essential Role of Home- and Community-Based Physical Therapists During the COVID-19 Pandemic
    From the point-of-view article: "For many patients, participation in physical therapist interventions reduces risk of hospitalization and allows them to remain at home instead of requiring nursing home-level care — both essential public health goals during a viral pandemic that is currently overwhelming hospital and nursing home capacity. Abdicating these essential roles — and allowing our profession to be designated as nonessential and our urgently needed interventions to be viewed as optional in a time of crisis — may disproportionately harm the most vulnerable patients and send a troubling message to payers and the general public about our value as physical therapists." The article was funded in part through a Foundation for Physical Therapy Research grant made possible through a donation from APTA.

    In a related PTJ Podcast, co-author Jason Falvey, PT, DPT, PhD, lays out pressing challenges facing the physical therapy profession, research priorities, and key opportunities as a result of the COVID-19 pandemic.

    Impact of COVID-19 on Physical Therapist Practice in Portugal
    Physical therapists in Portugal write about the challenges they face in determining what qualifies as "urgent" care and suggest strategies for reducing risk of infection for the PT. Authors write, "If the COVID-19 crisis lingers for a long time, physical therapists may start shifting their practice toward therapeutic exercise and away from passive techniques that require close proximity."

    Italian Physical Therapists’ Response to the Novel COVID-19 Emergency
    Physical therapists in Italy describe how their colleagues have responded and adapted their practice in the wake of COVID-19, and share insights they have gained from their experience thus far. Physical therapists, they write, "are first and foremost health professionals and, before that, citizens who want to make their contribution to support the whole population and all the components of the health system responding to this emergency."

    From Around the Web

    Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff (Cochrane Database of Systematic Reviews)
    A new Cochrane systematic review found that "covering more parts of the body leads to better protection but usually comes at the cost of more difficult donning or doffing and less user comfort," and thus could increase the risk of contamination. To decrease the risk of contamination and reduce errors, authors suggest modifying PPE design to make it easier to use, following donning and doffing guidance from the Centers for Disease Control and Prevention, and providing face‐to‐face training in PPE use.

    Respiratory Muscle Performance Screening for Infectious Disease Management Following COVID-19: A Highly Pressurized Situation (American Journal of Medicine)
    Researchers hypothesize that impaired respiratory muscle performance, which is linked to poorer baseline health, is "an underappreciated factor contributing to poor outcomes" in COVID-19 patients. Authors offer a theoretical patient management model to screen for impaired respiratory muscle performance and potentially intervene with respiratory muscle training. The article was funded in part through a Foundation for Physical Therapy Research scholarship awarded to lead author Richard Severin, PT, DPT, board-certified clinical specialist in cardiovascular and pulmonary physical therapy, made possible through a donation from APTA.

    The role of physical and rehabilitation medicine in the COVID-19 pandemic: the clinician’s view (Annals of Physical Medicine & Rehabilitation)
    In a letter to the editor, authors describe the effects of COVID-19 on the respiratory system and central nervous system, as well as virus-related cognition, deconditioning, critical illness-related myopathy and neuropathy, dysphagia, joint stiffness and pain, and psychiatric problems. They also provide suggestions for how rehabilitation could be modified in light of social distancing and in consideration of a patient's condition.

    Extracellular superoxide dismutase, a molecular transducer of health benefits of exercise (Redox Biology)
    Authors review the literature on an antioxidant, extracellular superoxide dismutase (EcSOD), and the role it plays in protecting organ systems from oxidative stress and related disease conditions. Because studies have shown that exercise can increase the production of EcSOD, authors propose that endurance exercise could help protect against cardiovascular disease, pulmonary disease including ARDS, and multiple organ dysfunction syndrome.

    COVID-19: A Time for Alternate Models in Cardiac Rehabilitation To Take Center Stage (Canadian Journal of Cardiology)
    Authors of an editorial propose a care delivery model of "technology-driven cardiac rehabilitation" that includes a wide array of technologies, including smartphones, mobile apps, websites, and wearable sensors.

    Neurologic Features in Severe SARS-CoV-2 Infection (New England Journal of Medicine)
    In a correspondence, physicians in Strasbourg, France, share their observations on 58 patients admitted to the hospital who developed ARDS due to COVID-19. In these patients, authors found that ARDS was linked to encephalopathy, agitation and confusion, and corticospinal tract signs.