Navigating Health Coverage During a Pandemic: Three Options
By Kate Gilliard, JD
While policy makers at all levels are working to respond to the COVID-19 public health emergency and get the country back to normal, the unfortunate truth is millions of people have lost their jobs and consequently lost their health coverage. This is true for PTs, PTAs, and the patients they treat.
So, what happens when you find you find yourself without coverage? And if your patients need to find alternative coverage, how could that affect the services you provide? Here are the three most common options available.
Keep in mind that this post does not constitute legal advice, and you should speak with an attorney or licensed insurance producer for more information. Also note that APTA cannot respond to individual questions about a specific situation; so any comments asking for this type of feedback will go unanswered.
U.S. Department of Labor COBRA webpage
Employee Benefits Security Administration's Employee's Guide to Health Benefits under COBRA
If you or your patient recently lost access to employer-sponsored health insurance, the first option in maintaining coverage is COBRA. The Consolidated Omnibus Budget Reconciliation Act, from which COBRA gets its name, gives workers and their dependents the right to maintain their health insurance benefits for limited periods of time under certain circumstances including involuntary job loss. This means you keep the exact same plan you had while you were employed, with identical benefits.
COBRA is a federal requirement, so it's available in all 50 states, and covers all group health plans offered by private sector employees with 20 or more employees, as well as state and local government plans. Your health plan and/or employer is required by law to provide you information on COBRA if you qualify. Information about what COBRA plans are available to you and how much they will cost should come from your human resources department or directly from your health insurance carrier.
COBRA and Your Patients
If your patient was able to see you for a reasonable copay under their employer-sponsored coverage, that should not change if she or he elects to enroll in COBRA. However, the employer probably will discontinue paying any of the premium, which means this option may be too expensive, especially for those without an income. Some employers offer to pay COBRA premiums for a limited amount of time after separating with an employee, but they are not required to do so.
Keep in Mind …
If you think you're entitled to COBRA, but haven't received any info, contact your HR department as soon as possible, as you only have 60 days to sign up. COBRA coverage due to job loss can last for up to 18 months; sometimes longer if other qualifying events occur.
Another consideration outside of COBRA: Let's say you are employed but are enrolled in your spouse's or other family member's plan instead of your employer's plan — and then the family member loses their job. There's a strong chance you can enroll you and your family with your employer's plan, if they offer coverage, even if it's outside open enrollment. Contact your HR team as soon as possible to find out how to enroll and what your options are. This also works the other way around: If you lost coverage but your spouse is still employed and her or his employer offers coverage, you might be able to enroll on their plan.
Zipcode-based search for marketplace coverage options
If COBRA isn't an option or your coverage has expired, you may choose to look to your state's health care marketplace. Most states use the federally facilitated marketplace, although many states have their own marketplace. The link to the zipcode-based search above can help you find out what's available in your area.
You are eligible for a subsidy to reduce your monthly premium payment if you make less than 400% of the federal poverty level ($49,960 for an individual or $103,000 for a family of four) as well as additional subsidies that reduce your cost-sharing, copays, and deductibles. You also can purchase additional coverage such as dental and vision insurance through the marketplace.
The Marketplace and Your Patients
Plans sold on the marketplace are subject to the Affordable Care Act's essential health benefits provision, which requires 10 major benefit categories to be covered by all plans (to some extent). This includes habilitation and rehabilitation services, meaning every plan on the marketplace covers physical therapy. However, prior authorization and visit limits vary from state to state and plan to plan, so patients on a marketplace plan could face certain restrictions. Patients shopping for plans should be encouraged to carefully review the way in which plans cover essential health benefits.
Keep in Mind …
Usually, you can only join a plan during the open enrollment period, but losing coverage due to a job loss qualifies you for a special enrollment period, during which you may enroll in marketplace coverage anywhere in the country. You should determine your options as soon as possible, as most special enrollment periods require you to enroll within 60 days of the qualifying event.
Listing of state Medicaid agencies
KFF List of Medicaid programs that cover physical therapy
If your income is low enough, you may qualify for Medicaid. The requirements vary greatly from state to state, so to determine if you qualify, you need to visit your state's Medicaid website (check out the link above).
Medicaid and Your Patients
Physical therapy is not a mandatory benefit in Medicaid. Some states cover it with visit limits, or only for certain populations (such as pediatrics), while others don't cover it at all. The online resource from The Kaiser Family Foundation, listed above, identifies which states' Medicaid programs cover physical therapy.
Keep in Mind …
If you make too much to qualify for Medicaid, but have children who need care, be sure to see if they qualify for the Children's Health Insurance Program, which provides care specifically for children in this situation.
Kate Gilliard, JD, is a senior regulatory affairs specialist at APTA.
Outpatient Services During a Pandemic: Finding Your Ethical Footing
By Debra Gorman-Badar, PT, MA
The COVID-19 pandemic and our public health response has tested the tension between two social goods — our health safety and our economic security. Within the stark limitations of our businesses, government agencies have deemed physical therapist services "essential" leaving it to outpatient physical therapy clinics and hospital departments to make the professional decision to continue to provide services. Especially concerning are in-person outpatient services.
Many are relying on their intuition to make these decisions. However, ethical decisions based on personal ethical intuitions are often unclear, dubious, and debatable. As a health care ethicist, I find the reasoning processes of health care ethical deliberation can give us more concrete guidance to discuss and decide our good, right, and reasonable actions during unprecedented and uncertain times.
Before proceeding, we must address three considerations.
First, the science of COVID-19 is not fully understood. We, as physical therapists, rely on scientific experts and public health officials to keep us informed of the "best evidence" regarding COVID-19, which seems to change weekly, if not daily. Therefore, we must be judicious in using this uncertain and shifting expert knowledge as the foundation for our decisions.
Next, our public health response to the COVID-19 pandemic is about surviving, not thriving. Outpatient physical therapist services are not emergency, or even urgency, services in health care. Certainly, our patients have disabilities that enormously benefit from our services, but those who need us most during this time — the elderly and the severely disabled — are the very ones that need to "stay home, stay safe."
Last, as health care professionals our first priority is always our patient’s well-being. We all know health care providers who are "only in it for the money" — an attitude gravely contrary to both sociological and philosophical definitions of professionalism. During the COVID-19 pandemic, decisions cannot be made primarily for a provider's economic well-being.
The current relationship between our two social goods of health safety and economic security requires creative thinking and decision-making. In circumstances such as these, when we're reminded of our interconnectedness and interdependence, it's useful to look at possible courses of action through a four-category framework: What actions are prohibited? What acrtions are ideal? What are permitted? What are required? In categorizing our actions, we should consider the consequences and trade-offs of different actions, our professional responsibilities and obligations, and the virtues needed to make the right decisions at the right time in the right place.
Most important, we are ethically required to think deeply and discuss widely when deciding how we are providing services. This necessitates risks-benefits analyses, selecting patients for the allocation of services and how they receive services, and always relying on patients to make the best decisions for their health and lives. We must follow the principles of our Code of Ethics and exercise the virtues held by our profession that call for prioritizing our patients, while also considering our economic obligations and commitments. Finally, we must balance our relationships in considered and creative ways that integrate the multiple human stories of the COVID-19 pandemic.
Our society, which values individualism, is being asked for a communitarian response to a pandemic. We are being asked to consider, both individually and collaboratively, which goods and how much of those goods we need from others and society. In addition, we are being asked if and how we can help provide those goods to others. Political decisions to reopen the country are being made even though the high and intense levels of testing and contact tracing recommended by many public health experts are not yet happening. Public health officials are predicting multiple waves of infection rates that may require returning to social distancing and further economic closures. This heightens the need for well-thought decisions for providing outpatient physical therapist services.
I am unceasingly amazed at the creativity and resourcefulness of physical therapists and physical therapist assistants. No "best" decision exists. However, there are better ways to think through and reason to the decisions we are being asked to make. Well-informed, thoroughly-discussed, and morally balanced decisions about how and when to provide outpatient care, especially in person, are needed. Within local settings and specific contexts, good, reasonable practitioners will make different decisions regarding how to care for all those who need them. During COVID-19, it is our professional skill in knowing how to creatively adapt, adjust, and cope — skills we teach our patients every day — that will bring us through these uncertain and unprecedented times. My hope is that we will all have a story we are proud to tell.
Debra Gorman-Badar is a doctoral candidate at the St. Louis University's Albert Gnaegi Center for Health Care Ethics
Post-Pandemic: APTA Fellows Weigh In on How COVID-19 Could Change — and Challenge — the Profession into the Future
While there's still much to be done to flatten the curve and make our way out of the COVID-19 pandemic, at some point the peak phase of the pandemic will pass, and we'll find ourselves on the other side of the most challenging health care crisis of the generation. But that eventuality begs a question: What then?
That's what nearly every facet of the country's health care system will (or should) be asking itself, and the physical therapy profession is no exception. What will be some of the physical therapy community's biggest challenges as the country emerges from the peak of the pandemic? What do we need to learn now to provide the best possible care in the coming months? Could this experience lead to positive change? If so, what kind?
The PTTransforms blog posed these questions to APTA's Catherine Worthingham Fellows — recipients of the association's highest honor for professional leadership and achievement. Fellows are recognized for their ability to see both the big picture and its components. They connect the dots between the profession's history, its current challenges, and possible ways forward. In other words, they're the people you want to hear from when the question is "Where do we go from here?"
This is what they had to say.
Carole Lewis, PT, DPT, PhD, FAPTA, editor-in-chief of Topics in Geriatric Physical Therapy and an adjunct professor at George Washington University
Future-proofing our profession relies on being indispensable. We must be smart, flexible, and creative. More than ever, we need to take risks and challenge ourselves to practice at the top of our license. Complacency and hoping for a return to the old normal will not help us thrive.
The current disruption calls for a renewed focus on improving our ability to help our patients. We must continue to hone our skills and constantly monitor our outcomes. Use down time to learn — whether that means becoming skilled in remote delivery or learning new treatment protocols. Communicate more by writing and sharing our expertise through whatever means available. Therapists have started YouTube channels and blogs, and have written for local groups. This crisis is an opportunity for us to position ourselves as essential, not optional. We all have a hand in determining our future. What will you write today?
Rebecca Craik, PT, PhD, FAPTA, dean of the College of Health Sciences at Arcadia University and former editor-in-chief of PTJ
A significant challenge we face as the country emerges from the peak of the pandemic is the lack of public awareness of the role that physical therapists are playing in COVID-19 recovery – in the acute care setting and beyond! While the focus of the media is on the incredible role that physicians and nurses are playing on the front line, there are few stories about the role that other health care professionals play. For example, the role that physical therapists play in helping shorten time on the ventilator and promote mobility. Also, the need for physical therapists and physical therapist assistants to help restore strength and functional performance in deconditioned patients who survive.
I see at least two challenges to our profession's ability to thrive as we emerge from this crisis. First, we need public testimony and research evidence that physical therapists are vital members of the hospital health care team, and that telehealth optimizes our ability to promote mobility of patients who have been discharged to home. Second, high school and college students seeking ways to serve in the "new world" are not seeing "virtual" role models or stories to attract them to our profession. How will we recruit the next generation of physical therapists and physical therapist assistants?
Ellen Hillegass, PT, EdD, CCS, FAPTA, president and CEO of Cardiopulmonary Specialists and an associate professor at Mercer University
Postacute COVID patients need PTs and PTAs to treat them holistically. These patients may have cognitive, depression, and isolation issues due to the disease. They have muscle weakness, endurance impairments, neuro issues…and, first and foremost, cardiovascular and pulmonary issues. It will take a long time to get back to where they were. They need therapists who understand all of these matters.
We should be prepared for a patient who has multiple specialty needs — no more "orthopedic" or "neuro" patient, but, rather, patients who have impairments that cross the barriers of our specialties. In order to provide the best possible care in this environment, we must learn what our weaknesses and strengths are, individually and facility-wide. Then, we need to know who to reach out to for help in addressing those weaknesses, and to provide the same kind of help to others. We must be more collaborative. I'm seeing this happening already. Lately I've noticed a decrease in the silos of APTA sections and academies. They're working together like they never have done before. Maybe this will help contribute to more collaborative care of the patient between specialties and, ultimately, to better patient care.
William O'Grady, PT, DPT, MA, FAPTA, former CEO of Olympic Sports and Spine Clinics, adjunct faculty member at Baylor University, and a board-certified clinical specialist in orthopaedic physical therapy
We need to prepare to integrate the changes that will be necessary in order to protect patients and staff alike when more patients resume office visits. This should include how to schedule patients so they continue social distancing, and having the proper equipment and supplies onsite to sanitize equipment and items with which patients have contact. I believe standard operating procedures should be developed for each type of clinic for screening, hygiene, and facility traffic management. This will help us safely manage our clinics and ensure proper screening techniques for patients entering our clinics. Some type of quick screening tool should be available for each visit.
In the long term, I would hope people will become more serious about hygiene, and that we'll see better clinic sanitation practices. I would also hope that more telehealth services will be reimbursed. At times when patients cannot come into the clinic, telehealth can enhance compliance — and it may ultimately help with cost containment, as well.
Stacey Dusing, PT, PhD, FAPTA, Sykes Family Chair of Pediatric Therapy, Health, and Development, University of Southern California
Pediatric physical therapy has always required a lot of creativity and parent engagement. The COVID pandemic has pushed us to look more critically at how we provide care, what parents can realistically do at home, and how best to engage and support parent and children remotely from both a medical and educational perspective. I am inspired by the creativity I have seen from therapists in all settings over the last few months. As we move forward, the am hopeful that therapists, administrators, parents, and researchers can work together to document telemedicine strategies that can be used in combination with in-person visits to enhance the efficacy and cost-effectiveness of interventions. However, research is needed to validate remote assessments and evaluate the efficacy of telerehabilitation. In addition, advocacy will be needed to ensure evidence and best practice are used to determine which innovations we should continue following the COVID pandemic.
Bruce Greenfield, PT, PhD, FAPTA, professor of physical therapy at Emory University
A consequence of the coronavirus pandemic is growing reliance on online education for clinical care. Traditionally used to reach patients in rural areas, livestreaming telehealth will likely become part of standard methods of practice across all health care settings. We can expect changes in treatment paradigms that rely less on hands-on practice and more on alternative, evidence-based pathways of care to accommodate offsite treatment. Different paradigms can influence outcome measures and value-based care.
There are also legal, ethical, and reimbursement challenges. Physical therapist who plan to use telehealth must consider that the state may require specific legislation to be in place beforehand. Ethically, physical therapists must adhere to standards of practice that preserve their fiduciary responsibilities to the patient. Most significantly, while temporary waivers now allow physical therapists to provide telehealth in some settings under the Medicare physician fee schedule, these waivers are set to be lifted once the public health emergency ends, once again leaving physical therapists without statutory authorization to provide these services.
The question is, are we ready to effectively use telehealth? It can be a benefit or a burden. Physical therapy educators should be prepared to integrate telehealth as part of the standard curriculum. Research is needed to assess the efficacy and effectiveness of telehealth as a method of clinical care.
Jody Frost, PT, DPT, PhD, FAPTA, president of the National Academies of Practice
This pandemic will challenge the profession to rethink and redesign how to provide physical therapy focused more on clinical reasoning, movement diagnostics, decision-analysis, and patient engagement as partners in a care plan, rather than "hands-on" techniques." We should also be ready for greater interprofessional collaboration with our health care colleagues to improve patient outcomes, and to provide better-coordinated care and preventive care at less cost. The profession will need to provide evidence of how physical therapy made a difference for patients during COVID-19, as defined by where and how we are "essential" to patient-centered care. PTs and PTAs who lost their positions because of the pandemic will reenter the workforce facing care demands that may require retooling in some cases.
From the perspective of physical therapy education and accreditation, there will need to be accommodations for virtual learning approaches, expansion of hybrid curricular models, and reduction in program length for learners to enter practice using competency-based education. Likewise, providing effective new and innovative models for clinical education will be a priority — based on evidence, practicalities of the real world, use of coaching models, more frequent feedback. and low-stakes assessment to drive best practices in clinical education. Higher education will reexamine the educational enterprise, including cost-cutting measures, redefining the role of faculty, investing in online/virtual learning platforms and training, re-examining the meaning of campus life and diversity, and accommodating greater variability in a learner-centric environment.
Cathy Ciolek, PT, DPT, FAPTA, vice president of APTA Geriatrics
As the United States emerges from COVID-19, we have the opportunity to reshape physical therapy care for aging adults. The pandemic has exposed an existing ageism, with media, politicians, and some physical therapists describing people over 65 as frail and by implication sacrificial. That is not true; if we have learned anything from this experience, it is that individualized assessment and person-centered care are essential to promote physical activity and functional mobility.
We need to establish physical therapy as a key component of an annual wellness visit, with programs that individuals enjoy, and an emphasis on maximizing strength and cardiovascular endurance to reduce comorbidities that may put aging adults at increased risk of communicable diseases. Ageing is a privilege denied to many in society; let's all work together to promote a healthier ageing and future. #AgeOn
Bill Bandy, PT, PhD, FAPTA, professor of physical therapy at the University of Central Arkansas and a board-certified clinical specialist in sports physical therapy
This experience affords us an opportunity to further establish ourselves as an essential profession and to continue to work to strengthen our designation as a primary care provider. We need to expand direct access where needed, and to instruct students at a level where they feel comfortable being an access point in the care of individuals with issues.
During the AIDS crisis we made strong statements on how we should continue to treat people with communicable diseases; we added this to our ethics statements. Even in times of crises and pandemics we should continue to seek to provide safe treatment to patients with pain — instead of sending them to the pharmacy for a script, or telling all those with increasing back pain that they should just tough it out and live with it. I personally believe that we, as a group of highly qualified professionals, can maintain a safe and sanitized environment, using appropriate screening procedures conducive to the health and well-being of our patients, and keep from spreading diseases. We are an essential profession, and we need to maintain care for all those with needs — even in a crisis.
Timothy Flynn, PT, PhD, FAPTA, owner of Colorado in Motion and professor, South College
The virus has shown dramatically that the health of the host matters. We are seeing large inequities in those hospitalized with some of our most vulnerable citizens greatly affected. We need to step up and take action in our role of building resiliency in our communities. Obesity, diabetes, and hypertension are significant risk factors for hospitalization from COVID with 94% of hospitalized patients having at least one risk factor. We need to focus our efforts on improving the health and fitness of our local communities as well as the rehabilitation of those affected.
Babette Seligman Sanders, PT, DPT, MS, FAPTA, professor and assistant chair for student affair in the Feinberg School of Medicine at Northwestern University
We're going to be facing radically different staffing models and a population of individuals who have been very sick with residual from the virus, so we're going to need to be open and flexible to roll with emerging trends.
We must be flexible because there are a number of questions we can expect to face: What are the residual effects of this virus? Will people like telehealth more than we anticipated, and prefer that to in-person physical therapy? What about the pandemic's impact on employment, health insurance, and a patient's ability to meet a copay? How might PTSD and other mental health issues resulting from the virus affect our patient population? Will the backlog for elective procedures mean that we'll be treating more deconditioned patients who had to wait for their surgeries? How do we provide the best support to a population of otherwise healthy individuals who had their ability to be physically active limited?
I don't think we have enough history to really answer those questions, but we may be starting to see trends. I think physical therapy will play an important role, but we'll need to maintain our focus on quality and the needs of individual patients.
Angela Campbell, PT, DPT, president of APTA's Cardiovascular & Pulmonary Section, professor at Springfield College, and a board-certified clinical specialist in cardiovascular and pulmonary physical therapy
The biggest challenge in the postacute phase will be the large numbers of individuals with new cardiovascular and pulmonary impairments in a system that is not prepared to accept them. Traditional pulmonary rehab clinics are few in number, will reach capacity quickly, and are not feasible for many patients to use. Moreover, typical outpatient therapy clinics do not usually see people with CVP impairments as the primary condition for physical therapy management, so they could be unprepared for these patients. Making matters worse, at this time COVID-19 has not been designated as a medical diagnosis that will be covered for reimbursement under "pulmonary rehab" codes. Existing pulmonary rehab programs, therefore, won't be able to treat these patients unless they use physical therapy codes, and many aren't set-up to do so. Physical therapy clinics already have slim reimbursement margins in some areas of the country, so the added burden of one-on-one treatments that these patients will need, along with their potential need for oxygen, makes fiscal operations challenging.
Despite the tragedies of this crisis, there is huge potential for positive change. Telehealth has great potential to improve efficiency in care delivery, mitigate infection-control issues, and provide increased access to care for patients. But perhaps even more important, we have already seen how clinicians are coming out of their section and academy silos to collaborate. This leads to creativity, vitality, and synergy. We truly are #BetterTogether. Postacute practices have an opportunity to demonstrate to the public that physical therapists have a strong medical background and can safely monitor and guide COVID-19 patients to optimized function.
Timothy Kauffman, PT, PhD, FAPTA, fellow of the Gerontological Society of America
The coming challenges will call on us to heighten our skills, because symptoms of COVID-19 in aging persons with comorbidities may not be as clear-cut as in young adults. We'll also need to reject ageism in all treatment settings and in our communities.
In terms of the way we treat, telehealth has proven to be critical, but we must never lose our hands-on care, which can be delivered with personal protective equipment. I also envision rehabilitation evolving toward more home health and away from services delivered in rehab units and nursing homes. In all cases, the best possible care and safety are paramount, but flexibility is requisite due to evolving knowledge, personnel, and supplies.
Positive change could result from this pandemic in the area of telehealth, expanding care to rural communities and prisons. Internationally, this could potentiate providing rehabilitation services to other remote areas of the world.
Ruth Purtilo, BS MTS, PhD, FAPTA, professor emerita at the MGH Institute of Health Professions and at Creighton University, and a past Mary McMillan lecturer
Moral courage — the resolve to move forward with purpose in the face of realistic fear or threat — has never been a more valuable resource for PTs than it is currently. Our professional commitment requires us to stay fit for purpose during a raging worldwide pandemic, And to remain so after the curve flattens and initial attention subsides.
The moral compass for sustaining during the long haul includes setting priorities consistent with our professional colleagues' core values of compassion, competence, and due care — and the courage to express those values. But physical therapists' unique function also requires courage to remain on the front lines when the encouraging societal appreciation expressed toward first responders has become yesterday's news. Physical therapists have played significant first-responder roles in addressing time-tested crises of war, terrorist carnage, and natural disaster. But a closer look at our history and sustained success highlights our focus on quality of life goals of individuals and populations who survive serious acute threats to life but have the will to face whatever new reality they are presented.
The good news is that we as a profession have joined others in declaring "we will get through this — together!" But it will require physical therapists to express stay-with-it courage to realize our quality of life function, with or without the encouragement of society's exuberant expressions of gratitude.
Ethel Frese, PT, DPT, MHS, FAPTA, professor of physical therapy at St. Louis University and a board-certified clinical specialist in cardiovascular and pulmonary physical therapy
Physical therapists will need to be aware of the possible effects of COVID-19 on the cardiac, pulmonary, and vascular systems. It will be incumbent upon PTs to carefully monitor vital signs — including heart rate, respiratory rate, oxygen saturation, blood pressure, and peripheral pulses both at rest and during exercise — in order to make the best clinical decisions regarding exercise prescription. Fortunately, it appears that the majority of people who have gotten COVID-19 do not have significant side effects to these systems, but some people have, so we need to monitor these patients to be sure they are doing well post-COVID-19. Breathing exercises also may be important to include for some of these patients with cardiac and pulmonary dysfunction.
Steve Tepper, PT, PhD, FAPTA, president of Rehab Essentials
From an academic viewpoint, we should be prepared for a paradigm shift. Although our profession and our educational model have traditionally been hands-on, students will most likely be unable to return to campus this summer or even possibly this fall. We will have to implement creative solutions for continued learning. We have a lot of talented people in this profession – let's put our heads together and try our best to fix this.
In a broader sense, I am hoping that this experience will remind each of us of what is truly important in life — our friends and families and the patients we care for. I hope this period of quarantine has facilitated some introspection as to the deeper meaning of life. This is an opportunity to become more mindful.
Ronald De Vera Barredo, PT, DPT, EdD, FAPTA, dean of and professor in the College of Health Sciences at Tennessee State University
In the wake of this pandemic, our profession will need to see to it that our health care systems recognize the role of physical therapy as a viable provider of telehealth services, and we'll need to develop strategies to advocate for the permanence of this role. We'll also need to reinforce the role of physical therapy in acute care, and better define the contributions of physical therapy in a pandemic. To accomplish this, we need to provide both a strong justification for the role of telehealth in the delivery of physical therapy services, and solidly demonstrate through outcome data that our high-touch practice can be delivered safely and effectively. We should also be prepared to conduct an honest evaluation of our professional education and scopes of practice to ensure that we can assist appropriately in battling future pandemics.
The pandemic experience has been pivotal in challenging habituated practice in both the clinical and academic settings. It has brought a great level of discomfort — if not distress — to clinicians and academicians who have been used to the usual and mundane. What we as a profession may have addressed slowly, deliberately, and peripherally prior to the pandemic has now come full circle and become central to our longevity and growth as a profession. My hope is that the current pandemic experience will serve as fertile ground for research focusing on three areas: (a) safe and effective practice, (b) alternative methods of care delivery, and (c) professional roles and scope of practice.
Nancy Kirsch, PT, DPT, PhD, FAPTA, vice-chair of Rehabilitation and Movement Sciences and a professor at Rutgers University
COVID-19 has had, and will continue to have, a profound impact on scientific thought, our political climate, our social structure, and our economic well-being. Physical therapy as a profession felt the immediate impact of the strain on the health care system; misinformation that belied scientific thought; personal, institutional and societal economic challenges; and political performances that showed both the best and the worst of leadership.
While we were separated by social distancing, we were brought together by sheltering in place. Separation made people anxious to come together, to connect. COVID-19 gave us an opportunity to "reset" — to take the time to appreciate our human connections. Similar to other watershed moments in our historical development, lessons learned will move our profession forward, with changes to come in education, delivery of services, and professional and regulatory area. We've learned that we can provide hands-on services in a hands-off environment. Going forward, we can take the best of what we learned and let it enhance our care, to reach more people. As we celebrate our centennial, we can celebrate the fact that challenges always have, and always will, motivate us to continue to move physical therapy forward into further growth and development.
Darcy Umphred, PT, PhD, FAPTA, professor emerita of the Department of Physical Therapy at the University of the Pacific
On the patient side, we can expect to see functional loss in many patients not able to access physical therapy over the last six to eight weeks, in addition to weight gain. Among those in our profession, students or young professionals who aren't able to graduate this June or August or complete their clinicals could suffer financial losses. Our association needs to recognize their emotional devastation and respond to their fiscal hardships. From a broader perspective, this pandemic may bring us to the realization that although we aren't necessarily considered "frontline," regaining function and getting back to life is critical to most people — and that's our area of expertise.
All experiences can lead to positive changes. Exactly what those will be at this moment is unknown. The world has changed, and hopefully we will all be wiser for that and realize that we all have a social responsibility to be part of a larger community, not isolated in our own comfort zones.
Gammon Earhart, PT, PhD, FAPTA, director of the Program in Physical Therapy and a professor of physical therapy, neuroscience, and neurology at Washington University
We need to prepare for ways to ensure access to health care for the underserved, who have been particularly hard hit by this virus, for people facing financial challenges or loss of employment and associated insurance benefits, and for those who may feel unsafe coming into a clinical setting. We also should be prepared to remodel our practice environments to implement new and important safety practices, including patient screening in advance of visits, social distancing, use of masks, and enhanced cleaning procedures.
Additionally, we should be ready to advocate fiercely for our continued ability to provide physical therapy through telehealth. The pandemic has opened doors for telehealth physical therapy that were previously closed, and patients are benefitting from these opportunities. If this door can remain open to permit continued delivery of telehealth physical therapy moving forward, this will be an important step forward for our patients and our profession.
Telehealth also is a means by which we can begin to address social determinants of health and provide care for people in their own neighborhoods. The need for this is more apparent than ever, as we look at the demographics of who has been most impacted by COVID-19. My hope is that this pandemic will place an even greater focus on, and investment in, addressing health disparities and inequities.