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  • 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.


    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.

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    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.