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COVID-19

 

HPA is committed to supporting all physical therapists, physical therapist assistants, and students, both association members and nonmembers, as we deal with issues arising out of the current Coronavirus pandemic. As a professional organization, we are not permitted to provide legal advice, however, we can provide references that will help you make good decisions for yourself, your patients, colleagues, and practices.

HPA Resources: (Updated 6/01/2020)

HPA COVID-19 Webinar Series

Complete the Telehealth PT Patient Satisfaction Survey

Coding Intel: Telemedicine and COVID-19 FAQ

APTA's Latest COVID-19 Update

Free Access to On Demand Patient Record Retrieval Service Across the Continuum

APTA's Interactive Audio and Video Telecommunications System Matrix

COVID-19/Telehealth Frequently Asked Questions (FAQs)

APTA's COVID-19 Webpage


HPA COVID-19 Webinar Series

5/28/20 Recording: Envisioning a New Normal for Physical Therapy: How Interoperability Can Protect and Grow Referrals, Enable Virtual Health, and Improve Care Coordination

5/23/20 Recording: COVID-19 Expert Panel: You've Got Clinical Questions, Let's See if We Have Answers

5/09/20 Recording: Topics, Discussions, and Resources for Beyond COVID-19 World (Part 2)

5/02/20 Morning Recording
Topics, Discussions, and Resources for Beyond COVID-19 World (Part 1)

5/02/20 Afternoon RecordingLeveraging New Models in Addressing Hospital Deconditioning and Physical Impairment to Establish a COVID-19 Hospital Throughput Framework

4/25/20 Recording: Physical Therapy Considerations of Neurologic Presentations in COVID-19

4/18/20 Recording: Physical Therapy Considerations of COVID-19 in the Post-Acute Setting

4/11/20 Recording: (Part 2) Acute Care Physical Therapy & COVID-19: How Can We Add the Greatest Value?

4/04/20 Recording: COVID-19: Minimizing the Impact of Social Distancing for the Older Adult

3/28/20 Recording: COVID-19: Clinical Best Practices in Physical Therapy Management

3/21/20 Recording: (Part 1) Acute Care Physical Therapy & COVID-19: How Can We Add the Greatest Value?

Find everything you need - the recording link, the presentation slides, resources, and the speaker info - in the document links above. Download to save and share! 


Complete the Telehealth PT Patient Satisfaction Survey

Check out this Telehealth PT Patient Satisfaction survey! Check out the Spanish version CLICK HERE!

Give this to your patients. Learn more about your customers/patients. Please share results with your state chapter, the APTA and the HPA Tech SIG so we can advocate, even more, for the ability for Physical Therapists and Physical Therapist Assistants to provide Telehealth services when appropriate.

APTA would like to encourage PTs and PTAs to share their stories about using telehealth during this COVID-19 pandemic. Please consider sharing this link with others and urging them to share their story on APTA Engage

These are two great ways to make a positive difference for our profession.  


Coding Intel: Telemedicine and COVID-19 FAQ

View the Telemedicine and COVID-19 FAQ on the Coding Intel website.


APTA's Latest COVID-19 Update

Letter From President Dunn on COVID-19 Impact

APTA President Sharon Dunn, PT, PhD, released a statement on the coronavirus pandemic that calls on the physical therapy profession to rely on its unique ability to help society through a troubling period.

Pushing for PPE, And Consistent AdviceAPTA has joined a push by health care professional organizations that urges Congress to not only step up efforts to supply providers with PPE, but to get CDC and other agencies on the same science-based page and to take steps to ensure that shortages won't happen again.

Ask the Right Questions About Telehealth
It's not enough to ask if telehealth is permitted by a state agency or payer: You need to ask specific questions to understand what you can and can't do. Here are five important questions.

E-Visit Questions and Answers
APTA continues to update its Q&A resource on the e-visit waivers now being offered to PTs by CMS. Get the latest information.

HHS Presses States
The Department of Health and Human Services says that federal waivers can only go so far, and calls on states to quickly act to relax licensure, telehealth, and other requirements that may impede an effective response to the COVID-19 pandemic.

APTA's Components Making a Difference
From helping physical therapy faculty move their courses online to conducting a webinar on providing acute care physical therapy during a pandemic, association chapters and sections are keeping the profession informed and creating an impressive array of tools. Check out some of the available resources.


Free Access to On Demand Patient Record Retrieval Service Across the Continuum

Kno2 is making their portal available for purposes of On Demand Patient Record Retrieval Service available at NO CHARGE (during state of emergency) to all of post-acute including LTACs, IRFs, Skilled Nursing, Homecare/Home Health, Therapy Providers, etc. This provides an opportunity to access the most recent patient records of other providers in the community as we treat patients during this public health crisis.

Late last week, Carequality passed an emergency waiver that allows end user organizations to access their network to query for records. This waiver removes the restriction that required end users to have an integrated EHR. This change is a VERY important move in allowing the entire care continuum to be able to access records and allow patient information to flow during this time of crisis. This waiver remains in effect as long as the State of Emergency is in effect.  

Kno2 is the interoperability provider for most of the EHR vendors in post-acute and outpatient settings. Their challenge has been that many of these vendors are not yet integrated with Carequality and thus could not participate. Now with this waiver, end users can access patient records through Kno2's portal account. And, for any provider that does not currently have an end user account, Kno2 is providing the account for free.

Carequality is the leading national query network where most of the major EHR vendors participate such as Epic, Nextgen, athenahealth, etc.

Kno2 also has these additional resources available about this topic:

Landing page with more information at: https://kno2.com/covid19_recordretrieval 
Registration page to sign up (each physical location): https://register.kno2.com/register/covid-19
Email at: covid19@kno2.com


APTA's Interactive Audio and Video Telecommunications System Matrix

In light of the COVID-19 pandemic, more PTs are considering adopting telehealth at least for some of their patient visits. With this in mind, the HPA Tech SIG, the FiRST Council Telehealth Group and APTA has created the following matrix together to help our members.

Please know this information was collected from websites as of March 20, 2020. Please contact each vendor directly to verify the information. Also, several vendors are offering reduced or free rates during this pandemic. Ask about discounts before purchasing.

Considerations Before Adopting Telehealth

Finally, before adopting any Telehealth solution, pause and consider a few key points for now and in the future:

  1. Your reason for adopting telehealth. Knowing this will help guide your decisions moving forward. For example, if you are adopting telehealth to provide live video visits, then you will look for a telehealth product with live video capabilities as its strength. On the other hand, if your primary goal is to increase communication with patients, you may want to choose a product with a secure texting solution as its strength.
  2. Remember to practice, and devote time to understanding telehealth. There is a unique set of skills to running a telehealth session. Practice with colleagues to understand the technology AND to learn the multi-tasking skills needed. Know how to use your technology.
  3. Prepare policies and procedures. Before starting, have contingency plans for what you would do if:
    1. You lose audio or video connectivity;
    2. The internet stops working;
    3. The patient has additional complications while you are working with them; and
    4. Your patient decides they do not want to do telehealth anymore.
  4. Get the highest bandwidth internet connection you can. Consider a secondary backup by a secondary type of provider. Meaning if one is by Fiberoptic, get a second by cable or DSL as a backup.
  5. Just because you can, does not mean it is the right thing to do. Examples:
    1. Just because you can do a tele visit while walking down the beach…there is huge background noise the person on the other end needs to deal with. Make it easy for them to hear you.
    2. Just because you can do a tele visit with the window behind you…there is a huge challenge for the person on the other end to ‘look into’ the sun coming in the window. Make it easy for them to see you.
    3. Just because you can do a tele visit with family nearby…this is a HIPAA breach. Be sure to have a secure location to provide this service.
    4. Generally speaking, pause and think about your surroundings, and ask yourself: is this the best place to conduct a telehealth visit?
    5. Just because you can…there are more…pause and think about them. Then, provide the best care you can. Now and always. You are the example of our profession. Every day.
  6. Check your state practice act to verify that you can provide telehealth services in your state.
  7. Document the legal and ethical reasons you are converting patients to telehealth visits. While the COVID-19 pandemic offers a good reason, you still need to document. And also remember to have written consent of the patient.
    1. Patients MUST consent, with right to refuse and be given the opportunity to be seen in-office.
  8. Your legal team should review and approve your emergency policies and procedures.
    1. Example: If your patient falls at home, while you are working with them, what process do you have in place to address this emergency?
  9. Your payment team should contact and contract with third party payers on your ability to furnish, implement, and use telehealth PT services for payment.
    1. For billing purposes, the POS (point of service) will usually be 02.
  10. Use secured portals and have BAAs (Business Associates Agreements) in place with your telehealth vendor and, potentially, others.
    1. Yes, the government has lessened the HIPAA requirements in certain circumstances during this pandemic. Even so, be thinking ahead and prepare now for a solution that you can continue using in the future.
  11. Review your malpractice to verify that you are covered. Here is one resource to check out:
    1. http://www.hpso.com/Documents/Risk%20Education/Businesses/CNA_HP17-14_060117_CF_PROD_SEC.pdf
  12. Be careful, and be wary of sub-optimal telehealth platforms. Use your gut check. Do your due diligence and research all vendors you are considering.
  13. Maintain a hybrid approach of telehealth and in-office visits wherever possible.

Additional Resources

Check out the Center for Connected Health Policy for information on parity, payment, and regulation.

Disclosures

  • Alan Lee worked on this project. He is on the advisory board for Blue Jay Health
  • Robert Latz worked on this project. His wife works on a limited basis for Physitrack.
  • No disclosures for Sara Gallagher, Sean Bagbey, Kara Gainer, Steve Postal

APTA's Interactive Audio and Video Telecommunications System Matrix


COVID-19/Telehealth Frequently Asked Questions (FAQs)

The APTA website recognizes that patient care is determined by the clinical judgment of the therapist, and encourages therapists to “first do no harm” and to “weigh the risks of providing care versus not.” APTA has a wealth of information and links on their website home page that is available to all therapists, regardless of association membership, in an effort to keep everyone informed. This information is updated regularly to address changes as the situation evolves.

This pandemic is an evolving situation. APTA will post updates on their website as appropriate.


Can I use Telehealth to manage my patients during this crisis?

Telehealth is one mode of delivery for PT services that can keep both the provider and patient safe. If you decide to use this service mode, we recommend that you check with your employer and legal counsel to ensure that you meet the requirements to provide telehealth. Also, click the link on APTA website that provides insight into the use of telehealth. 

The following are a few examples that you should consider when deciding whether to employ services via telehealth:

  • Is the patient a candidate for remote services – are they safe? Is there adequate supervision?
  • HIPAA: Are the devices you plan to use HIPAA compliant? Are you meeting all HIPAA security regulations? Information on these regulations can be found on the CDC website.
  • Reimbursement: Will the provider pay for services provided by telehealth? For example, Medicare does not recognize telehealth services provided by PT at this time. You may choose to provide these services at the risk of nonpayment, but you still must follow Practice Act, documentation standards, and other guidelines for best practice.

CMS released new regulatory waivers that allow PTs, OTs, and SLPs to engage in patient-initiated “e-visits” for the purposes of assessment and management services. Does this mean that telehealth is now permitted?

  • The use of “e-visits” in the APTA press release is a “limited type of service” and does not allow the use of all telehealth modalities. Rather, the action by CMS is described as an easing of Medicare telehealth restrictions adopted by CMS to expand the provision of telehealth and patient-initiated digital communications to help blunt the spread of COVID-19.
  • Under the waivers, PTs and their patients will be allowed to bill for e-visits under codes associated with online assessment and management services (codes G2061, G2062, and G2063).
  • 3 basic qualifications must be met:
    • The billing practice must have an established relationship with the patient;
    • The patient must initiate the inquiry for an e-visit and verbally consent to check-in services;
    • The communications must be limited to a seven-day period through an “online patient portal.”
  • Even though the patient must initiate the request for an e-visit, practitioners may educate beneficiaries on the availability of the service prior to patient initiation.
  • PTs still remain outside the reach of the so-called “1135 waivers related to telehealth, but with one exception: a type of remote interaction CMS calls an e-visit under Medicare Part B."

Are physical therapists and physical therapist assistants included in the recent legislation that gives CMS the authority to waive certain Medicare telehealth restrictions?

  • In a press release issued on March 16, APTA specifically states, “Physical therapists are not included as a provider type that can furnish telehealth as a covered service to Medicare beneficiaries under this legislation."

Does the legislation signed by President Trump allowing CMS to make certain waivers for Medicare, Medicaid, and CHIP relief in response to the Coronavirus include provisions for physical therapists?

  • APTA issued guidelines related to these waivers on March 16.

I provide care in a school district. Am I permitted to treat my pediatric caseload even when the schools are under mandated closures?

Again, this determination must be made on an individual basis. Some things to consider include:

  • Guidelines from your administration about accessing premises during the mandated closure.
  • Contract specifications, including consideration for PTs that are employees and PTs that are contractors.

If my employer closes my clinic, will I still get paid?

Again, that is an individual decision for each employer and employee to determine. Some factors to consider include:

  • Your terms of employment and/or contract.
  • Your eligibility to use vacation, sick, or personal leave time, and whether that is paid vs. unpaid.
  • Your personal circumstances: are you or a family member in at “at risk” category? If so, are you eligible to use FMLA (Family and Medical Leave Act provisions)? Does your employer pay when employees take advantage of FMLA? (The law does not require employers to pay for time used under this law).
  • We are aware of some employers who have offered additional days of paid time off for employees to take care of themselves or a family member. You may want to consider negotiating with your employer.

APTA is updating information on COVID-19 on a daily basis. We encourage you to visit the APTA Coronavirus website each day for ongoing current information. 


 

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