The current situation throughout the United States and the entire world with the COVID-19 pandemic has been a challenge. While some states might not be as hard hit as other states, those of us who work in healthcare assume that the worst is yet to come.
Right now, physical therapists (PT) are seeing fewer patients overall, perhaps even 20-25% less. Some PTs who specialize in niche roles may not be as hard hit, but many others are. For physical therapy, the general theme of providing care in the current state is as follows:
- Patients who have a high-risk medical history should be informed that perhaps now is not the best time to come in for physical therapy so as to protect their already-fragile health.
- Many patients are being seen less frequently so as to limit the number of visits to healthcare settings like clinics and hospitals.
- Some patients can be seen, evaluated, and then followed up through telehealth options.
PT Barriers and Adaptation
Physical therapy is about hands-on care. It is very difficult for a physical therapist to render treatment to a patient remotely when he or she is unable to lay hands on the patient directly. COVID-19 has significantly limited PT’s ability to provide care.
So during this time, PT, like many other healthcare providers need to be able to adapt to best serve the needs of their patients.
Supporting PT Patient Progress During COVID-19
Patients can request more frequent follow-ups from their provider through phone calls or video conferencing. PT can still assess important information like changes in range of motion, functional strength, and pain. Progression or regression of exercise programs or activity modifications can be made effectively in these types of visits. This distance treatment model is infinitely better than no treatment at all.
The best care options I have seen or participated in are less frequent in-person follow-up care with more frequent telephone or video contact for specific follow-up care. With some limitations, this can be done effectively to speed care along for the patient who needs active PT involvement.
Family can also help during this time by being involved in their loved one’s care. If a family member is healthy and able, they can ask questions and seek opportunities for additional telehealth visits for their loved ones. Many providers will make the effort to help answer questions and support the family in the care of the patient.
PT Teletherapy Options
Although PTs are working to provide care via telehealth during this crisis, it is up to the insurance provider as to whether or not the telehealth visit will be covered. Despite the uncertainty, if patients can not physically see a PT, then telehealth is a good option for the wellbeing of the patient. Most of us understand that telehealth can be beneficial in certain circumstances.
The Centers for Medicare & Medicaid Services (CMS), who governs Medicare, has allowed for telehealth in physical therapy. Once Medicare makes a change, often other healthcare payers follow. But telehealth also brings up many additional questions: Is there a mechanism in place to effectively treat by video chats? Can the provider actually bill for their time in their billing system? Will the third-party payer pay for the care? Right now there is not a clear answer for physical therapy care through telehealth. But demand is often the best way to facilitate change. So patient demand may be the only way for efficient teletherapy care to be made available across the board of systems.
COVID-19 Impact and Moving Forward
COVID-19 has impacted healthcare in many ways. Through this, telehealth, including e-visits, will be firmly in place in our medical care system with rules and regulations that allow patients to be cared for safely and the public protected from fraud and poor telehealthcare and malpractice.
The pandemic has provided the opportunity to learn many things. We can learn that any cold, flu, or potential pandemic is manageable if we are willing to take the steps to control its spread. We can learn the value of life and time with family as we experience isolation. We can learn that our health is far more important than a trip to the beach or to the restaurant. We can learn how easily our world can be turned upside down if we do not take a potential pandemic seriously.
Through this experience, I believe that we will see value in our preventive healthcare system, and thus be more prepared with financial savings, equipment stockpiles, and maintenance systems so as to limit the challenges we have faced with COVID-19 from happening again in a similar situation. I believe that we will be more appreciative of the current healthcare delivery system and healthcare workers who can make our lives so much better.
Author: F. David Paulson, PT, DPT, OCS, is faculty and the Fellowship Coordinator for the Doctor of Physical Therapy program at Rocky Mountain University of Health Professions (RMUoHP). Prior to coming to RMUoHP, Paulson was the manager and a clinician at Utah Valley Regional Medical Center in Provo and also managed physical therapy throughout the Intermountain Healthcare Urban South Region. He continues to actively treat patients on a part-time basis. He has 30 years of clinical orthopedic manual therapy experience with specialization in spine, extremity, TMJ, and headache.
Additional Resources
Letter from APTA President on COVID-19 Impact
HHS to States: Ease State Laws and Regs NowAPTA COVID-19 Resources
Furnishing and Billing E-Visits: Addressing Your Questions
Asking the Right Questions About Telehealth
APTA Joins Push for PPE, More Consistent Use Recommendations
