Guidelines Regarding Providing PT Patient Care During the COVID-19 Crisis

March 19, 2020

There is still no prohibition that you should cease treating patients in your clinic. Even in communities, such as Alameda County in California, where shelter in place orders have been imposed – healthcare operations are exempt from this prohibition.

Here are some guidelines that we think might help you to decide if and when to provide physical therapy care to your patients:

  1. With the underlying premise to “do no harm,” you and your patient(s) must determine if the risk to providing care outweighs the risk of not providing care at this time. We encourage you to reduce community exposure and cancel non-urgent, face-to-face visits where a delay would not result in an adverse outcome.
  2. If you do choose to see patients, conduct proper screening procedures for your staff, patients and those individuals accompanying patients to their appointments. Those failing basic screening questions should be redirected back to their home. Identify high risk individuals using the information provided by the CDC.
  3. If you do choose to see patients, create a social distancing protocol and appoint a staff member to manage and maintain social distancing whenever possible in your clinics. This would involve utilizing private treatment rooms and modifying schedules to reduce patient-to-patient interactions.
  4. If you do choose to see patients, maintain the highest sanitary levels via frequent handwashing/sanitizer use and surface disinfection. Inform patients of your procedures via a posted notice at the time of check-in as well as on your website.
  5. Follow guidance from federal, local, and state agencies that may influence how you handle any of the above suggestions.
  6. The financial implications of your decisions for your clinic should not be a factor in your decisions regarding treatment of patients during this pandemic.

While providing patient care via telehealth is technically legal for PTs and PTAs in Washington, it is not always paid for by payers. Restrictions on payment for PT provided via telehealth may ease up as this crisis continues. We are advocating for that. Please visit our telehealth web page  for guidance and updates as the COVID-19 crisis continues.

Thank you to our colleagues at APTA and from the California Chapter of the APTA for sharing the guidance they have provided to their members, which has helped us craft this update.

I hope you all stay well!

Meryl Gersh, PTWA President

Is PT Care Allowed During the COVID-19 Ourbreak?

March 17, 2020

Is treatment by PTs and PTAs allowed in light of recent government announcements about social distancing and gatherings of 10 or more people?

The short answer is yes, but…

On March 16, Governor Inslee’s office issued guidance that physical therapy is allowed, guidance that contained requirements for gatherings of fewer than 50 people. King County health officials posted a related message. And the CDC issued guidance for gatherings of more than 10 people in a high risk population. While the definition of an event or gathering does not appear to include a clinical episode of care, clinicians and their coworkers may find the guidance to minimize risk helpful. Some or many of you have already taken similar precautions and then some.

For clinicians looking for a definitive answer about whether they should continue with patient care, there is not one at this time but we will continue to monitor government guidance. We have reached out to the King County Health Department for their specific opinion about care provided by physical therapists and will let you know what we find out.

In the meantime, on March 17, APTA has provided some profession-related guidance that you might find helpful.

Some of you have chosen to close or dramatically reduce clinic operations during this time. PTWA supports your use of your clinical judgement to make these decisions. Others of you have chosen to continue care with increased measures in place to reduce exposure to COVID-19. PTWA supports your use of your clinical judgement in these situations too.

And an answer from the CDC website that we thought you might find somewhat relevant (although the primary market for this message is not PT providers):

Q: Should any diagnostic or therapeutic interventions be withheld due to concerns about transmission of COVID-19?

A: Patients should receive any interventions they would normally receive as standard of care. Patients with suspected or confirmed COVID-19 should be asked to wear a surgical mask as soon as they are identified and be evaluated in a private room with the door closed. Healthcare personnel entering the room should use Standard and Transmission-based Precautions.

When we learn more we will share that information with you. Our website, our Twitter feed, and our Facebook page are the places where we will share new information first.

Meryl Gersh
PTWA President

Hard-Fought Victories and Other Accomplishments Mark the Closing of 2018 for APTA

Two times each year, APTA hosts an hour-long virtual component leadership meeting to provide updates about federal and state government affairs, payment issues, and other activity highlights in the recent past or the near future. In November, I listened to the latest recording on this update – my first one as your newly elected president elect.

We achieved a lot in 2018! Here are some of the victories and accomplishments that APTA staff and President Sharon Dunn talked about during the meeting, some of which you may already know about:

Legislative and Payment Advocacy Victories

  • Congress passed a permanent fix to the hard cap on Medicare services in February 2018 after a 21-year advocacy effort. (The law took effect retroactively to January 1, 2018.) No more temporary requests for patches in January (there have been 17 over the past 21 years)! An unfortunate last-minute addition to the bill was a PTA pay differential of 85 percent beginning in 2022, which APTA strongly opposed and is working to change before the effective date.
  • Congress also voted to include PTAs as authorized providers in the TRICARE system. On December 18, the Department of Defense published draft rules so by PTAs should be able to get paid to provide treatment to TRICARE patients by early 2020 at the latest.
  • The Centers for Medicare and Medicaid Services (CMS) will eliminate mandatory Functional Limitations Reporting as of January 1, 2019.
  • Legislation that protects PTs and other health care providers who travel across state lines with a sports team became law, after several years of effort. The law provides added legal protections for sports medicine professionals when they’re traveling with professional, high school, college, or national sports teams by extending the provider’s “home state” professional liability insurance to any other state the team may visit. This cooperative effort also involved the National Athletic Trainers’ Association and the American Association of Orthopaedic Surgeons. We are #bettertogether!
  • Physical therapists who are ABPTS Board Certified Electrophysiological Clinical Specialists (ECS) are Medicare approved for reimbursement for the performance of nerve conduction velocity and electromyography studies, and for sensory-evoked potentials studies when permitted by state law.
  • The US Department of Veterans Affairs will permit reimbursement for physical therapy services provided via telehealth or virtual technology, regardless of where the provider or patient is located.
  • CMS and the Joint Commission agreed that pulse oximetry in the home does NOT require a physician’s order.
  • The Physical Therapy Licensure Compact law has passed in 21 states and six are issuing license privileges. An additional 8-10 states are expected to introduce licensure compact legislation in 2019. (Washington will probably begin issuing compact privileges in a few months.)
  • Looking forward in 2019: Efforts to support Medicare Advantage plans to include telehealth as part of a basic benefit package will continue.
  • The APTA PT Outcomes Registry will meet the requirements for approval by Medicare for the Qualified Clinical Data Registry status reports. Physical therapists will be able to use this registry to meet one of the merit-based incentive reporting requirements, eliminating some duplicative documentation demands.

More Good News

  • #Choose PT – our national public relations effort focused on the opioid crisis – continues to have an impact. APTA introduced a second PSA. They also held an online panel discussion with seven perspectives including a patient, a PT, a physician and others. They conducted a one-day September media tour that resulted in 463 airings and reached nearly 109 million people!
  • APTA purchased the land on which our new APTA headquarters building will be constructed. More details about building design and a ground breaking to come.
  • The American Society of Association Executives awarded a Power of A Gold Award to the APTA, AOTA and ASHA for our cooperative, successful effort in the permanent elimination of the Medicare therapy cap.
  • APTA received the Alexandria (VA) Chamber of Commerce Best in Business Award.
  • The APTA Minority Scholarship fund exceeded $1 million in scholarship distributions.
  • There is a new Council on Prevention, Health Promotion, and Wellness.
  • 16 clinical practice guidelines have been published with content from the sections and academies. 44 more are in the works

Anniversary Celebrations

  • Physical Therapist Assistants will celebrate their 50th anniversary in 2019; the first PTAs graduated from PTA programs in 1969. There will be celebrations throughout the year, including an event at CSM. Various chapters are participating in fitness-based PTA10Ks (including Washington) as a way to promote PTA membership in APTA with the goal of increasing it to 10,000 during this anniversary year. It’s currently just below 9,000.
  • The APTA will celebrate our 100th (centennial) anniversary in 2021 with the theme “connect, celebrate, inspire.” Stay tuned for more updates as we move forward to toast this magnificent milestone.

I hope you feel as energized by all of these accomplishments as I do. Many of you participated directly in helping to achieve these victories. Our hard work is paying off!

Meryl Gersh
PTWA President-Elect
PTWA Professional Enhancement Panel Director

PTA SIG is Back with More to Come

Last spring, several of us got together to once and for all bring the PTWA PTA Special Interest Group out of its dormancy.

We jotted down some ideas but really started with a survey that we sent out to all of you in August. Your responses to that survey influenced the directions we will take – although there were not really any surprises. You are interested in continuing education, information about various types of advocacy, and you would like the relationship between PTs and PTAs to improve.

We decided to start getting information out to you via an e-newsletter that we plan to send each month (possibly skipping one of the summer months). We will include some news that we think PTAs will be particularly interested in. We’re also planning to include a clinical pearl in each issue, starting with the next issue.

We’re in the early stages of forming work groups for Continuing Education and Communications.

And we’ll need to hold an election for PTA SIG leadership soon. So stay tuned for the scheduling of the meeting during which that election will be held.

There is much work to be done on the road ahead and several PTA members have already signed up to participate in our efforts. If you have an interest in being involved – or just have something you want to say – please email us at ptasig@ptwa.org.

Vince Nguyenpham, Brendon Larsen, Trent Smith

Ready to Get Involved? How to Get Started

As an SPT and even as a new graduate in the workforce, I always felt that advocacy for my profession was important but was too busy orienting myself to my new profession to even consider being involved on a bigger level. As I developed in my career, I felt called to do more.

AmandaScharen 8-2017

Amanda Scharen

Three years into my career, there was a student physical therapist at my clinic who was heavily involved in the APTA. She quickly became one of my mentors in encouraging my involvement in the APTA and asked if I would like to apply with her to be part of a new task force. The task force was addressing an issue that I was interested in, so I decided to apply. A few weeks later, I was disappointed to find out that I had not been selected for the task force due to lack of advocacy experience. I was frustrated – how could I possibly get experience if experience was a prerequisite for getting involved?

I decided to start attending my local PT Pub Nights to network with other like-minded professionals. It was a great way to connect with other professionals in the physical therapy community, and I enjoyed getting a taste of the bigger picture within my profession. After about six months of regularly attending Pub Nights, the organizer told me that she was moving to Boston. When I asked who would be organizing the Seattle events going forward, she said no one had volunteered. Seeing this as an opportunity to take on a leadership role in the local PT community, I asked if I could be the event organizer.

My first PT Pub Night was so much fun and ended up hosting almost 50 attendees. I got to know so many people who were involved in PTWA through these events. Eventually I was approached by Jim Shepherd from the Nominating Committee asking if I would like to run for the House of Delegates. I was elected, which I attribute to how much time I spent building relationships with local PTs at the Pub Night events. As a delegate, I met many esteemed PTs from across the state and found it easier to get involved in committees, meetings and events as my professional network expanded.

For someone who is struggling with where to start, I would recommend starting with something where the only requirement is simply to show up and have an interest. There are PT Pub Nights in Seattle, Tacoma and Spokane. Most metro areas have regular district meetings that anyone can attend. If you are interested in a specific topic or issue, consider joining a special interest group (SIG) or committee. These groups and committees are listed on the PTWA website and are open for members to join. Finally, consider attending Legislative Impact Day. This is a great way to not only connect with other PTs but also to your representatives in Olympia.

Recently, I was elected to Nominating Committee. I am so excited for this opportunity to hopefully seek out people who, like me as a younger professional, want to get involved but don’t know where to start. I hope to show our PT community the benefits of membership and the opportunities both big and small to get involved and make a difference in our wonderful profession.

Amanda Scharen
Nominating Committee member
Delegate to the APTA House of Delegates

Update on #StopTheCap Efforts

A message from Dena Kilgore, CAE, from APTA:

I wanted to provide an update on the efforts to permanently repeal the hard therapy cap that went into effect January 1. As you know, the federal government had been shut-down since midnight on Friday, January 19 due an impasse on funding the federal government over the lack of a deal to protect young documented immigrants from deportation, known as the Deferred Action for Childhood Arrivals (DACA).

Yesterday, Monday, January 22, Congress passed yet another short-term spending bill that will re-open and provide funding for the government open until Thursday, February 8.  The Senate spending deal will also fully fund the Children’s Health Insurance Program for six years, ending a nearly four-month lapse in the program’s long-term federal funding.  In return, Democrats accepted a pledge from Republican Senate Majority Leader Mitch McConnell (R-KY) to bring a vote on DACA to the floor if an immigration deal is not reached by Feb. 8.  Despite an enormous turnout on social media, phone calls, grassroots, Hill meetings, etc. by APTA, AOTA, ASHA, and partners in the Repeal the Therapy Cap Coalition, the short-term spending deal does not include the permanent fix to repeal the hard therapy cap, nor does it include a whole host of must-pass critical Medicare issues, impacting everything from rural health funding to community health centers.

On Friday there appeared to be a glimmer of hope that the Therapy Cap fix might be added to the short-term spending deal; APTA and our partners had been working with Senate Minority Leader Chuck Schumer to have it added to a revised deal that was under discussion with President Trump. Those talks did not produce a deal addressing the broader range of critical issues, including repeal of the Therapy Cap. Two senators who we’d like recognize are Sen. Ben Cardin (MD) who took to the Senate floor Tuesday afternoon to implore his colleague to address the Therapy Cap and other Medicare extenders in the next spending deal that must be passed by February 8. In addition, Sen Stabenow (MI) offered an amendment over the weekend to include the Therapy Cap and other Medicare extenders to the short-term deal.

The message from Capitol Hill continues to be that there is broad agreement to repeal the cap; the bipartisan, bicameral proposal to permanently fix the hard cap appears to be one of the few issues Congress is in agreement on. However CHIP funding and DACA continue to overshadow the politics and process.  With the issue of CHIP funding now resolved, Congress can focus on the critical Medicare extenders and Therapy Cap repeal to include in the next spending deal. However until DACA is resolved, it will continue to play a major factor in the work of Congress, and could potentially result in another government shut-down in the near future.

APTA and our partners will continue to wage an aggressive lobbying, social media, paid media, and grassroots efforts between now and February 8. APTA will be sending out additional action alerts to our members this week, and we will continue our push on social media (#StopTheCap).

During this time of uncertainty under the hard cap, APTA is also pushing CMS to provide additional guidance and clarification on their handling of outpatient therapy claims.  Most recently CMS provided information that they have been holding all outpatient therapy claims since January 1 that go above the $2,010 cap. CMS is expected to begin processing those claims in the near future, but they have not yet provided a timeline, In addition, CMS has stated that providers should continue to submit claims with the KX modifier, even though the exceptions process is not in place, under the assumption that Congress will retroactively apply the permanently therapy cap fix. APTA issued a FAQ document earlier this month and we will be revising it this week based upon additional expected guidance from CMS.

False Advertising and Insurance Surface as Top Priorities for PTWA Members

At the PTWA December 2017 board meeting we reviewed and addressed results from our October PTWA member survey.

The largest areas of survey input included:

  • PTWA members want the world to know that physical therapy professionals provide physical therapy services. You want other provider groups to stop saying they provide PT and you want consumers to understand and care about what that means.
  • PTWA members want their state association to do something about the dramatically shifting payment environment and what it’s doing to their ability to provide effective and qualitative patient care.

Strategic planning expert Janet Bezner, PT, DPT, PhD, FAPTA, helped our PTWA board to identify goals, objectives and strategies surrounding these two areas. Here are the two goal statements we came up with:

Goal 1:

Providers, consumers, and key stakeholders know that physical therapist practice is the best choice to optimize movement.

Goal 2:

Physical therapists/physical therapist assistants, payers, and consumers value care that is compensated on the basis of quality and the achievement of meaningful outcomes.

You can find the full plan document on this page on our website: http://ptwa.org/about/bylaws-policies-and-other-governance-documents.

Because these areas of focus are not going to be achieved by just pressing the easy button, we will be working on plans for each of them with a due date of July 1 for the two plans.

Also at the December board meeting we addressed and made recommendations for the revision of the PTWA vision and mission statements. PTWA’s current vision statement models the APTA’s achieved and since revised Vision 2020 language. The current APTA vision is, “Transforming society by optimizing movement to improve the human experience.” Our PTWA vision statement needed an update.

Our proposed mission statement remains similar to our current mission statement, as this is unique to Washington.

The board proposes the following vision and mission statements.

PTWA Vision Statement:  The physical therapy profession is recognized as the best choice for optimizing movement to improve the human experience.

PTWA Mission Statement:  The PTWA Mission is to advance the physical therapy profession in the state of Washington through compassion, accountability, representation and excellence (CARE).

Governance of an association requires member approval of strategic plan/goals, mission and vision changes at a Chapter Meeting. Our next Chapter Meeting will be held on October 6, 2018 in Tacoma. We won’t wait until then to start work on what you have already said are your top priorities for our association.

The work derived from the strategic plan and vision/mission is done primarily by committees. PTWA has existing committees that will work on these goals. We would love your involvement at any level: committee work, volunteer, expert witness, professional opinion etc. Many hands make light work.

Your involvement is as easy as emailing me at president@ptwa.org.

Best wishes for a “movement” filled 2018.

Erik Moen, PT
PTWA President