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Practice strives to provide tools and resources to support the safe and effective provision of physical therapy services in all settings.

COVID-19


8/31/2020

OSHA (Occupational Safety and Health Administration) has a series of publications and downloadable posters with industry specific and general guidance for keeping workplaces safe from the spread of COVID-19. Check out these resources here: OSHA COVID-19 Guidance.


OSHA confirms masks do not cause unsafe oxygen or carbon dioxide levels to wearers. OSHA recently issued FAQ guidance in response to increasing claims that mask wearing is unsafe. Read more here: Safety of mask wearing


7/24/20

HHS Secretary Alex Azar officially extended the public health emergency due to Covid-19 for an additional 90 days. It had been scheduled to end July 25 but is now extended at least until October 23.

HHS has released information regarding the Provider Relief Fund (PRF) reporting requirement. This document describes the reporting requirements providers who received one or more payments exceeding $10,000 total had to attest to as part of the funding award process. Reporting Document. Full instructions will be released August 17. The reporting system will be available beginning October 1, 2020.


The IRS has announced the CARES act Provider Relief Funds are classified as taxable income and do not qualify as a “qualified disaster relief payment” under section 139 of the IRS Code, even if those funds were received by a sole proprietorship.

Tax exempt providers as described in section 501(c) of the IRS code may be exempt but should review the information in IRS link: Frequently Asked Questions about Taxation of Provider Relief Payments.

The answers to other questions regarding the Provider Relief Fund can be found at HHS Provider Relief Fund FAQs or by contacting [email protected].

More information is available at Taxing CARES ACT.

Public Health Emergency Extended

6/29/20: The department of HHS announced that the PHE which was set to expire on July 25, will be extended by 90 days. This includes continuing allowing the provision of telehealth services by physical therapists into the first of October. This is the second extension for the PHE.

Avoiding and Relieving Neck Pain as We Adapt to Use of Face Shields

APTA staff have developed resources for members to guide care and access financial assistance during the Public Health Emergency (PHE).

APTA’s Learning Center has several “learning on demand” resources available for both members and non-members at no cost. In addition, several no cost live webinars are being offered.

Many states and cities are relaxing rules. Click here for an up-to-date list of reopenings.

CDC guidelines for outpatient and ambulatory care settings

HandLab has published some great resources for protecting therapists and patients. They have published instructions for fabricating a plexiglass shield for clinic use. See the detalils here.

Having trouble explaining the SARS-CoV-2 virus to patients? This YouTube video is one of the best I have seen for explaining how the virus invades and commandeers cells and how possible therapies may work.

Additional Helpful Tips for Providing Face to Face Care

  1. Inform patients they should mask prior to entering the office.
  2. Limit the number of people in the office by having patients text when they are in the parking lot and having your office text when they can come in.
  3. Screen all patients: remote temperature check, symptom check list (see CDC link above). Have pts use hand sanitizer, wipes or wash hands prior to treatment.
  4. Consider plexiglass screens. Premade screens can be found on Amazon. They range in price from $35.00-$200.00 and most ship free. If you are handy, you can build your own using PVC pipe or wood.

    Here is another example using PVC pipe courtesy of Dewane Jubara, PTA from Ohio.

    Plexiglass screen

  5. There is not documented proof of the temperature required to kill the virus so the use of heat for tissue preconditioning should include non-communal methods. CDC FAQs
  6. Orfit provides information for cleaning orthoses made from their products. In addition, orthoses should be cleaned with soap and water and/or disinfectant wipes prior to reheating in the splint pan when orthosis modifications are indicated.
  7. Disposable clinic options include: Semmes-Weinstein monofilaments, US gel pads, stethoscopes, electrodes, etc. These are available from most clinic supply sources.
  8. Should masks be worn with face shields? This study may be helpful for convincing you or your employer of the importance of using both. Face shields for infection control: A review

    This study emphasizes the importance of adequate masks

  9. How to adjust a shield and prevent neck pain when using one guidance, developed by University of Iowa physical therapists: Cari Everhart, Amy Little and Deb Parrott.
  10. Guidance for laundering exposed clothing It is highly recommended that outpatient providers wear short sleeves to avoid carrying the virus on clothing and change clothes prior to leaving the clinic in order to avoid contaminating others. Dangling necklaces, scarves, bracelets, watches and rings should be avoided and long hair should be held up and back with barrettes, etc.

Telehealth

The proposed Medicare Physicians’ Fee Schedule Rule released 8/3/2020 expanded some telehealth services but did not support including therapists’ use of telehealth after expiration of the PHE. CMS’ position was that the agency lacks the authority to included PT’s as authorized telehealth providers.

The rule does allow for other remote services including: e-visits, virtual check-ins, and remote assessments of recorded content or images from an established patient. CMS must now develop HCPCS codes designated as ‘sometimes therapy” codes in order to allow therapists to bill for these services once the PHE has ended.

CMS is soliciting comments on the use of telehealth by physical therapists, specifically supporting the addition of physical therapy codes to those used by telehealth eligible practitioners. (MD’s, PA’s, NP’s, etc.)

More information is available here: CY 2021 Medicare proposed PFS


Congratulations to APTA staff and members (like you!) who reached out to your legislators to advocate for modification of the requirements for providing telehealth! It is very important for therapists providing these services to review the information on the link below and follow CMS’ requirements, in part, so we can demonstrate responsible use and efficacy of telehealth. Appropriate execution on our part could lead to legislative support for permanent adoption. APTA has resources describing eligibility, HIPAA, billing/coding and other recommendations.

APTA has free webinars in the Learning Center on implementing Telehealth.

Physical Therapy Assistants

PTAs and maintenance therapy. In another change first adopted during the public health emergency thanks to APTA’s advocacy, CMS is proposing permanently allowing PTs to delegate maintenance therapy to their supervised assistants. Providers would still be required to follow existing rules that require use of special code modifiers when services are provided "in whole or in part" by an assistant.