The coronavirus pandemic has thrown rehab therapy practices everywhere one curveball after another. In a matter of weeks—days, even—practice leaders have been forced to come up with gametime strategies for everything from treating patients at a safe distance to staying in business amid state-wide shutdowns. As these practices search for ways to keep operations running smoothly during the pandemic—while continuing to provide patients with expert-level care—many therapy assistants, techs, and students are left wondering where all these changes leave them. To that end, we’ve put together this resource that’ll help rehab therapy practices make the best use of therapy extenders while weathering the COVID-19 storm.
But first, let’s cover a few basics that will help you decide how to use extenders in your clinic during this pandemic:
Follow state rules.
In light of COVID-19, many states that implemented temporary telehealth expansion measures have included physical therapist assistants and occupational therapy assistants as authorized providers. However, it’s crucial to know where your state stands on telehealth services with regard to PTAs and OTAs before you allow them to provide these services. So, check your state laws or email your state licensing board for more details.
Follow payer rules.
Second, check your payer policies to determine if they reimburse for assistant-led telehealth services. As of right now, physical therapist assistants, occupational therapy assistants, and speech-language pathology assistants cannot provide e-visit services to Medicare beneficiaries (remember, though, that e-visits do not fall under the umbrella of true telehealth).
However, if you find a payer is unwilling to reimburse you for assistant-led telehealth services, you might want to check in with your state-level professional association to see if there are any temporary measures that override the payer’s policy. For example, in light of the COVID-19 crisis, many states—such as Vermont, Massachusetts, Ohio, Arizona, Colorado, and Alabama—are not only recognizing PTs, OTs, and SLPs as telehealth providers under state statute, but also mandating payer reimbursement of those services (although that recognition does not override CMS policy). According to WebPT Chief Compliance Officer Veda Collmer, JD, OTR, “These rules are typically written broadly to cover all healthcare providers and any service that is reimbursed for in-person visits.”
Collmer advises clinics to consider assigning assistants to treat patients whose payers cover telehealth delivered by assistants. For example, Tricare—which will consider PTAs and OTAs authorized providers as of April 17, 2020—will reimburse for telehealth continuation visits. Additionally, some commercial payers—including United Healthcare and some Blue Cross Blue Shield payers—and Medicaid will reimburse for assistant-led telehealth services.
Check supervision guidelines.
Your state practice act still dictates supervision rules (which can also vary by setting). If the practice act requires general supervision of a therapy assistant—which, according to Collmer, most do—then the licensed therapist has to be available at minimum by phone throughout the service delivery. If your state requires direct supervision, then the therapist must be in the same building or line of sight.
Whatever level of supervision your state requires for in-person visits, that same rule will apply to telehealth visits. Keep in mind that certain payers—including Medicare and Tricare—may have their own supervision requirements, so you should also confirm any supervision requirements established by the payer. If that’s the case, always follow the most stringent requirement—whether that’s the state’s or the payer’s.
Assisting with Interventions During Virtual Sessions
When it comes to assisting with therapy interventions, you’ll need to—as stated previously—check your state practice act and payer rules before allowing extenders to work one-on-one with patients during telehealth sessions.
As mentioned above, in some cases, PTAs and OTAs may be able to render—and receive reimbursement for—telehealth services. If assistants are able to provide telehealth services, this is a great way to overlap treatment sessions by having the assistant work with one patient while you, the therapist, get set up with another patient.
Because technicians are not permitted to provide skilled care to patients, they will not be able to render services via telehealth to any patient—regardless of payer or state. However, according to the APTA, PT techs can perform designated tasks “that do not require the clinical decision making of the physical therapist or the clinical problem solving of the physical therapist assistant.” That said, just because techs cannot treat patients, it doesn’t mean they cannot assist patients or therapists with telehealth services in a meaningful way. For example, techs can help patients or PTs get set up for their telehealth sessions by ensuring all equipment—and technology—is ready to go before an appointment begins. For new telehealth patients, consider having a tech meet the patient online several minutes before the scheduled start time to identify and troubleshoot any audio-visual or software issues.
Students could potentially participate in telehealth treatment in a manner similar to assistants, provided that the therapist maintains the appropriate level of supervision. We advise contacting the student’s fieldwork coordinator to determine whether the student could complete a portion of his or her fieldwork in a telehealth treatment format.
That said, many payers do not cover services rendered by students—and because students complete clinical rotations to learn, practices should not use them to fill staffing gaps or provide unsupervised patient care. If the fieldwork coordinator feels it is appropriate to continue educating the student in a telehealth delivery format, the supervising therapist should still be providing meaningful supervision and instruction—even if it’s done virtually.
There’s actually a strong argument for having students learn how to treat patients via telehealth, as they may have to deliver services in this manner in the future. Telehealth requires different approaches to treatment and different problem-solving skills. For example, it may be necessary to educate patients on how to use the technology—or to leverage family members and caregivers to provide assistance and support during the session. After the pandemic, telehealth likely will be viewed as one of many treatment delivery methods in the rehab therapy toolbox, and students should be able to deliver services in this manner to meet their patients’ needs and expectations.
In addition to the accreditation standards, here are some other resources that will help you determine if a student can—and should—complete fieldwork through telehealth services:
- AOTA decision guide for telehealth
- Telehealth and interprofessional education
- PT ethical standards of practice
- OT ethical standards of practice
- SLP code of ethics
Providing Patient Education
Another great way to leverage extenders during this crisis is by having them provide patients with education that doesn’t involve directly administering interventions. Assistants who are unable to provide direct, skilled intervention via telehealth, along with technicians (who should never provide skilled interventions to patients), can help with:
- pre-appointment communications to confirm patients have access to the technology necessary to participate in the appointment (and that they understand how to use it),
- reviewing patient consent forms before sessions begin, and
- completing orders for retail items the patient may have purchased to use during home treatment sessions.
All of these components are critical to a productive telehealth session, but they are not reimbursable—which makes them appropriate activities for techs.
Filling Front Office Gaps
When assistants, techs, and students are unable to perform their usual duties—whether that’s due to state limitations or payer restrictions—you may want to shift their responsibilities to clerical duties or front office tasks like:
- reaching out to patients to educate them about telehealth service or e-visit offerings;
- collecting and updating patient information;
- verifying insurance benefits for telehealth services;
- collecting and processing patient payments; and
- updating and scheduling patient appointments.
Completing Continuing Education
Most states require therapy assistants to complete a certain number of CEUs for a given period, and this is a great time to have your PTAs and OTAs knock out those con-ed requirements. It’s also a good time for extenders to review journal articles and webinar recordings detailing the latest research and best practices. If you have some articles you’ve been waiting to read for yourself, consider tasking the appropriate staff to look them over and report what they’ve learned to you and the rest of your team.
So, there you have it: a guide to using assistants, technicians, and students during the coronavirus pandemic. For more resources on keeping your practice running smoothly during COVID-19, check out this recent webinar. And, as always, let us know if you have any questions. Simply drop them in the comment section below, and we’ll do our best to get you an answer.