The Crisis
With the advent of the coronavirus outbreak, our daily lives are slowly coming to a standstill. Events and concerts have been cancelled, restaurants and bars have closed, and we are told to stay home as much as possible.
However, healthcare providers seem to be as busy as ever. One of my friends texted me today asking what has changed in how I am treating my patients. Are you still going to work? I texted her back, with a short response “we’ve been told to wash our hands...” She said, “Aren’t your patients at high risk?” I told her sadly, yes.
“As practitioners, we are faced with an ethical dilemma.”
Every day as the outbreak escalates, healthcare providers in nonessential roles, such as physical therapy, are going to work and treating patients. In light of this current contagion, we as practitioners are faced with an ethical dilemma.
The care that we are providing that is supposed to help our community is potentially putting their lives at risk with unnecessary exposure. Some patients question whether they should be there, some don’t think it’s a big deal. Meanwhile, the corporations we work for are telling us to keep treating as usual.
The fact is, we are ticking time bombs. I am in my 30s, relatively healthy, and could be an asymptomatic carrier while treating my patients.
As more and more restrictions are added for practicing social distancing, holes in our infrastructure are being exposed. One of the most important shortcomings being how we provide healthcare in our country.
Can We Go Online?
During a press conference on March 17, 2020, President Trump proposed an expansion of telehealth services at no additional cost for Medicare beneficiaries (CMS.gov). This is a great solution to the problem we are facing in busy outpatient clinics where there are 20-50 people in the facility at a given time, or at assisted living facilities and in home health with the most vulnerable population. The majority of the patient care we provide as physical therapists is our expertise and education which could be provided over video chat.
The technology is readily available for telehealth services including an EMR system, billing and coding, and telehealth companies are sprouting up. Research also indicates that it is highly effective, which the APTA has compiled (here). Another innovative technology is remote patient monitoring for home health which has research backing its ability to do a better job of keeping patients out of the hospital than traditional home health alone.
The problem is bureaucracy restricting providers.
However, the problem is not how to deliver the care. The problem is bureaucracy restricting providers. It has been mentioned at private practices where the owner and office manager don’t want/care to take the time or headache of figuring out how to implement it. It has been mentioned at larger companies that don’t want to consider it because they are afraid it “may affect the bottom line”. The largest bureaucratic restriction is legislation. Physical therapists are not authorized providers of telehealth services through medicare.
The APTA has some detailed information in the article, (Telehealth in Physical Therapy in Light of COVID-19, regarding the specifics on the current legislation).
The Bottom Line
The bottom line is, the government, insurance companies, and healthcare companies should have an ethical response to our current healthcare crisis.
If allowing nonessential providers to treat via telehealth saves lives and reduces exposure risk, allow it. The immediate response should not be how it affects the bottom line. We don’t know how long the restrictions will last, some are speculating several months. As a collective, providers should be voicing their concerns so they can be heard.
Who knows, if these changes are allowed, we could see drastic improvements in our profession. In addition, any objective data compiled from using telehealth and patient monitoring could add to justifying the need for physical therapy and improve patient outcomes. This could be a time of major innovations. In the words of President Barack Obama:
“Change will not come if we wait for some other person or some other time. We are the ones we’ve been waiting for. We are the change that we seek.”
References:
- https://www.cms.gov/newsroom/press-releases/president-trump-expands-telehealth-benefits-medicare-beneficiaries-during-covid-19-outbreak
- http://www.apta.org/PTinMotion/News/2020/3/16/TelehealthCOVID19/
- https://www.apta.org/contentassets/9f3f182453004a4ab6abdfa72d725438/research-on-telehealth.pdf
- https://mtelehealth.com/
