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Mitigating the Impact of COVID-19: Some thoughts on what therapy clinics can do to keep their doors open and continue providing care.

The spread of COVID-19 around the country and the world has therapy clinics everywhere guessing at what’s next. The top concern for all, of course, is the safety and well-being of patients and staff, but just below that many are wondering how the pandemic might ultimately affect business. Many of our clients have already told us they’ve seen a dramatic drop in patient visits, and in recent days local and state emergency mandates have forced a growing number to temporarily close their doors. These clinics, sadly, are losing money right now, victims of a disaster that’s out of their control. There’s hope that things will turn around eventually, but no one knows exactly when that day will come—or who’ll be left standing when it does.

The good news against this dark backdrop is that our clients are refusing to give up as their outbreak-related challenges continue to grow. Rather, therapy practices large and small are confronting the pandemic with purpose and innovation and using it as a catalyst to adapt and evolve.

Before they were told they would have to stop seeing patients due to a “shelter in place” order issued by their county, for example, the team at a PT clinic in California, both modified their approach to patient outreach and fortified their policies around infection prevention. They’d had several patients cancel or postpone their appointments as it became clear the outbreak was serious, so the team spent time with those clients on the phone, answering their questions and offering advice to help them avoid falling behind on their home program activities. And around the clinic itself, the practice implemented a number of new measures designed to minimize the threat of contamination. Staff and patients alike will now be asked to stay home at the slightest hint of sickness, and hand sanitizers, disposable gloves, and protective masks will be offered throughout the office, including in patient treatment rooms.

More Options to Fight Cancellations

Halfway across the country in central Nebraska, the PTs, OTs, and SLPs who work at Grand Island Physical Therapy have also changed certain aspects of their workflow to account for the new reality that is COVID-19. At this point, says occupational therapist and partner Mary Walsh-Sterup, OTR/L, CHT, they’ve only had a few cancellations directly attributable to worries about the virus. On the other hand, she notes, patients are asking questions, “and we’re seeing a lot more concern from our employees as well.”

In response, practice administrators have been steering patients and employees toward reliable sources of information about the virus, including the CDC, the U.S. Department of Health, and the websites of the three major hospitals they work with. “We’re trying to avoid the media hysteria and turn to authorities we can trust,” Walsh-Sterup says. In addition, internally, they evaluated their ability to continue providing services without increasing exposure risks to visitors and staff, and they established a system for screening current and scheduled patients with a series of questions about their general health.

Finally, Walsh-Sterup notes, they’ve stepped-up housekeeping and infection control, implementing new or enhanced procedures for everything from hand-washing to surface cleaning. And they’re offering patients more choices when it comes to treatment, including greater flexibility around where and when they are seen. “When people call and ask what we’re doing, we tell them first of all, ‘You have to be comfortable. If you’re not comfortable coming in, we understand and we can reschedule.’ And we also tell them they can have a private room if they want so they don’t have to be out in the main gym area.” Patients who express concerns or have underlying conditions that may make them more vulnerable to the virus are scheduled for time slots when fewer people will be in the clinic, Walsh-Sterup notes. And while Grand Island doesn’t normally provide home care, “we’re exploring that as a possibility for some of the more critically ill patients.”

Looking Ahead: Physical Therapy Telehealth

Walsh-Sterup says all options are on the table as she looks ahead to the coming months. Her practice is investigating opportunities for physical therapy telehealth, for example, and it’s leveraging the patient-outreach tools that are part of its EMR system. (CMS announced on March 17 it was broadening patient access to telehealth and that PTs would now be reimbursed for providing remote “e-visit” services when qualified to do so through a “1135 waiver.” See the Clinicient webinar series, “Strategies for Minimizing the Impact of COVID-19,” for more on on-demand in-home services/telehealth/patient engagement and a look at what other practices are doing in these areas right now.)

At this point, Walsh-Sterup says, she’s just as focused on Grand Island’s 350-plus providers and staff as she is on its patients. The practice provides services to children in nearly 60 schools (as well as patients of all ages in about a dozen outpatient clinics), and there’s a chance that some or all of them will close as part of their efforts to limit spread of the virus. Should that happen, Grand Island may have to reduce the working hours for some of their employees. “So now we’re looking at our benefits package to see if we can make some adjustments around time requirements. That way, if we need to send people home, at least they’ll continue to get their benefits.”

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