Physical therapy services have been considered necessary by federal, state, and municipal advice throughout the pandemic, despite the fact that many physical therapists have proactively halted nonessential in-person care to flatten the pandemic curve.
To assess the impact of the COVID-19 epidemic on the physical therapy profession, APTA polled 5,400 physical therapists and 1,100 physical therapist assistants between April 24 and May 11.
The results of the survey are snapshots in time. The position for PTs and PTAs is projected to continue to evolve in response to changes in COVID-19 cases and changes in state and federal regulations.
Since the COVID-19 outbreak hit the United States in March, the physical therapy profession has changed dramatically. Many people have seen, and continue to observe, decreases in their working hours and earnings. Although telehealth and other video-based consultations have grown in popularity, in-person care remains the most common and preferred treatment method. Although the epidemic is more likely to raise than decrease professional pride, many PTs and PTAs suffer significant financial challenges.
The Physical Therapy Profession is Disrupted by COVID-19
• Physical therapy clinics that remained open during the early phases of the epidemic saw a decrease in the number of patients. The number of physician referrals and direct access visits has decreased. The number of hours spent in child care has decreased. Although there were hints of improvement by July, the pandemic’s impacts remained.
• PTAs, in particular, saw their employment and income decrease. As a result, many people applied for unemployment benefits. Revenue losses topped 50% for 72 percent of owners at some point. By July, 34% of business owners had seen revenue drops of 50% or more, with 40% experiencing declines of between 26% and 50%.
• In July, 24% of PTs and 30% of PTAs were having trouble paying critical bills. For half of the PTs and 58 percent of PTAs, nonessential (flexible) expenditure was a challenge, with the majority of both groups expecting it to take more than three months to return to former levels of flexible spending.
• Most PTs and PTAs reported no change in their degree of career pride as a result of COVID-19; however, 29 percent of PTs and 31 percent of PTAs reported a rise in their level of career pride as a consequence of COVID-19.
Telehealth adoption and use are increasing.
• Prior to the epidemic, telemedicine in physical therapy was the exception rather than the rule. When the pandemic started affecting people’s behavior, the number of physical therapists who offered video consultations skyrocketed. By July, however, only 13 percent of PTs providing telehealth were treating more than ten patients per week, with 32 percent seeing fewer than one patient per week on average.
• By late April, PTs’ ability to get paid for telehealth services had improved dramatically, but obstacles remained: Many physical therapists are concerned about compensation, patient satisfaction, and outcomes. Patients’ and clinics’ technological issues continue to be a roadblock to wider adoption.
Demonstrated Professional Judgment
• The main reason for the 45 percent of PT clinic owners who said their clinic closed for in-person treatments at some point during the pandemic was to use professional judgment to avoid risk.
• Prior to the pandemic, just 30% of practices had an emergency preparation strategy in place, leaving many PTs and PTAs asking for assistance. • The CDC was the most-used source for external information, although APTA was not far behind. As the association released information on the pandemic and changing rules regarding telemedicine, the APTA’s website set traffic records.
During the pandemic, most PTs and PTAs were able to keep their jobs and compensation, but the physical therapy community endured furloughs, layoffs, and revenue losses.
Most PTs and PTAs are seeing a decrease in practice hours.
Physical therapist visits were reduced as a result of stay-at-home directives. During the early stages of the pandemic, 10% of PTs saw their hours increase, while 54% saw their hours fall. A higher percentage of PTAs – 64 percent – reported a reduction in hours. By July, 36 percent of physical therapists and 48 percent of physical therapist assistants were working fewer hours than before the pandemic.
Direct Access and Physician Referral Affected
Physician referral and direct access were both on the decline in the early stages of the epidemic, but by the summer, they were showing indications of recovery. In July, 62 percent of physical therapists reported a decrease in physician referrals, compared to 88 percent in the spring. Meanwhile, in July, 39 percent of PTs reported a decrease in direct access traffic, compared to 64 percent who reported decreases in the spring.
In July, 40% of physical therapists and 44% of physical therapist assistants reported lower weekly earnings than before the epidemic. While only 5% of PTs said their income had increased, 15% said their hours had increased. Meanwhile, 6% of PTAs reported a rise in income, while 14% reported an increase in hours.
The Struggle to Find Work Continues
According to the July poll, 7% of PTs have been laid off, 16% have been furloughed, and 2% have resigned or quit since the start of the pandemic. As of July, 55 percent had returned to their prior job, and 11 percent had found a new one, but 33 percent remained unemployed. 82 percent of individuals who lost their jobs applied for unemployment benefits.
According to the July poll, 15% of PTAs have been laid off, 26% have been furloughed, and 3% have resigned or quit their jobs. As of July, 33% had returned to their prior job, and 8% had found a new one, while 54% were still unemployed. 89 percent of individuals who lost their jobs applied for unemployment benefits.
The Norm Is Essential Care
80% of physical therapists who worked during the pandemic said their boss never told them to provide in-person treatment for what they considered nonessential physical therapist services.
Personal Protective Equipment (PPE) is widely available.
PTs who continued to give in-person care during the pandemic reported receiving adequate PPE in 85 percent of cases. Fifty-nine percent of those who thought the provided PPE was inadequate said they were requested to reuse it, while 43 percent said they weren’t given enough, with some mentioning the lack of N95 masks or face shields.
Personal Finances in Peril
In July, the pandemic was hurting the ability of 24 percent of PTs and 30 percent of PTAs to pay basic bills and expenses. For half of the PTs polled and 58 percent of PTAs, nonessential (flexible) expenditure was a challenge. 64 percent of PTs and 68 percent of PTAs predicted that returning to former levels of flexible expenditure would take more than three months.
Increased Job Satisfaction
While the majority of PTs and PTAs believe the pandemic has had no impact on their professional pride, 29 percent of PTs believe their career pride has increased, compared to 11 percent who believe it has decreased, and 31 percent of PTAs believe their career pride has increased, compared to 17 percent who believe it has declined.
Procedures for producing aerosols are uncommon.
Only 16 percent of physical therapists polled in July stated they used aerosol-generating treatments on patients. When performing an aerosol-generating procedure with patients who have suspected or confirmed asthma, the CDC recommends that physicians wear complete PPE, including N95 or other filtering respirator masks — such as powered air-purifying respirators or elastomeric respirator masks. COVID-19.
Screenings of patients are fairly common.
In a July poll, 51 percent of physical therapists said they were individually screening patients for COVID-19. Ninety-three percent offered screening questions and seventy-eight percent took their patients’ temperatures.
Telehealth, perhaps more than any other aspect of health care, was severely impacted by the pandemic.
The Centers for Medicare and Medicaid Services stated on March 17 that it was loosening regulations to allow physical therapists to offer “e-visits.” CMS did not add PTs and PTAs in private practice among the providers authorized to bill for services performed through real-time, face-to-face technology until April 30 — after strong agitation by APTA and its members. Then, on May 27, CMS added outpatient facility-based providers to the list of Medicare providers who can bill for telehealth services delivered using real-time, face-to-face technology.
The number of physical therapists who offer telehealth has significantly expanded, yet most have only used it infrequently.
Pivot of PTs to Video
Prior to the pandemic, 98 percent of PTs polled said they didn’t offer live video consultations. By July, 47% of respondents said they offered live video consultations. Just under half (45%) treated one to five patients per week through live consult, while 32 percent treated fewer than one patient per week, 11 percent treated six to ten patients per week, and 13 percent treated more than ten patients per week.
Uncertainty continues to exist.
Half of the physical therapists polled in July were unaware which payers covered telehealth services, and 56% were unsure if telehealth services were reimbursed at the same rate as in-person care. In terms of satisfaction and outcomes, 46 percent of respondents didn’t know how their patients rated their telehealth care in comparison to in-person care, and 49 percent couldn’t compare outcomes in both settings.
Telehealth is outperformed by in-person care.
Of those who could compare patient satisfaction and outcomes via telehealth, 46 percent said patient satisfaction was equivalent or better, 47 percent said outcomes were equivalent or improved, 54 percent said patient happiness was lower, and 53 percent said results were worse.
Zoom Takes the Lead
Zoom was named the most popular platform for video consults by 45 percent of PTs polled in July. Doxy.me was utilized by 27% of respondents, whereas Epic was used by 10%. More than two dozen platforms were recognized by respondents as being used to assist video-based care.
Gaps in technology create barriers to wider adoption, according to 34% of respondents and 27% of respondents, respectively.
Two of the top three barriers to telehealth were technological: Patients and clients lacked enough technology in 29 percent of cases, whereas technology in 16 percent of cases was a limiting factor. Lack of payment for services was another typical stumbling block.
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