The Ongoing Impact of COVID-19 on Patients, Physical Therapists, and the US Health System

By Robert Hall, JD, MPAff

I, and almost everyone I know, have been feeling COVID-19 fatigue for months. Nevertheless, it is important to focus on the health of patients, the role of physical therapists, and the US health system despite the challenges of the pandemic.

COVID-19 INSURANCE COVERAGE

Patients who have survived COVID-19 infection have been showing signs of long-term effects that may indicate significant physical therapy and other medical needs in their future. The extent and causes of these needs have not been fully studied, but health care providers are learning more with time. In fact, many patients are health care professionals themselves and have reported symptoms including memory loss, fatigue, shortness of breath, joint pain, and chest pain. The long-haulers, a term used to describe patients with long-standing symptoms, also display surprising demographic characteristics: Physicians at a Paris hospital recently reported, “…the average age [of long haulers] was around 40 years, and women outnumbered men 4 to 1.”¹ COVID-19 after-effects are an important reason to keep protections for patients that exist in current law. COVID-19 will be treated as a pre-existing condition by any logical insurer since patients who have survived it may need long-term ongoing care and treatment. It’s also reasonable, as well as humane, to spread the cost of care to others who buy insurance. If insurers can skirt community rating rules by imposing widely variable age bands or gender ratings, rescissions, and pre-existing condition exclusions, they will do so. Medical losses stemming from actual treatment, after all, are just what the name implies. I am very hopeful that insurers will continue to implement baseline rules that ensure costs are spread as widely as possible so that insurance prices have the chance to remain low based on patient health and care needs.

PERSONAL PROTECTIVE EQUIPMENT (PPE) COST COVERAGE

For physical therapists, COVID-19 will have an even larger impact if proposed cuts to Medicare prevail. Despite those cuts however, there have been some positive outcomes from the pandemic. In July, in response to a request by the American Medical Association (AMA), PPS leadership was asked to complete a survey regarding incurred costs resulting from increased PPE during their patient encounters. The AMA tabulated all of the returned surveys and determined an average for the cost of PPE across specialties and providers. Physical therapists typically have a lower burden than some other healthcare professionals like surgeons, but the survey confirmed they still have non-negligible costs. The information provided by PPS members, along with other members of the medical community, led to the creation of a new CPT code, 99072. This CPT code has now been promoted by the AMA and is starting to be reimbursed by some private payers. As of this writing, CMS has not recognized the code for payment under Medicare, however PPS and other health care associations are advocating for payment of this code through the remainder of the public health emergency. For more information about this code, visit the free CPT coding assistant publication at www.ama-assn.org/system/files/2020-09/cpt-assistant-guide-coronavirus-september-2020.pdf.

TELEHEALTH COVERAGE

In addition to new coding, the future of telehealth is also directly linked to the pandemic. While there has been great variability in how telehealth services have been accepted by payers for coverage and payment during the pandemic, the lynchpin that caused most payers to reimburse was the public health declaration by HHS Secretary Azar and the explicit loosening of rules by CMS and the White House to allow Medicare and other federal payers to reimburse services. This effort intended to bolster telehealth’s support for social distancing during the pandemic’s early days. In recent months, payers have initiated conversations for returning their policy regarding telehealth to pre-COVID-19 coverage. Prior to the pandemic, telehealth was not widely recognized for payment, and even during the pandemic, different payers recognized and reimbursed for different aspects of the platform. Recently, certain payers are re-imposing the collection of copays when using telehealth service, a process which will dis-incentivize large telehealth companies from providing services for a lower cost to the patient when compared to receiving care from a brick and mortar physical therapist, offering a leveling of the playing field. Fortunately, telehealth has become an acceptable tool for patients and physical therapists to solve some of the problems in the health system due to the pandemic. I highly doubt the opportunity to utilize telehealth to supplement in-person care will completely retreat post-pandemic.

So many things have been unpredictable about the COVID-19 situation, and it can be genuinely challenging to adjust and succeed in private practice. Throughout the duration of the pandemic and beyond, PPS will continue to advocate for you as you strengthen your position to achieve your mission.

References:

¹Davido B, Seang S, Tubiana R, de Truchis P. Post-COVID-19 chronic symptoms: a postinfectious entity? [Published online ahead of print July 22, 2020]. Clin Microbiol Infect. doi:10.1016/j.cmi.2020.07.028.

Robert Hall, JD, MPAff, is a senior consultant for PPS working to advocate with private payers. He may be reached at rhall@ppsapta.org.