COVID-19 has created the perfect witch’s brew of intense stress. People across the country are concerned about the health of themselves and their families; job security is shaky (and household incomes are dropping); and basic necessities like food staples and hygiene supplies are still—even after two months—difficult to find.  

All of this creates an environment for mental illness to not only grow, but flourish—which is why there’s never been more important time for clinic leadership to learn about mental health and refine how they approach it.  

The goal of this article isn’t to teach you how to fix you employees’ mental health problems. Even if that were possible (or a good idea), your employees have to take initiative when it comes to addressing their personal health. That said, there’s plenty you can do as an employer or colleague to understand mental health—and to empathize and better communicate with peers who are shouldering its burden.  

Why is this important?

For those who don’t experience it, mental illness is difficult to fathom—the same way it’s hard to imagine the pain of a broken foot if you’ve never broken a bone. The difference between that  broken foot and mental illness, however, is that people can easily identify when someone else has broken a foot (usually because the unlucky person is wearing a cast or using crutches). And, most people recognize that a person with a broken foot needs to take it easy; if he or she went on a jog, for example, it would exacerbate the injury—prolonging the healing process and causing unnecessary pain. 

It’s not a perfect comparison, but it might help to think about poor mental health like it’s a broken foot. When people ignore their own poor or failing mental state—when they push forward despite needing to slow down—it can lead to devastating effects. Symptoms can drastically worsen (e.g., social withdrawal can turn into complete social isolation) and temporary afflictions can turn into chronic conditions (e.g., an isolated bout of situational depression can turn into lifelong clinical depression). It’s also worth mentioning that poor mental health—and the symptoms that come along with it—can also weaken the immune system. 

In other words, if mental health is not given the attention and treatment it deserves, things can turn sour—very, very quickly. 

It’s affecting your staff more than you might think. 

Mental illness was widespread in the US long before the novel coronavirus found its footing. According to 2018 statistics from the Substance Abuse and Mental Health Services Administration (SAMHSA), one in five US adults experience mental illness each year. 

But, you don’t have to be diagnosed with a mental illness to experience its symptoms during high-stress situations. And that would likely explain why the number of people with poor mental health has increased in response to the pandemic. Different sources are reporting that: 

• “More than four in ten adults overall (45%) feel that worry and stress related to coronavirus has had a negative impact on their mental health.” (Kaiser Family Foundation)
• “88% of workers reported experiencing moderate to extreme stress over the past 4 to 6 weeks.” (Ginger)
• “The greatest increase was in prescriptions for anti-anxiety medications, which rose 34.1% from mid-February to mid-March…The number of prescriptions filled for antidepressants and sleep disorders increased 18.6% and 14.8%, respectively, from February 16 to March 15.” (Express Scripts)

The bottom line is that it’s very likely that some of your colleagues (job titles notwithstanding) are currently struggling with mental health troubles. Some may have struggled prior to the pandemic, but it’s likely that more are struggling now.

Mental illness limits workplace performance. 

When employees suffer from poor mental health, their workplace engagement takes a hit. According to a poll conducted by the American Psychiatric Association (APA), 24% of respondents said “they have trouble concentrating on other things because they’re thinking about COVID-19.” When employees aren’t fully engaged with patients (be it in the front office or on the treatment floor) the patient experience suffers—and now is not the best time to deal with patient complaints. 

But it’s not only the patient experience that takes a hit: the aforementioned Ginger survey found that, of those who reported that they were experiencing moderate to extreme stress, “62% noted losing at least 1 hour a day in productivity and 32% lost at least 2 hours a day due to COVID-19–related stress.” Now, those numbers might play out a little differently in a clinic than they would at a desk job, but even so, they are mind-boggling. 

What does poor mental health look like? 

Like many illnesses, there is no “one-size-fits all” list of poor mental health symptoms that applies perfectly to everyone. Poor mental health manifests a little bit differently in everyone, and presenting symptoms can vary based on the type of poor mental health a person is experiencing (e.g., depression versus anxiety). Additionally, those presenting symptoms can vary in severity. That said, here’s a list—compiled from the CDC, Mayo Clinic, and Healthline—of some of the most common symptoms associated with poor mental health due to COVID-19: 

• Feelings of helplessness, hopelessness, sadness, anger, anxiety, and fear
• Excessive irritability
• Difficulty concentrating 
• Difficulty completing daily tasks
• Hyper-vigilance
• Emotional dysregulation
• “Increased use of alcohol, drugs, or other drugs”

Don’t confuse symptoms for laziness or a lack of motivation. 

Before we move on, I want to briefly talk about the “difficulty concentrating” and “difficulty completing daily tasks” symptoms. These symptoms should never be confused with laziness or a lack of motivation—but often are. The affected person could be putting in their best effort (maybe even 110%), but he or she might only make the smallest dent in his or her workload. 

It’s kind of like trying to push a heavy piece of furniture across a tile floor while wearing socks. No matter how hard you push, that piece of furniture isn’t going anywhere; you’re just going to slide around like you’re Tom Cruise dancing in Risky Business.

It’s also worth noting that difficulty concentrating and completing daily tasks can be a result of other, lesser known symptoms of depression or anxiety, such as: 

• brain fog (lack of mental clarity),  
• executive dysfunction (difficulty focusing on “desired information while suppressing uninteresting or irrelevant information”), or
• dissociation (feeling disconnected from the present moment).

Poor mental health can create physical symptoms. 

As I mentioned in the opening of this article, poor mental health can lead to a weakened immune system—but that’s not the only effect it can have. Poor mental health can cause other physical symptoms like: 

• Stomach pain, 
• Back pain, 
• Headaches, 
• General aches and pains, 
• Changes in eating patterns (i.e., eating too much or too little), 
• Changes in sleeping patterns (i.e., insomnia or excessive sleeping), or 
• Exacerbation of chronic health problems.

Symptoms of poor mental health align with symptoms of burnout.  

Did any of those symptoms look familiar to you? If you’ve been reading up on burnout, then they should—because there’s an almost one-to-one match between symptoms of poor mental health and symptoms of burnout. In fact, many experts recommend looking at mental health if you want to address employee burnout. 

How do I identify when staff members are struggling if everyone experiences mental illness differently?

We’ve established that poor mental health manifests differently for every person who experiences it. So, how exactly are you supposed to identify when your staff is struggling?

According to this Engaged HR resource, the best way to spot potential cases of failing mental health is to pinpoint unusual changes in employee behavior, like: 

• Changes in work habits (e.g., decreased productivity or poor concentration);
• Changes in physical appearance (e.g., decreased grooming);
• Changes in demeanor (e.g., increased agitation, restlessness, irritability, passiveness, disinterest, or worry);
• Increased absenteeism or tardiness;
• Sudden lack of emotional regulation (e.g., mood swings, outbursts, or disruptive behavior); or
• Changes in social habits (e.g., self-isolation or unwillingness to communicate). 

However, don’t assume you’ll always pinpoint when your employees are in the thick of it; some people are extremely adept at hiding their poor mental health. You’ll only know they are struggling when they feel comfortable coming forward and seeking help—and that will typically only happen in an environment that foundationally encourages empathy, acceptance, and mutual respect. 

How do I communicate with employees who are struggling?

The best way to communicate positively with employees who are suffering from poor mental health is to lead with empathy and compassion. 

Understand that mental health is still stigmatized—and that talking about it makes everyone uncomfortable. 

Mental health can be uncomfortable to talk about, especially for those who experience it. Though poor mental health is more widely talked about now than it was, say, ten years ago, it’s still attached to some stigma, and that stigma too often leads to prejudice. According to the National Alliance on Mental Illness (NAMI), “People with mental illness were shown to be perceived as incompetent and less promotable, receive lower wages and have less access to quality jobs. Even in terms of supporting existing employees with depression, about 25% of managers reported they did not feel confident in doing so effectively.” 

This prejudice directly contributes to employees’ reluctance to talk about their mental health. But beyond that, talking about your poor mental health makes you feel vulnerable. Opening yourself up to that kind of vulnerability is tough—especially in a work environment, and especially in an unsupportive work environment.  

The best way to encourage open communication about mental illness is to support your employees by chipping away at that stigma and creating a non-judgemental environment that thrives on mutual respect. If they trust you and feel supported by you—if they respect you and feel respected in return—they’ll feel less vulnerable when opening up about these topics. If you normalize conversations about mental health and sustain judgement, that will help foster open, honest communication. Keep in mind that it’s not enough to just tell employees that they can trust you. You have to earn that trust by actively demonstrating that you won’t withdraw your support when they explain aspects of their mental health. 

Lead conversations with empathy. 

Say you notice that one of your therapists seems a little off. Her productivity is flagging; she’s not engaging with her patients as enthusiastically as she used to; and she’s distancing herself from her coworkers. You suspect that she might be suffering from poor mental health. So, how should you reach out to her? This resource recommends following these nine steps: 

1. Choose a neutral, private, and quiet space to start a conversation. 
2. Assure the employee that this information is confidential. Communicating about personal mental health is a huge exercise in trust—and if you spread that information to your peers (even to other members of leadership) without permission, you could severely damage your relationship with the affected person. 
3. Don’t make assumptions about the employee’s symptoms or how it affects his or her job. Give the employee a chance to explain what’s going on. 
4. Listen attentively and respond to the individual—not to the problem. Poor mental health manifests in a myriad of different ways, so there’s no single approach that’s going to solve every person’s problems. Your best bet is to “focus on the person, not the problem. Adapt your support to suit the individual and involve [them] as much as possible in finding solutions to any work-related difficulties.”
5. Prioritize honesty and clarity. “If there are specific grounds for concern, like high absence levels or impaired performance, it’s important to address these at an early stage.” 
6. Collaborate on an action plan. Work with the employee to understand what kind of a solution he or she is looking for, and develop a plan that helps the employee identify:
   • how his or her mental health affects his or her work,
   • what his or her stress triggers are, and
   • how you can adjust his or her work process to support better outcomes.

   Effective adjustments can be as simple as offering flexible work hours, increasing managerial communication, shifting caseloads, or changing break times. Other times, an employee might need more significant intervention—like task reallocation, mediation between colleagues, or even position redeployment (i.e., moving the employee to a different role in the clinic). If the employee suggests an adjustment, but you’re not immediately sure if it’s feasible, set aside some time to evaluate the proposal’s: 

   • practicality,
   • effect on service,
   • financial cost, and 
   • effect on other employees. 

   I strongly advise against evaluating the proposal during the meeting. Remember, the affected employee came to you from a place of vulnerability, and an immediate discussion on the potential negative impact of the request may cause the employee to feel ashamed for reaching out—and to withdraw from the table altogether.

   If you determine that the proposed adjustment isn’t feasible, then pinpoint your biggest hangup and reach out to the employee at a later time. Communicate your concern and ask if the employee can collaborate with you to find an alternate solution that addresses your worries. (The key here is to keep the collaborative spirit alive and well. This is essential if you don’t want to accidentally shame the employee for asking for help.) If, however, you determine that the proposed solution is totally doable, then touch base with the employee to confirm when the adjustments will begin, and plan a future meeting to review the situation and determine if your intervention is working.

   Please note: Do not implement work adjustments that the employee did not agree to. No matter how good your intentions, you should not violate the collaboration aspect of an action plan. For example, if the employee asks for a change in his or her break time, and you instead reduce the employee’s caseload, that may come across as a punishment—especially if your therapists are evaluated based on their productivity. 

7. Encourage the employee to seek advice and support. How your employee chooses to address or treat mental health outside of the workplace isn’t your business—however, it doesn’t hurt to share a gentle reminder that seeking professional help can make a big difference when managing mental health.

8. Get educated. Don’t rely only on this article to learn about mental health! Do your own research to find additional information. Understanding the parameters of mental illness and mental health will help you make smarter and more empathetic choices when you interact with your employee.

9. Offer reassurance. Even if you do everything right, the employee you’re concerned about might not be ready to talk about his or her struggles. Let the employee know that you’re always ready to talk and that you’ll support him or her—no matter what. 

Are there other ways for me to support my employees? 

There are many other ways you can support your employees! Some of them cost a little money (so this might not be the ideal time to implement them)—but others don’t. Here are some suggestions from the CDC: 

You can invest in offering clinic-wide employee support. 

• Offer mental health self-assessment tools. 
• Provide free or subsidized clinical mental health screenings from a qualified mental health professional.
• Provide health insurance plans that cover (or reduce the cost of) mental health counseling and mental illness medication. 
• Host depression and stress management workshops that offer actionable suggestions (e.g., mindfulness training).

Or, you can find free resources to support your employees.  

• Promote external digital mental health and stress management webinars or programs.
• Establish and maintain a dedicated quiet space for at-work depressing.
• Train all leadership about mental health. Help them recognize the signs and symptoms of poor mental health, and teach them strategies to communicate effectively and empathetically with employees about these topics.
• Create a forum where employees can give feedback about your clinic’s work processes and collaborate to foster an environment that encourages and bolsters everyone.

These are stressful times, and everyone is doing their best to muddle through. If you’re in a leadership position at your clinic, you have the unique opportunity to help your staff weather this crisis. Our communities can come out of this pandemic stronger than we were before—but we have to actively work to support each other—physically, emotionally, and mentally. 

The post Coping with COVID-19: Prioritizing and Addressing Mental Health in Your Rehab Therapy Clinic appeared first on WebPT.

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It feels like the entire country has been in a state of hibernation for the past two months. As new instances of the novel coronavirus begin to decrease and an end to stay-at-home orders appears within our sight, people are itching to emerge from their caves and embrace the warmer weather. However, we’re not in the clear yet—and as patient volumes inch closer to pre-pandemic levels, it’s absolutely crucial that PT practices take precautions when working with new and returning patients. After all, despite an apparent flattening of the curve, the risk of infection is still present. Here’s what outpatient physical therapy practices need to do when seeing patients after the COVID-19 lockdown has been lifted:

Check your state and local laws.

As states begin easing restrictions on stay-at-home orders, they are also providing specific safety measures that practices must adhere to. For that reason, you must check your state and city guidelines to see if there are any rules or requirements for things like the number of patients allowed in the clinic at any one time and the use of personal protective equipment (PPE). This will tell you what, at a minimum, you’ll need to do to remain compliant. If you need help researching the requirements that apply to you, this US Chamber of Commerce resource is a great place to start.

Start slow.

Before you do anything, map out a game plan for reopening your practice to the public. It’s super important to include key individuals in the planning process—such as your clinical director, office manager, HR department, and, if applicable, your attorney—to ensure you have additional perspectives from, and communication across, the entire organization. That way, you can be sure everyone’s on the same page and enforcing the same protocol. You’ll also want to loop in any third-party vendors that are important to helping you run your business and designate one person to field patient feedback.

In a recent post, WebPT Chief Compliance Officer Veda Collmer, JD, OT/R, discussed strategies for reopening your clinic and explained that an effective work plan should account for the following:

• disseminating information on new clinic protocols to employees;
• communicating important information to patients;
• reviewing workplace safety policies;
• informing your referral sources that you’re accepting new patients;
• updating signage and online listings with your current hours of operation;
• stocking up on cleaning supplies and PPE;
• creating checklists to ensure you haven’t overlooked anything pertinent; and
• updating your cleaning protocol to adhere to CDC guidelines (more on that in the next section).

While you might be tempted to jump right into treating patients like you were before, doing so is highly inadvisable. A period of “soft reopening” (i.e., reopening incrementally) will help prevent a sharp increase in new COVID-19 cases as well as allow patients and providers to adjust to these new changes.

Follow all safety and sanitization guidelines.

As practices start opening their doors and allowing more patients into the clinic, it’s vital that they adhere to all sanitization and safety guidelines to avoid contributing to a spike in infections. The Centers for Disease Control (CDC) has released a bevy of materials outlining the safety precautions clinics should take when working with patients. Chief among them:

• cleaning and disinfecting all equipment and surfaces between patients; and
• using PPE (e.g., gloves, gowns, face mask, and/or face shield/goggles) during treatment. (Both patients and providers may use PPE.) 

It’s important to also adhere to social distancing guidelines while working with patients. Many states have issued specific requirements businesses must meet as they reopen, so as I mentioned above, be sure to verify your local laws. That said, here are a few things to consider beyond state and local guidelines (as adapted from this American Medical Association [AMA] resource):

• Modify your staff schedule to avoid high volume, and ensure patients do not come into close contact with one another.
• Add some padding to each appointment slot to prevent overlap.
• Ask any patient companions to wait in the parking lot if their participation in the appointment is not necessary.

Furthermore, the CDC advises practices to require all visitors to wear a cloth face covering. It’s crucial to explain this expectation to each patient (and visitor) before he or she arrives for a scheduled appointment. To assist with compliance, provide or direct patients to resources that explain how to make a cloth mask using common household items. Or, if available, provide each patient and visitor with an approved facial covering upon arrival. 

Only allow healthy patients on site.

Part of your reopening plan should include screening every patient at the start of his or her appointment. If a patient exhibits symptoms of COVID-19, he or she should not be allowed on site. According to the AMA, “For visits which must take place in person, administrative staff should contact the patient via phone within twenty-four hours prior to the office visit to 1) review the logistics of the reopening practice protocol and 2) screen the patient for COVID-19 symptoms.” The AMA also recommends using a script to conduct these conversations and has provided an example in this guide.

There will undoubtedly be times when you have to turn one patient away to ensure the health of all the rest—and your staff. You’ll want to have a script for this conversation as well so you and your staff can politely and clearly explain the reason for the precaution. (The AMA has also provided a template for this script in the aforementioned guide.) Patients who should not be allowed in the practice include:

• Those showing symptoms of COVID-19;
• Patients who have been in close contact with someone who is suspected to have/was diagnosed with COVID-19; and
• Patients who have recently traveled to high-risk areas.

If a patient displaying COVID-19 symptoms does enter your practice, be sure to sanitize any areas he or she might have touched.

Conduct virtual visits whenever possible.

Thanks to recent relaxations on telehealth restrictions, it’s easier than ever for PTs to not only conduct virtual visits, but also get paid for them. If your practice is not already taking advantage of this, you should do so now. That way, patients who cannot come into the clinic—whether they are displaying COVID-like symptoms or are part of a high-risk population (e.g., diabetics, the elderly, etc.)—can still receive care without putting themselves (and others) at risk.

We’ve covered this particular topic at great length in the past few weeks, so for more information, check out the following resources:

• 10 Steps to Get Up and Running with Telehealth in Your Clinic
• Download: Telehealth Billing Quick Guide for PTs, OTs, and SLPs
• How to Market Your Clinic’s New Telehealth Services

Educate yourself on best practices for working with COVID-recovered patients.

Finally, it’s highly likely you’ll work with at least one patient who has recovered from the novel coronavirus—especially if you live in an area that’s been hit hard by the pandemic. If so, you may need to adjust the way you work with these patients (e.g., factoring in break times when scheduling appointments for COVID-recovered patients, as they will likely need time to stop and rest throughout their treatment). While this is an ongoing learning process, the APTA has provided the following clinically-focused educational materials on working with patients who have recovered from COVID-19:

• APTA Cardiopulmonary Section webinar series
• COVID-19: Clinical Best Practices in Physical Therapy Management

To say the past two months have been challenging for physical therapists would be a serious understatement—but there is hope on the horizon. However, even as the number of new COVID-19 cases continues to follow a downward trend, it’s still critical to take every precaution to prevent a second wave. Doing so not only ensures the health of you and your patients—it ensures the health of everyone. Have questions about reopening? Let us know in the comment section below, and we’ll do our best to point you in the right direction.

The post How to Safely Work with Patients in Outpatient PT Practices Post-Lockdown appeared first on WebPT.

SEED SPOT believes that catalyzing diverse impact-driven entrepreneurs of all ages is the key to solving society’s most pressing challenges. To unleash the innovation of entrepreneurs nationwide, the national Demo Day competition elevates the voices of students that are building businesses for good. Demo Day is an event that showcases a select group of those student-built ventures.

Meet the 3 Demo Day Winners below! Pitches will be debuted at SEED SPOT’s Virtual Demo Day event on May 12th (RSVP here: bit.ly/sdspot-demoday).

SEED SPOT Demo Day Winners will all win the following prize, valued at over $2,000:

• Lifetime access to SEED SPOT’s Alumni Network
• 1:1 mentorship through SEED SPOT’s National Mentor Program
• Pro-bono legal support
• Access to continued business courses and webinars
• Marketing and branding services
• SEED SPOT Swag Package

Congratulations to all students who participated – many of whom have had school canceled through the end of the year. Your grit, resilience, and belief in what is possible will create solutions to the problems we face as a global community today.

iKlozet

School: The Lighthouse | Black Girl Projects

Students: Madison Jackson & Jamian Jackson

iKlozet Pitch

MyInk Journal

School: Notre Dame College Prep

Students: Bennett Curran & Lauren Skemp

MyInk Journal Pitch

Yarrow

School: MET Professional Academy

Student: Robert Anderson & Kohl McCabe

Check out Yarrow’s pitch at Demo Day!

RSVP for Demo Day on May 12th to catch pitches by the finalists! bit.ly/sdspot-demoday.

The post SEED SPOT Schools Demo Day Winners! appeared first on SEED SPOT.

Before COVID-19, telehealth was not widely used in the rehab therapy community. But pandemic or no pandemic, rehab therapy telehealth offers many benefits:

• Patients living in underserved areas can obtain critical rehabilitation and habilitation services.
• Patients can receive therapy instruction in their home setting between appointments, thus improving skill carryover.
• Patients who cannot come to the clinic (perhaps due to transportation difficulties, lack of childcare, or health issues impacting travel) can still receive services.  

And even though telehealth was far from ubiquitous in the pre-pandemic rehab space, it was gathering steam—slowly. Some states—such as Louisiana and Ohio—had already authorized telehealth as a mode of service delivery for physical therapists. A few state Medicaid programs, such as Minnesota, reimbursed for OT and SLP telehealth services. Of course, Medicare did not authorize rehabilitation providers to deliver services virtually—and even states and payers who did allow rehab therapy telehealth often imposed limitations. For example, many required:

• the therapist to be licensed in the state where the patient was physically located,
• an initial face-to-face encounter prior to telehealth service delivery, and
• use of a clinic or facility as the telehealth site.

Then, the sudden declaration of a public health emergency made many of those telehealth barriers disappear. Nearly all states have issued executive orders (EOs) broadly authorizing telehealth services. More importantly, many EOs not only authorized telehealth, but also mandated insurance coverage. Pursuant to its 1135 waiver authority, even CMS eventually authorized PT, OT, and SLPs to provide services to Medicare beneficiaries via a number of virtual methods, including telehealth visits, virtual check-ins, and e-visits.  

The expansion of telerehab opportunities occurred via a patchwork of temporary changes to billing policies, technology requirements, and legal obligations. To facilitate use of telehealth and immediately reduce the risk of infection, for example, the government promised not to penalize providers for waiving co-pays—something that is generally viewed as an unlawful kickback. New billing codes, place of service codes, and modifiers were introduced to ensure providers were able to receive payment for telehealth services rendered. And, when the public health emergency is over, we’ll likely see even more changes in the telehealth arena. With so much rule variation and complexity, providers must be extra vigilant to avoid billing and compliance errors that may lead to serious consequences—even during a time marked by so much regulatory relaxation.

There’s a good chance that telehealth—in some capacity—is here to stay for PTs, OTs, and SLPs. So, now is the time for us to prove the unique value we provide using telehealth. We must show that we can use this means of treatment delivery to improve the lives of our patients. To do so, we absolutely must provide telehealth services with medical necessity and care quality in mind. We also must proactively incorporate telehealth into our compliance programs. That way, we can ensure adherence to all applicable laws, payer guidelines, and other requirements. If you don’t have a compliance program, or you’re not sure what it is, be sure to read this post on creating a compliance plan for your practice or this one outlining the steps for creating an effective compliance program.

Without further ado, here are the dos and don’ts of telehealth compliance. 

Do understand fraud and abuse laws. 

Don’t be willfully clueless.

As I mentioned previously, telehealth is a relatively new concept in the rehab world. Widespread adoption of telehealth in PT, OT, and SLP practices happened in a matter of weeks—at the onset of a national health crisis, no less. As such, there is limited guidance to answer all the billing questions that inevitably come with a new treatment method. To complicate matters, the state executive orders and federal 1135 waivers will expire at the end of the public health emergency, thus guaranteeing the rules will change yet again.  

Still, ignorance of the law is no defense. And having a solid understanding of fraudulent and abusive billing practices is crucial for any therapy provider navigating complex and ever-evolving telehealth laws. Luckily, you don’t have to obtain a law degree to understand fraud and abuse laws. This Medicare Learning Management article clearly outlines inappropriate billing practices. Here’s a quick overview:

Fraud

Fraud is knowingly submitting a false claim or knowingly making misrepresentations to obtain payment from a federal healthcare program, such as Medicare.  

Examples of fraudulent telehealth practices include:

• Billing for telehealth services not rendered (e.g., a patient doesn’t show up for a scheduled telehealth appointment and you bill for the visit anyway).
• Billing for non-covered services or services delivered by unqualified personnel.
• Providing non-medically necessary telehealth services.
• Routinely waiving copays to encourage patients to utilize your services.

Fraud Example 1: Technical Difficulties

Your patient is scheduled for a telehealth visit. The patient is able to log into the platform, but her Internet connection becomes unstable, and the screen freezes soon after the session begins. The connection drops and she emails you to communicate that she is having technical difficulties.  

The appropriate response: While you may be tempted to bill for the visit anyway, you absolutely should not do so. Document what happened in the patient’s record, and reschedule the session. For the patient’s next session, consider conducting a telephone visit or asking the patient if she would be comfortable coming into the clinic.

Fraud Example 2: The Therapy Tech

You are a licensed therapist who owns a small practice. You wonder if you can schedule a technician to provide telehealth services to your patients, and then bill the services under your NPI. You will be in the office suite to supervise the session.

The appropriate response: Health insurance payers—especially federal payers—do not reimburse for the services of an unlicensed technician. Submitting a claim with your NPI for the services of the technician constitutes billing for non-covered services. Instead, you should deliver the telehealth services yourself and leverage your technicians to assist with educating patients on the non-reimbursable aspects of telehealth (e.g., walking patients through the process of logging into the platform).

Abuse

Abuse involves receiving payment for unnecessary items or services, and it does not require intent to deceive or misrepresent. In other words, even if you didn’t mean to do it, you’re still on the hook for any legal repercussions. Abusive or wasteful billing practices those that are inefficient, excessive, not medically necessary, or do not meet professionally recognized standards of care. Examples of abusive billing practices include:

• Upcoding—such as billing for a code that pays more even though the services were not delivered—in order to seek high reimbursement.
• Billing for services that were not medically necessary.

Abuse Example: The Technology-Resistant Patient

Your patient agrees to try telehealth as an alternative to in-person visits. During the first session, he struggles to hear your instructions and reports that his vision affects his ability to see the computer screen. Still, he says he’s willing to continue trying telehealth. Alternatively, he says he can come into the clinic for an in-person visit.

The appropriate response: Based on the patient’s difficulties with hearing and vision, telehealth therapy services will most likely not benefit him. Billing for these services could be considered wasteful. Switch to in-person visits to ensure the patient will benefit from your instruction and other intervention strategies.

Do waive patient financial responsibility during the public health emergency, if you prefer.  

Don’t offer free gifts and giveaways for patients who schedule a telehealth visit with your practice.

Rewards, incentives, discounts, and giveaways are common marketing tactics for attracting new customers. However, in the complex world of healthcare reimbursement, these tactics can be construed as unlawful kickbacks. Generally, you should never offer any incentive that may encourage patients to seek your therapy services. Instead, patients should seek and receive your services because the services are medically necessary.

On March 17, the Department of Health and Human Services Office of Inspector General (OIG) announced it would not sanction providers who waive co-pays and other patient cost-sharing obligations for telehealth services during the public health emergency. The OIG wants to encourage patients to use telehealth so they can receive necessary medical care while simultaneously reducing their risk of exposure to the virus. Allowing providers to waive out-of-pocket patient expenses is one way the OIG can facilitate telehealth utilization.

Once the public health emergency is over, however, the OIG’s policy will expire. When that happens, routinely waiving copays and deductibles will once again implicate unlawful kick-backs, and you should avoid doing so. If your patient cannot pay his or her portion for the telehealth services, then implement a policy and process for financial hardship. For more information on copay collection and waivers, check out this blog post.  

Furthermore, refrain from giving away high-ticket prizes like laptops or iPads to encourage patients to sign up for telehealth. In fact, don’t supply vouchers, cash prizes, discounts, t-shirts, or any object of value that may be perceived to induce your patients to seek your services. For more information about the federal Anti-Kickback Statute and the many ways it can get you into trouble, refer to this resource on the OIG’s website.

Do train your staff on telehealth billing requirements.  

Don’t hope they will learn complicated telehealth billing processes by osmosis.

Healthcare billing is very complicated. Telehealth billing is very, very complicated. Many of the billing rules for telehealth are brand-new to therapy providers. And those rules are evolving on a near-weekly basis. Plus, rules are not consistent among all payers. To top it all off, Medicare has different types of virtual visits, each with its own billing codes and requirements. Failure to observe those requirements could negatively impact your practice in a big way, because believe it or not, telehealth billing errors can lead to overpayments—and overpayments can lead to fraud enforcement at both the state and federal level.  

So, train your staff on the rules. Don’t make them guess, because if you do, you can pretty much guarantee billing errors. Those errors ultimately hurt the therapy profession and our patients, so do your part and take the extra time necessary to bill correctly.  

Here are some resources you can use to learn about, and train your staff on, accurate telehealth billing:

• The Medicare fact sheet about virtual visits
• This FAQ on Medicare e-visits
• The Medicare Learning Network video on Medicare coverage of virtual services
• WebPT’s webinar on tackling telehealth
• WebPT’s webinar on telehealth updates
• WebPT’s telehealth billing quick guide
• WebPT’s guide to COVID-19 and telehealth
• APTA’s telehealth resources
• AOTA’s telehealth resources
• ASHA’s telehealth resources

Do remain adaptable and receptive to change.  

Don’t assume current telehealth provisions will remain intact.

Before the pandemic, rehab therapy telehealth was like dial-up Internet service: not easy to use or efficient. Most payers, including Medicare, didn’t reimburse for it. Often, it was only available in rural areas. Usually, an in-person visit was required to initiate it. Strangely, the originating site (where the patient was located) had to be another clinic—rather than the patient’s home. And it usually involved a live video/audio stream and excluded telephone-only communications.  

The public health emergency miracuously lifted most barriers to telehealth delivery and reimbursement in a matter of weeks. But please remember that the orders creating those paths are set to expire at the end of the public health emergency. Therapists will then have to forge the traditional paths of legislative change in order to make telehealth a permanent part of the rehab therapy repertoire. And those paths are long and fraught with hurdles, which means our ability to provide telehealth may come to a halt—at least temporarily.

Here in Arizona, for example, OTs, PTs, SLPs, and ATCs were working together before the pandemic to pass legislation authorizing us as telehealth providers. Even if that law had passed, it would not have promised insurance reimbursement of telehealth services, so more advocacy efforts were needed. The bill was paused in the Senate when the pandemic descended, so the legislature could shift focus to the budget. One week later, the governor issued an order that not only granted therapists the ability to provide telehealth, but also guaranteed they would receive reimbursement for it! But that order—like many state orders—will expire. Telehealth lobbying efforts will almost certainly resume, but in the meantime, therapists will not be able to provide telehealth.

So, stay abreast of your state’s executive orders. Check in often with your national professional organization for updates. If you haven’t already, join your state professional association and consider supporting its telehealth advocacy efforts. And stay flexible, adaptive, and open to change.  

One last “do” before I sign off: Proactively seek the counsel of an experienced healthcare lawyer if you have more questions about telehealth billing compliance. Don’t rely on this blog post as legal advice. While I am a lawyer, I am not your lawyer. This blog post does not create a legal engagement, and it is only intended to educate you about telehealth billing compliance.

Have telehealth compliance questions? Leave them in the comment section below, and the WebPT team will do their best to supply an answer.

The post The Dos and Don’ts of Telehealth Billing Compliance appeared first on WebPT.

Get to know Peter Costa, founder of Baltu Technologies: 

Q: What inspired you to start your venture? *

A: Using technology for good and being able to make a difference while creating a profitable business.

Q: What did you hope to gain by applying to SEED SPOT’s Impact Accelerator program? *

Q: What’s the most valuable lesson you learned during the Impact Accelerator? *

Q: What does the future hold for your venture? *

A: We are excited to continue to build our technology and to get acquire customers as soon as possible. We want to see our business scale to the point where we can upskill one million workers using our Just-in Time training platform.

Q: What is one piece of advice you have for entrepreneurs just beginning their journey? *

A: Don’t overthink it, just get it done. Your customers, investors, and supporters will tell you how it needs to get better.

Hear Peter pitch Baltu Technologies at SEED SPOT’s Impact Accelerator Demo Day coming up on May 12th – RSVP here.

The post Baltu Technologies – 2020 Impact Accelerator Venture appeared first on SEED SPOT.

Last week, CMS announced that PTs—along with OTs and SLPs—are eligible to provide telehealth services to Medicare beneficiaries for the duration of this emergency, which is huge. Rehab therapists have been advocating hard for this move since well before the pandemic struck, and now that this change is on the books, there’s the possibility that it could stay there well after the threat of COVID-19 is behind us. That means rehab therapists may be able to expand their reach to serve more patients in the long term, while also increasing revenue streams to potentially offset the dramatic losses incurred over the past few months.

But, is telehealth truly the golden goose that the industry has been waiting for? While it has its benefits, it also comes with some pretty serious challenges—something every practice leader should consider before adopting a telehealth model. Here’s what Guy Welch, PT, of Welch Physical Therapy (in business for 24 years) had to share about the biggest telehealth challenges his clinic has faced:

1. Regulatory changes are simultaneously happening too fast—and not fast enough.

One of the biggest telehealth implementation challenges Welch pointed out was that this option was “thrust upon” providers so quickly that “no one [was] prepared.” And he said providers weren’t the only ones caught off guard; when the APTA first began suggesting that PTs adopt telehealth as a supplemental service, some states (Arizona, for example) still had bylaws on the books that prevented therapy providers from legally doing so. Weeks later, once those bylaws were finally modified, it still wasn’t clear which payers were willing to actually pay for the services—and even those that were reimbursing for telehealth weren’t able to provide clear guidance on how to perform or properly bill for remote care services. Information on copays and deductibles was also nearly impossible to track down. As a result, everyone was more or less flying blind. And even now, weeks later, that lack of clarity still persists for some providers.

According to Welch, how providers handled this confusion was mixed: while some of his peers threw caution to wind and began offering these services to patients without fully understanding the rules of the game, others (including Welch) spent an inordinate amount of time reading industry publications, checking regulatory updates, questioning their professional organizations and networks, and listening to webinars to gain whatever clarity they could on how to move forward—all the while losing valuable time and money.

And even news that sounded great at first turned out to be fraught with limitations. For example, Arizona Governor Doug Ducey signed an “executive order that required insurance companies in the state…to cover telehealth at the same reimbursement rates as onsite visits,” which felt like a huge win. However, it soon became clear that most insurance companies are federally (as opposed to state-) regulated, which means they don’t fall “under the jurisdiction of [the] AZ state government” and thus “were not bound by the order” or even “on the same page,” Welch said.

2. The financial benefits aren’t yet known.

According to Welch, the financial benefits of offering telehealth were (and largely still are) unknown, and the time and effort required to research, develop, and implement these services didn’t make up for the cost. In essence, he and his team were trying to establish a brand-new service offering without the tools, knowledge, instruction, or permissions necessary to do so effectively. 

As Welch put it, “time is a valuable commodity,” and the cost of investing so much time into something that didn’t have a clear payout seemed “astronomical,” especially in an environment where he was “trying to hold onto every dime [he] had.” According to Welch, it felt like “trying to fill up a jug of water that had holes in it.” Everytime he set out with a plan, the rules changed and he had to start again.

With reimbursement data still lacking, it’s difficult for practice owners to perform an accurate return on investment (ROI) analysis for telehealth services—which may deter them from taking the telehealth plunge. Furthermore, we don’t yet know the extent to which temporary telehealth provisions—like those that have expanded opportunities for rehab therapists to deliver telehealth services—will evolve into permanent statute. That makes investing in telehealth even more of a risk for therapy providers (and, as we’ll discuss in upcoming WebPT Blog posts, gives PTs, OTs, and SLPs even more reason to continue advocating for themselves and their patients).

3. The telehealth technology available isn’t ideal—and patients aren’t always comfortable using it. 

On top of all the other learning curves that go along with implementing telehealth in the midst of the current pandemic, there’s also the issue of technology. Even in non-crisis times, adopting, implementing, and training staff and patients on a new tool is challenging; in the current climate, it can be downright taxing. In Welch’s case, he wasn’t comfortable taking on the expense of a videoconferencing platform designed for telehealth without knowing that he would be able to recoup that cost. So, per the Office for Civil Rights (OCR) relaxation on guidelines for suitable tools, the team began using a popular online meeting software to conduct telehealth appointments. While that platform did the job, it had its flaws. Many patients had trouble logging in and staying connected. The team created patient instruction documents to email patients prior to their scheduled appointments, but even that wasn’t enough. Often, the team had to call patients on the phone to walk them through connecting to the platform on their computer, thus costing them even more time (and patience).

4. PT patients want—and expect—hands-on treatment. 

Many patients seek out physical therapy because they want to receive hands-on treatment modalities. In line with that expectation, the team at Welch Physical Therapy have branded themselves on the exceptional hands-on modalities they provide—things like “dry needling, scraping, cupping, muscle energy techniques, spinal adjustments, and a ton of other manual treatments.” 

According to Welch, patients come to the clinic because they can obtain these services. In fact, the team makes a focused effort to train their patients on the benefits of these services and the importance of showing up to appointments consistently in order to experience the maximum benefit of physical therapy treatment. That was all in line with prior regulatory and practice guidelines supporting the importance of in-person physical therapy, Welch explained. “It was impossible to un-train them,” he added—especially in the span of only a couple months. Despite encouraging patients to schedule telehealth visits, most opted to either brave it in-clinic or wait it out until they felt it was safe to return.

Welch’s Solution: A Combination Method

Telehealth

So, how has Welch responded to these challenges? His team focused their telehealth efforts on cash-pay patients and those involved in motor vehicle accidents working under an attorney lien (with advanced attorney approval). That way, his team knew for sure they would receive some form of reimbursement for their efforts. While Welch’s cash-pay patients weren’t willing to try telehealth, five of the clinic’s motor vehicle patients were. 

In order to facilitate the sessions, the team shipped patients physical therapy equipment, such as foam rollers, TENS units, and therapy bands. Given that even Amazon was operating on a significant shipping delay, this step proved difficult, and several patients didn’t receive their equipment prior to their appointments. That said, according to Welch, the appointments went well. “We have provided exercises, reviewed proper technique, [and] instructed them in the use of TENS units and home exercise equipment,” he said. “We feel that the patients are receiving benefits.” He noted, though, that they’re “having difficulty progressing patients in the telehealth environment. Physical therapy without manual treatment/touch is a difficult thing. Our hands are our tools. When we are not able to use them, patients seem to see a diminished value in our profession.” To help offset this, even telehealth patients are encouraged to have occasional in-person sessions.

In-Person

Beyond that, the team at Welch doubled down on in-clinic practices to support those patients who still wanted to come in. Instead of having their front-office staff share the benefits of telehealth—which wasn’t proving very fruitful—the team switched over to communicating their safety best practices and hypervigilant cleanliness: “We have [patients] enter the office, take their temperature, usher them to a private room, assess them, and treat them,” Welch shared.

While the situation is far from ideal, Welch and his team are doing the best they can, acknowledging the unique reality in which they’re currently operating. According to Welch, their referring providers were seeing fewer patients, not performing surgeries, and trying to navigate changes themselves: “The last thing they were concerned about was referring patients to physical therapy,” he said. “New patients were almost nonexistent. Patients were afraid that social distancing in our facility was not possible. Masks were impossible to procure. Everyone was in a heightened sense of awareness.” 

Frankly, everyone was scared—and so were Welch and his team. They lost 40-50% of scheduled visits in two weeks. “We were decreasing our employees’ work time by 40-50% to stay afloat,” he said. “We had to prioritize our efforts to what we knew, and where we knew that we would receive reimbursement—not towards something completely new.” After all, Welch knew for certain the cost of providing in-person treatment and the amount of reimbursement he would receive from payers. He was able to calculate the visit cost ratio to the dollar and adjust his schedule to the best of his ability. Right now, the goal at Welch Physical Therapy is to merely “keep afloat and survive until [they] can get back to normal,” a sentiment that likely resonates with many other clinic leaders.

The Takeaway

It would be a flat-out lie to say that anything associated with the COVID-19 crisis has been easy. Providers and patients were (and still are) faced with incredibly difficult choices about how to navigate a situation no one was prepared for—all in a matter of days, and all while juggling questions about business solvency and patient and employee safety. While telehealth represents a huge opportunity for rehab therapists to reach more patients and generate crucial cash flow when in-person visits aren’t possible—even beyond the pandemic—it’s not perfect. In the rehab therapy world, telehealth comes with some pretty big hurdles—hurdles that become giant obstacles during a global crisis. So, what can we do?

Recognize the benefits and limitations of telehealth.

Acknowledge the current limitations of telehealth, while recognizing its potential. The industry’s introduction to telehealth was nothing short of trial by fire. But, things are starting to change for the better: providers and patients are learning the ropes, and payers are beginning to recognize the benefit of enabling PTs to provide this type of care. Will there continue to be a learning curve? Absolutely. Is telehealth right for every practice out there? No. But there are definite benefits to having this option available to you and your patients. And for some practices, this may be the difference between keeping the lights on and shuttering for good.

Advocate to ensure rehab therapists always have telehealth as an option—even beyond the pandemic.

Whether or not you choose to adopt this treatment method in your practice now, retaining the option is imperative for the industry—and that means providers must advocate for payers like Medicare to keep rehab therapy telehealth on the books permanently. After all, wouldn’t it be great to already have a backup option in place should we need it again? By establishing supportive legislation in advance, we can ease the burden on everyone down the road and ensure we’re not scrambling for action and regulatory clarity in the midst of chaos. As WebPT Co-founder and Chief Clinical Officer Heidi Jannenga has discussed previously, it’s high-time we start acting proactively (otherwise, we’re operating in a constant state of reactivity). And there is no better example to demonstrate how problematic that kind of pattern can be than the present situation.

The post The 4 Biggest Telehealth Challenges for PT Clinics appeared first on WebPT.

Get to know Jason DiLorenzo, founder of PSLFjobs: 

Q: What inspired you to start your venture? *

A: The student loan advisory company I started several years ago, Doctors Without Quarters, has several thousand clients pursuing PSLF. It was there that the need for a jobs platform became evident not just for doctors, but all borrowers.

Q: What did you hope to gain by applying to SEED SPOT’s Impact Accelerator program? *

Q: What’s the most valuable lesson you learned during the Impact Accelerator? *

Q: What does the future hold for your venture? *

A: I hope to be responsible for the forgiveness of over $1 billion in student loan debt while helping thousands of graduates do fulfilling Public Service work in their careers.

Q: What is one piece of advice you have for entrepreneurs just beginning their journey? *

A: Don’t procrastinate, if you’re passionate about your mission then take it to market!

Hear Jason pitch PSFLjobs at SEED SPOT’s Impact Accelerator Demo Day coming up on May 12th – RSVP here.

The post PSLFjobs – 2020 Impact Accelerator Venture appeared first on SEED SPOT.

Get to know Francesca, founder of the Barking Lot PHX: 

Q: What inspired you to start your venture? *

A: It was the summer of 2017 and I had just adopted my dog, Cash. She is a big Doberman german shepherd and had tons of energy. The asphalt was too hot on her paws to take walks and going to the dog park was absolutely miserable. When I asked my friends where they go to exercise their dogs in the summer they told me “we don’t”. At that moment I knew, there had to be a better way to dog park!

Q: What did you hope to gain by applying to SEED SPOT’s Impact Accelerator program? *

Q: What’s the most valuable lesson you learned during the Impact Accelerator? *

Q: What does the future hold for your venture? *

A: We are eager to secure a space for our final location. That is our primary focus!

Q: What is one piece of advice you have for entrepreneurs just beginning their journey? *

A: DO. Stop planning, stop overthinking, stop focusing on the barriers. Do what you can with what you have and you will LEARN how to make your full vision come to life through that action and experience.

Hear Francesca pitch the Barking Lot PHX at SEED SPOT’s Impact Accelerator Demo Day coming up on May 12th – RSVP here.

The post The Barking Lot PHX – 2020 Impact Accelerator Venture appeared first on SEED SPOT.

Get to know Dr. Ryan Stoll, Co-Founder of COMPASS for Courage

Q: What inspired you to start your venture? *

A: The inspiration behind COMPASS emerged from my personal experiences with anxiety and seeing an opportunity to affect meaningful change in the world by combining science with design. Growing up, I struggle, often silently, with anxiety that left me with a deep understanding of the “anxious experience” and the suffering associated with high anxiety. While I didn’t have a program like COMPASS to help me overcome anxiety, I cultivated my courage and resilience through design, skateboarding, and music.

Many years later and shortly into my PhD program in clinical psychology, I learned that psychological science has produced hundreds of interventions capable of treating and preventing most of the mental health problems facing youth, families, and communities today without medication. Despite knowledge of what works, most consumers don’t receive, have access to, or have awareness of these interventions. Instead they are receiving solutions that are often insufficiently validated, complex, and not capable at achieving lasting impact and benefit.

These experiences, combined with passion in design, led to COMPASS and continue to serve as a motivating force behind my efforts, as a social entrepreneur and psychologist, to vastly improve the wellbeing of youth, families, and communities by prioritizing prevention and making proven mental health tools accessible to all.

Q: What did you hope to gain by applying to SEED SPOT’s Impact Accelerator program? *

Q: What’s the most valuable lesson you learned during the Impact Accelerator? *

Q: What does the future hold for your venture? *

A: Global impact.

Q: What is one piece of advice you have for entrepreneurs just beginning their journey? *

A: “Whatever you do, you need courage. Whatever course you decide upon, there is always someone to tell you that you are wrong. There are always difficulties arising that tempt you to believe your critics are right. To map out a course of action and follow it to an end requires some of the same courage that a soldier needs. Peace has its victories, but it takes brave men and women to win them.” Ralph Waldo Emerson

Hear Ryan pitch COMPASS for Courage at SEED SPOT’s Impact Accelerator Demo Day coming up on May 12th – RSVP here.

The post COMPASS for Courage – 2020 Impact Accelerator Venture appeared first on SEED SPOT.