As the number of presumptive and confirmed cases of COVID-19 continues to rise in West Virginia as well as in our neighboring states, we know that clinics are finding it necessary to limit care hours, limit the types of patients seen and in some instances have closed their doors to face to face visits completely. Telehealth technologies can enable the delivery of health care services in a manner that will limit the transmission of COVID-19 to health care providers and patients while providing clinically appropriate, medically necessary health care services to those quarantined or practicing social distancing. We recognize that for many who have not even begun to consider the integration of technology into daily practice, this is intimidating. And, during a time of crisis when the stakes are so high is not the best time to be considering it. We want to assure you that the chapter has been working everyday to try to get some clarity on this issue, especially as it relates to payment. However, that clarity is difficult to find.
WVPTA is sharing the article “Tips and Tricks to Start Telehealth Tomorrow” which provides a 10-step guide for setting up your digital practice for delivery of service to those that need you the most. We continue to recommend that you seek guidance on the APTA resource page that has been shared in previous communication and is linked again here. If you scroll down that page to Recommended Resources, you will find a link to the page specific to the available resources on telehealth. It is important to note the different types of virtual patient visits. Telehealth and e-visits are not the same. E-visits allow for the care of established patients only - for those with whom you are already involved in an episode of care. Telehealth includes assessment and evaluation provisions for new patients. Print materials, recordings of webinars - all are available to you to help guide you through this maze. APTA staff is also working hard for you to try to provide the most up to date information relating to the effects of COVID-19 on practice - even as it can change multiple times per day
Telehealth services will be available in WV on June 5, 2020 with the passage of HB 4003 this past legislative session. With WV in the middle of COVID-19, your patients need this service NOW! Telehealth provides the avenue that health care professionals can use to continue to engage existing patients while in quarantine or to limit exposure as a preventive measure and in order to protect public health and mitigate exposure to and the spread of COVID-19. Physical therapists can also use telehealth to assist the larger healthcare team in triaging patients who might otherwise find their way into emergency departments or urgent care facilities to seek care for non-COVID-19 related conditions. Insurance providers in the state have begun to look at how they may cover these services in light of our current crisis - and many are supportive of covering this service sooner than the June 5, 2020 mandate. However, details on billing processes and codes are still being developed. When we have contacted payers regarding how they are handling this, it was not possible to get definitive answers across the board. So much is still unknown right now about how this will play out. Practitioners are still encouraged to pursue this type of visit option and are advised to contact payers directly to confirm their policies regarding the delivery and payment of telehealth in our current healthcare situation.
Documentation will be important. You must include that the patient requested he visit (for e-visits specifically), that they consented to the virtual visit, the mode of technology used (HIPPA regulations have been relaxed temporarily to help facilitate the use of telehealth through methods outside of secure online patient portals - so Facetime, Skype, Zoom are acceptable at this time. Telephonic communication is also being permitted in the short term), the specifics of what was done during the visit including any and all clinical decisions that were made during the visit. Also, include the minutes for each call. For some payers, you will bill a lump sum time within a 7-day period. For some, you will bill per visit. So, to cover all, it is recommended that you document the time spent for each visit within your visit documentation. The Chapter is working at the level of state government to try to find a solution to the commercial billing challenges that we are facing with the immediate implementation of telehealth. We will keep you updated as best we can.
It is very hard to try to provide you all with guidance and a sense of sound direction during this time in light of the constantly changing landscape. The Chapter would like nothing more than to send to you a nice clean page of bullet point instructions on how to navigate our current situation and say you are all set! However, this is not the reality and we have not been able to secure information that would provide you that confidence. Please know that we are with you and we feel your frustration, anxiety and fear. We know that you want to care for your patients, your staff, your families and your community. We want the same. Please reach out to firstname.lastname@example.org with your concerns and your questions. We may not be able to give you a direct answer on the spot, but we will do our best to help you find one.
Thank you all for what you are doing to assist those in need during this time in our history. Support your local communities as best you can. That might mean direct patient care for our PT/PTA practitioners in care settings that go to work everyday, putting themselves at risk to care for their patients. That could mean making those calls to patients to check in, provide treatment, see how they are doing and try to alleviate some of their anxieties about what is happening around them. It could mean donations to your local food banks, or blood drives. It could mean calling your favorite local eatery for takeout. However, and wherever you see the need - try to fill it. Physical therapy practitioners are caring, compassionate and essential caregivers - you are valued and needed by your community right now.
Thank you for stepping up.