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Impact of COVID-19 on the Physical Therapy Profession

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Impact of COVID-19 on the Physical Therapy Profession Impact of COVID-19 on the Physical Therapy Profession A Report From the American Physical Therapy Association August 2020 Update Introduction COVID-19 pandemic on March 3, 2020. Over the next two months, the country responded to a rapidly spreading pandemic with an unprecedented shutdown that affected schools, business, sporting events, and more. On March 17, APTA’s Board of Directors issued a statement encouraging physical therapists to “use their professional judgment to determine when, where, and how to provide care, with the understanding this is not the optimal environment for care, for anyone involved.” The day before, the Trump administration and the Centers for Disease Control and Prevention released guidelines that noted that those who work in a “critical infrastructure industry,” such as health care, have a “special responsibility” to maintain normal work schedules. Throughout the pandemic, physical therapy services have been treated as essential by federal, state, and local guidance, although many physical therapists have proactively stopped nonessential in-person care to flatten the curve of the pandemic. Between April 24 and May 11, APTA surveyed a representative sample of 5,400 physical therapists and 1,100 physical therapist assistants to gauge the impact of the COVID-19 pandemic on the physical therapy profession. APTA performed a follow-up survey between July 2 and 22 with 1,813 PTs and 271 PTAs responding. This report includes data from both surveys. change according to fluctuations in COVID-19 cases and changes in state and federal guidance. ©2020 American Physical Therapy Association. All rights reserved. 2 Table of Contents Executive Summary .......................................................... 4 Practice and Workforce Implications. 5 Telehealth Adoption and Utility ................................................. 9 Impact on Practices .......................................................... 12 Trusted Sources of Information ................................................ 14 Recommendations for the Profession .......................................... 15 Recommendations for Policymakers ........................................... 16 Appendix: Timeline ........................................................... 17 ©2020 American Physical Therapy Association. All rights reserved. 3 Executive Summary The physical therapy profession has not looked the same since the COVID-19 pandemic began to affect the United States in March. Many have seen, and continue to see, reductions in hours and income. Use of telehealth and other video-based consultation has increased, but in-person care remains more common and preferred. Many PTs and than decreased it. COVID-19 Disrupts the Physical Therapy Profession • Physical therapy clinics that stayed open during the early stages of the pandemic had fewer consumers walking through their doors. Physician referrals and direct access visits declined. Care hours declined. By July there were signs of progress, but the effects of the pandemic remain. • • longer than three months to return to previous levels of flexible spending. • reported that their career pride increased as a result of COVID-19. Telehealth Adoption and Utilization Expands • Prior to the pandemic, telehealth was the exception to the rule in physical therapy. Once the pandemic began than one patient per week via telehealth on average. • still remain: Many PTs are uncertain about payment, patient satisfaction, and outcomes. And technology challenges among patients and clinics remain a barrier to wider use. Professional Judgment Demonstrated • pandemic, exercising professional judgment to reduce risk was the main reason. APTA Helps PTs and PTAs Stay Informed • and PTAs looking for help. • The CDC was the most-used source for external guidance, but APTA was not far behind. APTA’s website set ©2020 American Physical Therapy Association. All rights reserved. 4 Practice and Workforce Implications Although most PTs and PTAs have retained steady employment and pay during the pandemic, the “We closed for in-person visits for one physical therapy community faced furloughs, week, but then saw only truly urgent layoffs, and income reductions. patients, amounting to three to four Practice Hours Decline for Most in-person visits per week. While closed PTs and PTAs Stay-at-home orders reduced the volume of we immediately started seeing patients via telehealth.” their hours increase during the early phases of the —PT respondent of PTAs were experiencing a decrease in hours compared with before the pandemic. Percent of PTs Whose July Work Hours Were Lower Than Before the Pandemic Percent of PTs Whose Work Hours Declined Acute-care hospital 29% Hospital-based outpatient 33% facility or clinic Private outpatient office or 45% group practice Skilled nursing 40% facility/long-term care Patient's home/home care 46% School system (pre-K to 12) 35% Academic institution 12% (postsecondary) Inpatient rehab facility 20% Other 32% % across all settings 36% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% ©2020 American Physical Therapy Association. All rights reserved. 5 Physician Referral and Direct Access Affected Physician referral and direct access both declined in the early phases of the pandemic but were showing signs of who reported declines in the spring. Percent of PTs Whose Patient Caseload Declined April/May PhysicianPercent oReferralf PTs Whose Caseload of Physician-Referred Patients Declined July Acute-care hospital 45% 78% April/May Percent of PTs Whose Caseload of Physician-Referred Patients Declined July Hospital-based outpatient 62% 96% facility or clinic Acute-care hospital 45% 78% Private outpatient office or 76% 97% grouHp opsrpaictaticl-ebased outpatient 62% 96% facility or clinic Skilled nursing 63% 74% facility/longP-treivrmat ec aoruetpatient office or 76% 97% group practice Patient's home/home care 47% 83% Skilled nursing 63% 74% facility/long-term care School system (pre-K to 12) 19% 31% Patient's home/home care 47% 83% Academic institution 59% 76% (postsecondary) School system (pre-K to 12) 19% 31% Inpatient rehab facility 25% 50% Academic institution 59% 76% (postsecondary) Other 63% 79% Inpatient rehab facility 25% 50% % across all settings 62% 88% Other 63% 79% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% % across all settings 62% 88% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Direct Access Percent of PTs Whose Caseload of Direct Access Patients Declined April/May July Acute-care hospital 19% 33% April/May Percent of PTs Whose Caseload of Physician-Referred Patients Declined July Hospital-based outpatient 38% 67% facility or clinic Acute-care hospital 45% 78% Private outpatient office or Hospital-based outpatient 51% 81% group practice 62% 96% facility or clinic SkillPerdiv nauters oinugtpatient office or 28% 41% 76% 97% facility/long-term care group practice Skilled nursing Patient's home/home care 27% 49% 63% 74% facility/long-term care School system (pPrea-tKie ntot' s1 2h)ome/home care 26% 31% 47% 83% AcademSic hinosotli tsuytisotnem (pre-K to 12) 19% 31% 32% 63% (postsecondary) Academic institution 59% 76% (postsecondary) Inpatient rehab facility 16% 16118%%8% Inpatient rehab facility 25% 50% Other 48% 62% Other 63% 79% % across all settings 39% 64% % across all settings 62% 88% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% ©2020 American Physical Therapy Association. All rights reserved. 6 Income Declines experiencing declines in weekly income compared with Hazard Pay: Approximately 7% of PTs and 6% of PTAs received hazard or premium pay during the pandemic. Percent of July Respondents Whose Weekly Income Was Lower Than Before the Pandemic Member Type Percent of Respondents Whose Income Declined PT 36% PTA Acute-care hospital Member Type Percent of Respondents Wh32o%se Income Declined PT 31% 36% PTA Hospital-based outpatient Acute-care hospital facility or clinic 38% 32% Hospital-based outpatient 31% 57% Private outpatient office or facility or clinic 38% group practice 47% 57% Private outpatient office or Skilled nursing 39% group practice 47% facility/long-term care 62% Skilled nursing 39% facility/long-term care 46% Patient's home/home care 62% 46%2% Patient's home/home care 27% 62% School system (pre-K to 12) 27% School system (pre-K to 12) 22% Academic institution (postsecondary) 22% Academic institution (postsecondary) 22% Inpatient rehab facility 22% Inpatient rehab facility 31% Other 31% Other % across all settings 40% % across all settings 40% % across all settings% across all settings 44% 44% 0% 10% 200%% 103%0% 20%40% 30%50% 40% 60%50% 70%60% 807%0% 9080%% 100%90% 100% PTAs data not repPorTtAeds dfraotma n soot mreep osretetdti nfrgosm d suoem teo ssemttianlgl sn udmueb teor somf arell snpuomnbdeer notfs r.espondents. “I am worried about the long-term effects of COVID-19 on the PT industry. I was —PTA respondent Percent of Respondents Employment Challenges Continue Percent Wofh Rosees pInocnodmeen tDseclined Whose Income Declined ©2020 American Physical Therapy Association. All rights reserved. 7 Employment Loss by Facility Based on July Survey Employment Loss by Facility PT PTA Resigned/ None of the Resigned/ None of the Laid Off Furloughed Laid Off Furloughed quit above quit above 3% 10% 2% 87% 5% 19% 0% 76% Acute-care hospital 5 18 3 163 1 4 0 16 Hospital-based outpatient 4% 21% 1% 74% 9% 24% 3% 68% facility or clinic 17 81 4 282 3 8 1 23 Private outpatient office or 12% 22% 3% 66% 25% 41% 3% 33% group practice 70 129 16 385 19 31 2 25 Skilled nursing 8% 6% 1% 84% 15% 18% 0% 69% facility/long-term care 7 5 1 70 6 7 0 27 6% 17% 3% 76% 12% 18% 18% 53% Patient's home/home care 6 16 3 72 2 3 3 9 2% 3% 2% 94% 0% 33% 0% 67% School system (pre-K to 12) 1 2 1 60 0 1 0 2 Academic institution 0% 2% 1% 97% 0% 0% 0% 100% (postsecondary) 0 2 1 110 0 0 0 7 2% 7% 2% 90% 0% 0% 0% 100% Inpatient rehab facility 1 4 1 52 0 0 0 9 6% 11% 2% 84% 20% 20% 10% 50% Other 6 12 2 89 2 2 1 5 7% 16% 2% 77% 15% 26% 3% 57% Grand Total 113 269 32 1,283 33 56 7 123 % of Total 0% 41% Essential Care Is the Norm treatment for what they considered nonessential physical therapist services.
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