Reader Comment: In light of COVID-19 Crisis, Congress Should Prevent Specialty Provider Cuts
READER COMMENT

Reader Comment: In light of COVID-19 Crisis, Congress Should Prevent Specialty Provider Cuts

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As the COVID-19 pandemic rages on, Idaho has not yet become the hot spot that many feared, however the impact of the deadly disease will resonate with our state’s economy and healthcare system long after this unprecedented crisis begins to abate.

Since the Idaho Department of Health and Welfare issued a statewide stay-at-home order, many businesses including healthcare practitioners have had to find new ways to serve vulnerable populations who find themselves unable to leave their homes. Physical therapy practices like mine are no exception. While I worry about the financial stress lower patient volume and burdensome Medicare regulations have on my bottom line, I am terrified that my most vulnerable patients—senior citizens and Idahoans with underlying health conditions—will forgo the care they need to maintain their health and wellbeing.

As hospitalization and death rates make clear, patients who are elderly, suffer from chronic health conditions, or a combination of the two are bearing the brunt of the COVID-19 national emergency. Unfortunately, the social distancing guidelines that are undoubtably necessary to keep these individuals safe also create long-term health setbacks as thousands of patients have their continuity of care interrupted. Fearing the risks of exposure to the deadly disease, many Medicare beneficiaries have cancelled important healthcare appointments, putting them in jeopardy of suffering serious injury, limited mobility, severe pain, or death. Even as we continue to expand our telehealth offerings, we have seen nearly half of our patients cancel their physical therapy sessions, while new patient screening (most often recommended by a patients’ primary care doctor or surgeon) has come to a virtual standstill.

This is dangerous for seniors. Because physical therapists provide highly specialized care to help patients deal with debilitating pain, regain mobility, prevent falls, and recover from serious illness and injury, any delay in care can be dangerous. Continuity of care is vitally important because any disruption or delay in treatment can make permanent the loss of mobility, independence, and pain-free living. It’s no exaggeration to say that many seniors who put off physical therapy during the COVID-19 crisis will completely miss the opportunity to regain full functionality.

To understand why, consider just one of the many dangers physical therapists help seniors avoid: falling.

Every single year, falling causes 2.8 million injuries, 800,000 hospitalizations, and 27,000 senior deaths in the United States. On top of these severe health ramifications, falls also generate billions in preventable Medicare costs at a time when we can ill afford it.

So, given the current national health crisis and its implications for both physical therapists and their patients, the least one might expect is supportive policy from federal officials in Washington D.C. Unfortunately, much of the current policy on the books does the opposite.

Current Medicare policy included in the Physician Fee Schedule (PFS) final rule for Calendar Year 2020 imposes substantial across-the-board cuts to various medical specialties, including physical therapists, starting in 2021. Following a decade of other significant reimbursement reductions, any new cuts will make it harder for specialty practices, including physical therapy, to meet the growing burdens placed on us. As a physical therapist and small business owner, I’ve been proud to help heal ailing patients in the heart of the Magic Valley, Boise and Eastern Idaho communities, but it’s becoming harder to stay afloat. With rising costs and sinking payments, it’s hard to imagine how the future will be sustainable for physical therapists across the state and the country.

In order to better ensure patient access to care, I’m calling on Idaho’s lawmakers in Washington to support efforts to provide much-needed relief by striking budget neutrality provisions from the existing evaluation and management (E/M) payment codes, thereby preventing cuts to specialty providers.

Providing immediate relief to specialty providers like physical and occupational therapists is not only the right thing to do for patient care, it will also have an amplifying impact on our healthcare system and economy. Protecting access to care and stabilizing healthcare specialty practices across the nation is a win-win for everyone.

Bryan Wright is Founder and CEO of Wright Physical Therapy.

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A small outbreak of coronavirus at a Fry Foods plant in Weiser gives a prime example of the importance of testing for COVID-19. More than that, it represents a warning shot across the bow of potential pitfalls if we don’t reopen our economy the right way.

As we tiptoe through Stage 2 of Gov. Brad Little’s phased reopening plan and approach a more robust Stage 3, it’s going to become even more important that we take the necessary steps to prevent future outbreaks.

And there will be future outbreaks.

The fact remains that the novel coronavirus that causes COVID-19 is still out there. It’s ready to strike again, and without a vaccine, it remains a potentially destructive and fatal disease.

Aggressive and quick testing remains one of the key elements — perhaps the most important element — of controlling outbreaks at this point.

Fry Foods offers an early case study.

The Weiser food processing plant employs 260 people to make onion rings and other food products. It shut down earlier this month when at least seven employees tested positive for the coronavirus.

Fry Foods initially didn’t test all 260 employees at the Weiser facility — only the 50 or 60 who likely came in contact with the employees who tested positive. Other employees were able to get tested on their own.

The Idaho Bureau of Laboratories (state run-laboratories) tested all that they had the capacity to do in one day, according to Kelly Petroff, director of communications for the Idaho Department of Health and Welfare. The state lab can do about has a testing capacity of approximately 200 tests per day.

“We are not prepared to handle this,” Doug Wold, human resources manager for Fry Foods, told the Idaho Statesman, referring to the lack of coordinated response. “If you don’t have an employer who’s willing to be proactive, we’re just going to fail.”

Fortunately, Crush the Curve Idaho, a private, business-led initiative established during the outbreak to increase testing, stepped in and tested every employee at Fry Foods.

By Tuesday of this week, 20 employees — about 8% of the plant’s workforce — had tested positive for the coronavirus, along with at least two of their family members. Nearly all were asymptomatic.

RAPID-RESPONSE TESTING

That’s what needs to happen: rapid-response testing. If you have an outbreak at your workplace, get everyone tested. For those who test positive, keep them home and isolated. For those who test negative, they can keep on working and you’re back in business.

When the outbreak hit Fry Foods, company officials made the decision to shut the plant down.

Without adequate testing, that’s unfortunately the right thing to do. Without testing, you have no idea whether you have seven infected employees, 70 or 270.

We applaud Fry Foods company officials for making the tough call to shut down, even though they were given the green light by the Southwest District Health Department to resume operations.

Coronavirus is stealthy. A person can carry coronavirus longer without symptoms, potentially spreading to others unwittingly. Some people who carry coronavirus have no symptoms at all.

We are encouraged that Crush the Curve Idaho stepped up and stepped in here.

But Idaho needs a more concerted and organized plan to do rapid-response testing.

We are a fragmented health system. Health providers include Saint Alphonsus, St. Luke’s, Primary Health, Saltzer, among others. Then think about all the entities who pay for health care: Blue Cross of Idaho, Regence BlueShield, PacificSource, SelectHealth, etc. Throw in Medicare, Medicaid and those who are uninsured.

Even our own government health management system is fragmented, with the Idaho Department of Health and Welfare and seven independent health districts not operated by the state.

And, in the case of Fry Foods, situated in a city bordering Oregon, workers were from two states.

NO COORIDINATED EFFORTS

No wonder Fry Foods officials were at a loss for where to turn for help. Without some sort of coordinated effort to test all employees and somehow pay for those tests, shutting down the plant was the best option.

It’s worth noting that the Fry Foods employee who initially had coronavirus was at a family gathering of a larger number than outlined in the governor’s reopening plan and was with visitors from out of state, two violations of the governor’s guidelines. That’s why we have the guidelines, and that’s why it’s important to follow the guidelines. Otherwise, this is what you get: an outbreak that shuts down an entire food manufacturing plant.

Unfortunately, shutting down operations every time there’s an outbreak is not going to get the job done.

And there will be more outbreaks as we reopen our economy, reopen factories and workplaces.

Idaho has a lot to be optimistic about, and we have a golden opportunity to lead the nation in reopening our economy in the face of the coronavirus pandemic. We have had relatively few cases (around 2,300) and few deaths (77). Our early efforts to shut down parts of our social interactions and Little’s quick call to issue a statewide stay-home order clearly have paid off. Idahoans’ adherence to the stay-home order has helped to flatten the curve and control the number of new cases. Residents and businesses, alike, have done their part to make this happen.

Our hope is that Idaho can chug along through the stages of reopening. Our fear is that if we don’t do this the right way, we’ll have a surge and we’ll be back to a statewide stay-home order. Nobody wants that.

Idaho’s structure of electing governors and LG’s completely separately — different from many states which bind them together — allows for the office holders to come from different points of view.

For future historians and artists who'll chronicle today's health and economic crisis, one humble item will stand out as the chief cultural emblem of the times: wearing a mask. Or not.

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