Staying well during the Coronavirus - my thoughts on health and business

All I can say is “whew”!  I am tired - no doubt so are you. What a strange and unprecedented (in our lifetimes) time we are living through.  We all have felt the fear and uncertainty and interruption and challenge.  Thank you to each of you who have communicated with me in one way or another – practice owners trying to decide what “the right thing” is to do about their businesses or sharing tips to valuable information, and co-workers concerned for both our patients and their own safety, as well as stability.  It all helps.

With that in mind, I want share what we are doing at our hand therapy clinic in Lynnwood, WA (spoiler alert – we are not planning to close unless advised to do so by health authorities) and what I anticipate we will do.  I want to share a little bit about telehealth, particularly for hand therapy.  Finally, I want to focus on the opportunities and the good that can come out of all the uncertainty.  This is a long post… I have so many thoughts… I hope some of it helps all of you. 

First of all, I hope you and those around you are well, and that you stay well.  My thoughts go out to anyone who is directly affected by the virus and is ill or has a family member or co-worker who is affected.

For the rest of us, we have the liberty of making a choice about how we handle this time.  I am choosing to be prepared and not hysterical.  It’s “easier” and normal when faced with a crisis to use our survival instincts and notice an immediate fight or flight response - to collapse into fear and foreboding and convince ourselves that the world is about to end.  But it is ALSO possible once that moment passes to use our pre-frontal cortex to make a decision to handle the situation with grit and with grace… (more on that in a minute).  I truly believe that we can take control of our thoughts, and through that small (and enormous) step, can control our feelings, actions, and results. 

What we are doing at Hands for Living

1. We are staying open to see patients who want to be seen. As of today, guidance from the CDC and state health officials does not include closing medical practices, including therapy. I see that so far “essential professional services” such as medical care, are on the list of services that continue, not on the list with restaurants, gatherings, etc, that are cancelled.
   
   
2. We are working with each patient’s individual preferences – people have varying degrees of co-existing conditions, history, risk tolerance, and urgency of injury. Some can and should cancel and wait.  Some can and need to be here. 
   
   
3. In order to coordinate care and prepare for the possibility that we may decide later to close, we have made a list of all of our patients and have prepared a “triage” plan… ranking those with the most urgent to the least urgent needs as well as the likelihood that we could provide assistance via video conference, so that we know how best to organize communication and coordination for all our our patients. 
   
   
4. Anyone who is or has been sick is asked to cancel and reschedule their appointments. We are practicing increased sanitization methods as most clinics are, in order to decrease risk of infection to patients and staff.  We ask patients and visitors to wash their hands on arrival at the clinic before each session starts, we wash our hands (as we always do) between sessions and extensively sanitize all equipment and tables used between patients.  
   
   
5. We will match the hours scheduled for each therapist to the patients that need and want to be seen. Washington state has a SharedWork program for employers that is expected to help for the reduction in hours where necessary.  I have committed to pay my employees fully through the end of March, and have applied for the SharedWork program to help after that time.  It allows employees to work partial hours and still receive unemployment for a 10-50% reduction in hours.  In the event of full reduction in hours, it reverts to regular unemployment.
   
   
6. In the event that we need to close, we will do our best to meet our patients’ needs. Again, thankfully, hand therapy is not generally a critical care issue, although our patient’s concerns have not gone away with the arrival of the virus.  We will be prepared to visit via video conference with any patients who are interested.
   
   
7. I realize that each practice and practice owner has to grapple with this decision and will come to their own conclusion, but for us, for now, the right decision is to continue to care for our patients. I completely respect and appreciate each owner’s decision to do what is right for their clinic and patients. 

Telehealth

I have been providing telehealth services for some patients via a HIPPA compliant platform called doxy.me, and for some hand therapy patients it works well.  Obviously, there are other patients for whom it is not an option, or for whom limited service can be provided.  It definitely changes our role from a heavily hands-on therapy to primarily education and advice and demonstration, as well as teaching people about ways that they can care for themselves.  In the absence of locally available, skilled care, it is a better option than nothing. Additionally, I believe once people learn that they can access skilled professionals this way, the whole system will be better off. 

It is legal for OTs to provide telehealth services to patients in Washington, and it’s pretty much a free-for-all in this crisis.  Normally, each state varies as to whether or not you must be licensed in that state (where provider and patient live) to provide services.  Given the upheaval in rules, norms, and plans, I would imagine that anything done in the next few weeks to help people will likely be forgiven, which isn’t necessarily to say that services will be paid for!  But probably prioritizing what people need in the moment is key.

We have provided visits via telehealth as a cash based service up to this point, and for the moment, will continue to do so at a reduced rate.  There has been recent advocacy efforts by several Washington therapists that may eventually be able to confirm that payers will pay for OT/PT services via telehealth (and at what rate?), but I have not seen solid documentation from the payers that would guarantee payment at this time, with the *new* exception from Medicare that has emergency guidance and provides a method for assistance through e-visits.

Opportunities

There are still opportunities to be good humans in all of this.  Here are some good things that I see out of this crisis.

1. We, as therapists, can BE HELPERS. Many of you have seen the Mister Rogers quote or meme advising us – in times of crisis to – “look for the helpers” the people that help others in times of crisis… I believe it is our responsibility to do this.  Our ability to help people emotionally and physically during this time is SO IMPORTANT.  Thankfully, hand therapy is not usually a life or death intervention, which allows us the luxury of being in less of a crisis mode than some other groups of healthcare providers.  I think we can help people make the best of the situation and figure out how to use this time of uncertainty productively and peacefully.
   
   
2. We’ve all developed a heightened sense and increased awareness of how contagious conditions can spread through a population. This is good for all of us, for this challenge and for others.
   
   
3. The adoption of telehealth as a method of healthcare delivery has been advanced by years. The national spotlight/boost for this way of providing care has moved it up on everyone’s priority list, and the media has helped to educate the public that we can help people in this way.  Most providers I know have had relatively slow uptake from patients – we haven’t been trained as patients to look for help in this way.  More availability, more awareness.  All good.
   
   
4. In many cases, it is an opportunity to slow down – take time to care for yourself and your family – rest, enjoy, etc. With schools, churches, events, and social activities closed, some people have a rare opportunity to spend extra time with loved ones or to pursue other activities or rest that refresh us.
   
   
5. We have an opportunity to change or recommit to our personal routines, for health, for self-care, for communication, for reflection. All of these areas help us to prepare for the future.  This crisis will pass, and we can be stronger for it.
   
   
6. We have an opportunity to practice controlling and taming our thoughts. We think our thoughts are unchangeable facts, but in reality they are just that, thoughts.  They come and they go.  But those thoughts create our feelings and the feelings that we have lead to the action that we take.  And as we know the actions we take lead to the results we achieve in our lives.

With these things in mind, the crisis is not all good or all bad, it just is.  We are strong and resilient, and I am confident that each of us will take the actions that we need to take to get through this in the best possible way.

This quote is from one of my coaches, and it really resonated with me.  I wish you all grit and grace as we move forward through these days.

“Grit is the ability to move through the tough stuff over and over. Grace is the ability to accept what is and readjust. I see you. And I see the people in Italy who have been shut in their homes but are singing from their balconies. I see the doctors and nurses who are risking their lives every day because it’s their job. I see homeless people who will get sick and have nowhere to go. I see all this, choose to be of service where I can and still look for joy, close in.”  - Jen Verharen, Cadence Coaching

I am thinking of all of you as each day goes by, and wishing you health, peace, and even a bit of joy in the opportunities that unfold in this time of uncertainty.  Best wishes to each of you as you figure out how to navigate the next few days and weeks.

I would love to hear from you – shoot me a text or email and let me know your thoughts and questions!