A Discussion with Compliance Expert Daniel Hirsch, DPT

When you hear the term “Compliance,” what do you think? 

Do you wince away from the topic? Are you confused by the term? Or (worse) are you struggling to understand how to implement effective compliance during the rollercoaster that has been this pandemic?

We understand, and feel the same way. 

In times as uncertain and ever-changing as these, the best we can do is assist each other from our respective fields by providing valuable knowledge and resources to hopefully offer as much stability as possible. 

This is why we decided to consult with compliance expert and DPT, Daniel Hirsch. 

As Compliance can be an incredibly broad and all-encompassing topic, we chose to stick with a single area for the purposes of this piece: Ethics

The following are my notes from a recent discussion with Daniel Hirsch:


We’re currently faced with the challenge of the psyche of people as a result of COVID-19. 

People are confused, desperate, and exhausted. 

The Code of Ethics for Physical Therapists principle #2 states: Physical therapists shall be trustworthy and compassionate in addressing the rights and needs of patients and clients. 

Let’s apply this to travel restrictions and returning to work. Part of that challenge is the question of: are the employees going to remain honest & ethical, or will they be more in the “survival mode” of needing to get back to work and make a living? 

This is a tough issue seeing that, as physical therapists, we have a professional duty to perform as essential workers and continue to treat our patients – but how do we manage this while having to protect others from possible COVID exposure? As clinic owners and licensed therapists, how can we control this? 

With travel, everyone is freaking out. The issue of travel largely depends on location. 

For example, in the Tri-State area (NY/NJ/CT) travel advisories are updated every week, with new information and regulations normally being released on Tuesdays. Travel advisories are especially important right now because summertime is the season for family vacations.

So how can you practice being “compassionate and trustworthy” when you yearn to take a (much needed) escape to the beach with your family for the weekend? And not being sure who you may put in danger upon your return to the clinic? 

This presents a huge dilemma. Where is the incentive to tell the truth? It’s difficult because most folks are asymptomatic, a large majority of physical therapists (for example) have only a few years of work experience and are young and healthy – aka, not concerned about getting sick. You’re allowed to be working in the office, but should you be? 

This public health and safety issue will likely remain a grey area for therapists because of our duty to treat as essential healthcare workers in an environment where the government advisories may be issuing conflicting messages.  

Another issue we face amid this pandemic is the issue of HIPAA. At one point in time, we were incredibly conscientious about protecting our health records… but now it seems to be to one’s benefit to disclose all of one’s physical problems and medical history. You may have additional benefits available to you if you’re more sick! 

All this will likely spin you into a constant state of conflict – you want to uphold your profession and help people, but is it safe? If you come down with a fever for example, this could indicate many things, but since it’s on the list of symptoms for Covid, there are many more potential repercussions. 

The APTA is very careful about taking a stance, and understandably so. Therapists and owners who are travelling need to know what they should do. But honestly, it’s hard to keep up, and it gets exhausting. One may wonder: can I even go on vacation safely? Will I be able to return to work when I get back? Things are changing all too often – resulting in a daily conflict. 

We’ve begun hearing a lot about offices where a therapist or member of the staff comes down with Covid. If someone tests positive (or is confirmed to have had direct contact for a “prolonged period of time” with someone who tested positive), they must self-quarantine for 14 days. But this shouldn’t be perceived as the end of the world. If we’ve learned anything through this pandemic, it’s that we have the ability to provide high quality and skilled Telehealth services! 

The staff member should be cleared by their physician who signs off and says that they are okay to return to work after the 14-day quarantine. This instance of positive Covid must be reported to local health officials/authorities. This is considered best practice. 

In essence: send your employee home, then wait for the doctor’s okay to bring them back. 

Consider “incentivizing” your staff to be honest. One available option is to forward or advance your therapist’s paid time off, as this is an acceptable way to help everyone manage expectations. You may also want to think outside the box by applying a “Team approach” in order to keep utilizing your staff.

We’re all in this together. We’ve watched our physical therapy community step it up and provide a lot of content and resources for each other. Let’s communicate well and be honest. And of course, be transparent and upfront with your employers. 

End of discussion.  

We wholeheartedly support Daniel’s message here: while there is much confusion with the restrictions and their constant change, we are all in this together. 

Exercise your compassion by sharing what you know with your fellow physical therapists. Practice trustworthiness by using good judgement and flexibility if you travel, and by communicating effectively and transparently with your employers. Make your staff feel comfortable by creating an atmosphere of mutual respect, and highlight ways in which we can all remain safe and ethical. 

For more information on Compliance, pre-order our new “Ethics and Compliance Program For Your Private Practice” created in partnership with compliance expert, Daniel Hirsch!

Save 15% if you pre-order the course by August 1, 2020.

CLICK HERE to register for Early Bird Savings!

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