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Telepsychiatry Basics

4 May, 2018

In many specialties, telemedicine is an emerging concept. In psychiatry, however, telemedicine is a well-established tool that allows providers to reach patients regardless of the location of either party. Per the American Psychiatric Association, telepsychiatry was first practiced in 1959 to coordinate group therapy, ongoing therapy, training and consultations. Since then, it has grown in many ways, and it is now considered to be as effective as in-person care in many instances.

What is telepsychiatry?

Telepsychiatry is exactly what is sounds like. It’s the delivery of psychiatric treatment and therapy through live-video or store-and-forward connections.

According to the American Psychiatric Association, “Telepsychiatry is equivalent to in-person care in diagnostic accuracy, treatment effectiveness, and patient satisfaction; it often saves time, money and other resources.”

Are there times that telepsychiatry is preferred over in-person care?

Studies say yes! Research has shown that pediatric and adolescent populations may have better outcomes with treatment delivered via through telepsychiatry providers. Family interactions via telepsychiatry services may be more authentic, and children feel more comfortable in their own environment. Additionally, young people are confident when using technology. There is also information to support improved treatment in severe anxiety disorders and PTSD. Keeping these patients in their own environments and at a distance from someone who they are unfamiliar with bolsters treatment. Additionally, treatment adherence is frequently improved with telepsychiatry.

Do I still need to see patients in person?

Initially, that’s determined by state laws and rules. Some states don’t allow providers to establish care via telemedicine, and some require in-person care at certain intervals. You can get more information on establishing care from the AMA here: https://www.ama-assn.org/sites/default/files/media-browser/specialty%20group/arc/ama-chart-telemedicine-patient-physician-relationship.pdf.

If your state allows fully virtual care, then it’s up to you or your physicians to determine if they’re comfortable treating patients without in-person interview and follow-ups. We work with groups who are fully virtual and others who have chosen to retain some of the in-person care. Many psychiatrists and community mental health centers are confident in telepsychiatry for treatment delivery, and they have turned to telemedicine to reduce overhead and limit brick and mortar locations. Other physicians and groups prefer to retain the in-person evaluation for certain diagnoses, while still others require regular in-person care with supplemental telemedicine.

Going fully virtual is entirely possible, but the feasibility will vary by the patient population, comfortability of the providers and the state laws and regulations. Mend can help you sort through the best option for your practice.

What do I need to get started?

All you need is an internet-connected device with a front-facing camera and microphone. When you work with the right platform, you don’t need expensive technology or peripherals. Some providers opt to use multiple screens because that is how they have developed their workflow, but it isn’t required. In fact, by working with a platform like Mend that allows you to shrink down the telemedicine screen and nest it on top of your EMR, you’re able to maintain better eye contact with the patient while charting, which enhances the therapeutic relationship and mimics an in-person interaction.

How do I get paid for my services?

Reimbursement is the one of the few pieces of telepsychiatry that still has considerable variation by location. Some states have telemedicine parity laws that require payment for these services and others do not. More so, some states require that telepsychiatry services be reimbursable but exclude many other medical specialties. The best resource to find out where your state falls is the state-by-state guide from the Center For Connected Health Policy at www.cchpca.com.

If billing insurance isn’t part of your business plan, then you can skip those steps all together. Mend can process credit card payments based on your preferences.

What’s next?

Have more questions about getting a telepsychiatry practice up and running? We work with mental health groups and practices across the country, and our workflow experts can help sort out your ideal implementation plan. Just ask!

h/t: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662387/#B13

h/t: https://www.ptsd.va.gov/professional/newsletters/research-quarterly/V26N2.pdf

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