Often, we spend time with customers, or potential customers that have built in assumptions about what Telepsych can and can’t do. Often, this comes down to what can and cannot be billed. While there are some very significant and annoying regional (state-by-state) limitations, the general rule is that every payer will pay for telepsychiatry services if they’d pay for a face-to-face service. The significant limitation to this generality is that Medicare continues to refuse to pay for Tele services outside of their designated geographic approved locations (rural locations and health care provider shortage areas). While we all hoped this rule would be changed in the 2019 rule year, a slight loosening of limitations was approved (ACO/MSSP patients can now receive Medicare reimbursed services in their own homes) but the general geographic limit remains.
Additionally, we often hear that telehealth providers can’t enter orders into a health record. This myth also comes from the roots of telehealth. Medicare’s initial “allowance” of telehealth was really focused on extending physician capacity to rural locations in a consultative model. This use case continues in many telehealth services provided across the county. A physician can consult with another physician specialist to obtain expertise that simply doesn’t exist in their community. But today, physicians deliver care 100% via telehealth and this of course means they enter orders and manage all aspects of patient care. Our friends that provide rapid response to strokes via telehealth have been pioneers in delivering life-saving care very rapidly wherever it is needed. Their motto that “time is brain,” certainly underscores the clinical use case for tele-neuro. But in many ways, the same can be said for telepsychiatry.
We know from a variety of studies over decades, that psychiatric acuity (and its risks) continue and worsen the longer treatment is delayed. We know that a significant majority of patients who complete suicide were not under the care of a mental health professional in the months leading up to their (largely preventable) deaths. We also know that the crisis of access to acute psychiatric beds, psychiatric services and psychiatric care in general is growing worse by the day. Doctors aren’t selecting psychiatry training, and many are leaving or aging out of the profession.
Telepsychiatrists can order medication, minimize the use of polypharmacy (especially multiple anti-psychotics) and prevent unnecessary use of the ever-diminishing number of acute psychiatric services. In some locations, even involuntary legal processes can be started or stopped by a telepsychiatrist, and care and the recovery process can begin rapidly.
It’s true, there are many things that a telehealth provider can’t do that an onsite provider can. But in the unique world of behavioral health and psychiatry, too many patients see the doctor on-duty, not the doctor they need.
If your team needs behavioral services to provide care to your patients and communities, you owe it to them to explore a behavioral health solution provided by a telehealth group. Many services can be customized to meet each facility’s needs, tele-therapy, tele-assessment, after-hours relief call, weekend relief, clinic-telepsychiatry, emergency telepsychiatry, consult liaison telepsychiatry, direct-to-consumer services … It’s a new world and due time to help your patients obtain access to the care they need, wherever they live.
–Miles D. Kramer, LCSW, CCHP