Expanded telepsychiatry services during COVID-19 pandemic may revolutionize access to care
Telepsychiatry has served and will continue to serve an important role in expanding psychiatric practice during the COVID-19 pandemic and beyond, according to a presenter at the American Psychiatric Association Spring Highlights Meeting.
“For years, various types of regulations have prevented telepsychiatry from exploding across the United States and across our profession,” Avrim Fishkind, MD, CEO and consultant for emergency psychiatry and psychiatric emergency services design at Empathic Soul Health, said during a presentation. “A few of them have been temporarily wiped out, which has led to a new explosion.”
Fishkind noted several examples of eased restrictions related to the COVID-19 pandemic, including CMS’ decision to waive the requirement that out-of-state providers be licensed in the state in which they are providing services. This also allows out-of-state providers to provide care to Medicaid and Medicare enrollees impacted the pandemic who are in another state.
CMS has also removed any requirements regarding documentation of the history of physical examinations in the medical record because the ability to conduct physical exams that might be required may not be possible at this time, according to Fishkind.
Further, the HHS Office for Civil Rights announced it will exercise enforcement discretion and waive penalties for HIPAA violations against health care providers that treat patients “in good faith” using everyday communication technologies.
“I don’t think anybody in medicine thought they would see a lack of enforcement or waiving of HIPAA violations,” Fishkind said. “This means that video communications like FaceTime, Skype, Zoom, Facebook Messenger and Google Hangouts can now be used.”
Another major regulation that has been temporarily lifted is the Ryan Haight Online Pharmacy Consumer Protection Act, a federal law that prohibits the prescribing of controlled substances unless an in-person evaluation takes place. Thus, clinicians can currently prescribe controlled substances via telemedicine.
Fishkind highlighted the importance of practical telemedicine considerations for clinicians and patients, such as removing distractions, logging onto the technology 15 minutes before the appointment to ensure connectivity and finding a location with privacy and good lighting. Clinicians may also want to be aware of additional billing codes that have been provided during the pandemic.
The expansion of telepsychiatry during this crisis presents some positive opportunities for the field, according to Fishkind.
“A true democratization [of care], where every psychiatrist thought of themselves as both a live and audio/video psychiatrist, didn't exist, but in a blink of an eye, every psychiatrist and every mental health professional can now see themselves as telepsychiatrists,” Fishkind said. “I think this is one of the greatest things that has ever happened to our profession because instead of people saying, ‘I can't find a psychiatrist,’ they can be now be found with fantastic access. No-show rates decrease dramatically when people have flexibility to talk to psychiatrists when they want to schedule and where they want to schedule.”
With the recent expansion of telepsychiatry services, mental health care is now more accessible in rural locations and medically underserved urban areas, as well as to patients with disabilities that may hinder their ability to meet in person, according to Fishkind.
“This is going to improve people's health by giving them improved access to lower-cost care by decreasing overhead and providing the service that the patient actually needs,” Fishkind said. – by Joe Gramigna
Fishkind A. Expansion of psychiatric practice through telepsychiatry during the COVID-19 era. Presented at: American Psychiatric Association Spring Highlights Meeting; April 25-26, 2020 (virtual meeting).
Disclosure: Fishkind reports he holds stock in SOC Telemed.