Topic 4: Telepsychiatry


Relevance to the Underserved Issue

Telepsychiatry is currently one of the most effective ways to increase access to psychiatric care for individuals living in underserved areas.

Summary of Key Information

Telepsychiatry, or telemedicine, is a specifically defined form of video conferencing that can provide psychiatric services to patients living in remote locations or otherwise underserved areas. It can connect patients, psychiatrists, physicians, and other healthcare professionals through the use of television cameras and microphones. Telemedicine currently provides an array of services, including but not limited to diagnosis and assessment; medication management; and individual and group therapy. It also provides an opportunity for consultative services between psychiatrists, primary care physicians and other healthcare providers. Telepsychiatry is also being used to provide patients with second opinions in areas where only one psychiatrist is available.

Telepsychiatry has been shown to improve collaborative services between professionals. Studies indicate that healthcare professionals feel telepsychiatry has given them an opportunity to work more effectively as a team. Patients surveyed say they felt that the communication between their physicians had improved their outcomes. There are a few barriers to providing telepsychiatry services. Reimbursement is still difficult to receive, especially through third-party payers, and licensure can be difficult to obtain.

Overall, telepsychiatry provides increased access to services and has helped enhance the provision of services to families with children and other patients who are homebound. Patients participating in telepsychiatry say they are satisfied with the care they are receiving and that they feel telepsychiatry is a reliable form of practice.


Model Programs and Collaborative Project

  • The Rural Health Care Program of the Universal Service Fund:

    The Rural Health Care Program provides discounts to eligible rural healthcare providers, for telecommunication services and monthly internet service fees. The program's goal is to keep telecommunications affordable in rural areas. More information can be found below at:     http://www.universalservice.org/rhc/
    Contact Information
    2000 L Street, N.W.
    Suite 200
    Washington, D.C. 20036
    Phone: (202) 776-0200
    Fax: (202) 776-0080

  • Colorado School of Public Health, Centers for American Indian and Alaska Native Health, Center for Native American Telehealth and Tele-education

     

    CNATT organizes and focuses technological resources for Native American health from an array of telecommunications services at UCDHSC to offer technical training, distance education, clinical care, and research opportunities.

     

    Telemental Health Guide/Essential Telemental Health

    The telemental health guide provides essential information for developing, implementing, and sustaining telemental health services.

     

    Native Telehealth Outreach and Technical Assistance Program

    Street Address: 13055 E. 17th Avenue

    Mailing Address: Mail Stop F800

    Nighthorse Campbell Native Health Building

    13055 E. 17th Ave., Aurora, CO 80045

    Phone: 303-724-1414 • Fax: 303-724-1474

    E:mail: CAIANH.Webmaster@ucdenver.edu 
  • Medical College of Georgia Telemedicine Center
    This program provides training in telepsychiatry for students, online distance education for mental health professionals, and psychological consultations. More information can be found at:     http://www.georgiahealth.edu/Telehealth/psych.htm
    Contact Information
    1120 15th Street, EA-100
    Augusta, GA 30912
    Phone: 706-721-6616
    Fax: 706-721-7270
    e-mail:     maxs@mcg.edu or ekhasanshina@mcg.edu
  • Military Psychiatry, Walter Reed Army Medical Center
    Video teleconferencing (VTC) for forensic military cases, broad range, general, family and children, and in prison systems used from Walter Reed to other military facilities, i.e., Fort Belvoir and Fort Drum. More information can be found at:     http://www.wramc.army.mil/Patients/healthcare/psychiatry/mentalhealthservice/Pages/default.aspx.
    Contact Information
    Forensic Telepsychiatry Program, Walter Reed Army Medical Center
    Major Brett J. Schneider, MD
    Phone: 202-782-8047
    Brett.Schneider@us.army.mil
    General information: Sona P. Patel     sona.patel@na.amedd.army.mil

Relevant Web Resources

  • The American Telemedicine Association has published two papers on telemental health that are available on its website.
  • The APA's Division of Government Relations has posted a number of telemedicine references that may prove useful.
  • Telemedicine Licensure Report/HHS Office of Rural Health
    This 2003 report provides information on state medical and nursing licensure laws concerning telemedicine and the need for interstate licensure as a result of telemedicine.
  • Telemedicine Guidelines
    The Board of Trustees of the American Telemedicine Association has established a     set of practice guidelines for telemental health. The 2009 guidelines focus on specific criteria for healthcare providers, patients and the use of technology when providing telemedicine services.
  • Reimbursement
    Reimbursement for telepsychiatry services is becoming more prevalent. Several surveys on telepsychiatry reimbursement have been completed and are included in The Private Payer Reimbursement Information Directory. This directory includes information on some of the programs receiving reimbursement for telemedicine services as well as on private payers who are currently providing reimbursement for telemedicine services. It also includes information on states that have passed legislation mandating private-payer reimbursement for telemedicine services. The Private Payer Reimbursement Information Directory can be found at:     ftp://ftp.hrsa.gov/telehealth/licen.pdf
  • Medicare
    Medicare has specific criteria for payment of telemedicine services. Medicare provides payment for telemedicine services for face-to-face services via video conferencing; and non-face-to-face services delivered through telecommunication technology, e.g. x-rays, tissue samples. Coverage for telemedicine in home healthcare settings is very limited and is explained in detail in the document listed below. More information on Medicare coverage for telemedicine practice can be found at: http://www.cms.gov/MLNProducts/downloads/TelehealthSrvcsfctsht.pdf
  • Private Insurance
    AMD Global Telemedicine is a private company that reports it is "the world's leading supplier of complete telemedicine solutions with installation in 80 countries."  They provide equiement and say they can manage encounters.     http://www.amdtelemedicine.com
  • Developing a Telemedicine Program
    According to the Technical Assistance Manual prepared by the National Rural Health Association there are seven steps needed to build a successful telemedicine program:
    1. A needs evaluation
    2. Developing a care services plan
    3. Developing a business plan
    4. Planning for technology that will be used
    5. Training personnel
    6. Testing care that will be provided
    7. Evaluating outcomes.
  • State Programs
    Telemedicine programs are now being developed in Alaska, Arizona, Arkansas, California, Colorado, Connecticut, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Mississippi, Montana, Nebraska, New Jersey, New Mexico, New York, North Carolina, North Dakota, Oklahoma,Oregon, Pennsylvania, South Dakota, Tennessee, Texas,Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming, and Ontario, Canada
  • Telemedicine Technical Assistance Documents: A Guide to Getting Started

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