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Telepsychiatry: Advances and Challenges

     

Telepsychiatry, psychiatric services provided remotely via a video link, offers many advantages and is becoming more available. Potential advantages include more efficient use of psychiatrist and other mental health providers time, easier, more convenient access for patients, and potentially less stigmatizing services. And there is much evidence supporting the effectiveness of services provided remotely.

Telemedicine, including psychiatric services, are becoming more widely accepted and technology is making it easier. The use of telepsychiatry is increasing in the primary care settings, including pediatrician’s offices, and in schools where psychiatrists or other mental health professionals can collaborate with teachers and other school staff. Despite increased use, telemedicine, including telepsychiatry, make up only a very small portion of health and mental health claims submitted to insurers.

Managing risk with telepsychiatry

One potential barrier identified in a recent study is that reimbursement rates for telepsychiatry are less than for in-person services. Researchers found that to be the case overall and for nine of the top 10 telemedicine services. Many of the claims involvee major depressive disorder, bipolar disorders and schizoaffective disorder.

Most states have regulations on the use of telemedicine, including telepsychiatry, and for reimbursement for services provided remotely via video conference. However, the regulations vary from state-to-state.

As of July 2017, 34 states and the District of Columbia had telemedicine parity laws in place requiring coverage for telemedicine services that are covered if they are provided in person. But only three states (Delaware, Hawaii and Minnesota) require health insurance companies to reimburse telemedicine services at the same rate as in-person services. In addition, state laws and regulations vary a great deal in several areas, such as the types of services that are covered, the types of providers covered, the location of the patients and the types of technologies that can be used.

What is Telepsychiatry?

Telemedicine is the process of providing health care from a distance through technology, often using videoconferencing. Telepsychiatry, a subset of telemedicine, can involve providing a range of services including psychiatric evaluations, therapy (individual therapy, group therapy, family therapy), patient education and medication management.

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Another possible barrier is lack of awareness that the services are available. A report from the Center for Connected Health Policy notes that despite growing awareness of ‘direct-to-consumer’ type telemedicine services, “the health care consumer is generally unaware of what telehealth-delivered services are covered and available under their own plan.” Greater education for both providers and payers is needed according to the Center.

Another possible concern is lack of training and experience, according to Shabana Khan, M.D., Director, Child and Adolescent Telepsychiatry at New York University Langone Health. Most medical students, residents, and fellows, are not regularly exposed to telepsychiatry, though that may be beginning to change.

References/Resources

     

AnxietyDissociative DisordersADHDBipolar DisordersIntellectual DisabilitySleep DisordersDepressionAutismPatients and FamiliesHoarding DisorderGender DysphoriaOCDPersonality DisordersEating DisordersGambling DisorderSpecific Learning DisorderSomatic Symptom DisorderSchizophreniaPostpartum depressionAddictionPTSD

 

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