With our increasing mobile society, it’s only reasonable that practitioners learn to maintain the continuity of care when their patients cannot come to the office, leave town or relocate to other areas. There’s no need for our patients to be deprived of care when the technology currently exists for us to service them where ever they may be located.
Medicare and Medicaid already are reimbursing for telemental health in specified circumstances provided by psychiatrists, psychologists and social workers. To the nay-sayers, practicing clinicians already obtaining reimbursement point to the fact that federal insurance programs don’t typically funds “fads” or other approaches that haven’t been proven effective after extensive research. In the case of telemental health, that literature has been developing for 40 years, and is irrefutable.
Caution is in order however.
Remote care is not for every patient, every condition, or even every practitioner. The empirical body of research clearly indicates which areas of intervention are currently established a successful for remote care and which are promising. That also literature shows which type of equipment is has been tested and accepted as the standard of care, and which methods of verifying patient identity is acceptable (also known as authentication). Even slower to evolve is the literature suggesting which patient groups and disorders to avoid in telemental health care.
It’s interesting to note that the vast majority of this scientific literature has largely ignored the email and chat-room interventions that seem so popular among counselors online today. Rather, it has focused almost exclusively on videoconferencing.
Furthermore, the accepted videoconferencing platforms are not the public videoconferencing systems already found on the Internet such as Skype or other VoIP-based systems, but typically in virtual private networks (VPNs) or other proven secure video platforms.
As a result of the proven efficacy and safely of such VPNs and their counterparts, Medicare and Medicaid only reimburses telemedicine for video-based sessions, and not email or chat room interventions.
Practitioners well versed in videoconferencing also point to the need for clinicians to:
- be aware of their legal and ethical mandates so as to practice responsibly and “do no harm”
- obtain continuing education post-licensing before extending their reach into new areas of practice and technology
- adhere to licensing laws and understand the role of licensing in determining whether a practitioner will be covered by insurance when practicing over state lines
- work within the bounds set by HIPAA and other state and federally-based security requirements
- obtain a well-discussed, documented and videoconferencing-specific informed consent agreement and
- only practice with a familiarity and access to emergency backup services in the geographic area of the patient or client, in case things go wrong.
Those are my views. Might you provide additional information that could help me see it differently? Please comment below.