Psychiatrists should remember that older patients – who may be uncomfortable with email, much less video conferencing – may still struggle with video-calling technology. In such cases, consider:
- Sending the patient instructions in advance of the appointment.
- Have your office hold a “tech check” prior to the appointment to ensure the patient is ready.
- Be prepared to provide troubleshooting.
Whether the patient is tech savvy or not, make sure communication is clear:
- Speak in short sentences on teleconferencing sessions.
- Speak slowly and use a lower frequency.
- Recognize that non-native English speakers may struggle with comprehension, and explore interpreter options.
Dr. Gupta noted that the first minute of the virtual therapy session is crucial in setting the tone.
“The patient wants to hear a professional, confident tone on the other end at the beginning of the session,” he said. “Be warm and respectful throughout the visit, and make sure to explain to the patient how the session will be reconnected if the call is interrupted.”
Clinicians should also make sure to identify the patient’s physical location during the session in case of an emergency, such as the patient becoming suicidal.
Impending ‘telehealth cliff’
Many laws and licensing requirements for telehealth are still relatively loose, falling under the COVID-19 public health emergency (PHE) policies. These policies allow practitioners who are eligible to bill Medicare for telehealth services regardless of where the patient or provider is located, and providers can also deliver telehealth services across state lines, depending on state and federal rules.
However, Dr. Gupta warns that practitioners should be prepared for the potential “telehealth cliff” that is anticipated when those PHE policies are lifted, as barriers in licensing, billing, and other factors, such as HIPAA, are reinstated.
“HIPAA is [flexible] now as long as the public emergency policies exist,” Dr. Gupta said. “However, in noncrisis times, technology will be required to be HIPAA compliant. If you are a solo provider, for instance, you really need to choose a telepsychiatry platform that is HIPAA compliant before that happens.”
While the timing of the “telehealth cliff” is still uncertain, providers have been promised a 60-day advance notice of the PHE end, and at that time, there will be an additional 151-day grace period before the waivers lift.
A key federal measure that could protect more favorable telemedicine policies across state lines, the Temporary Reciprocity to Ensure Access to Treatment Act, currently remains stalled in Congress.
Regardless of those developments, Dr. Gupta underscored that “telepsychiatry is here to stay because the patients and their families like it, and they will be the driving factors.”
He noted that “the future is likely going to be a hybrid model of in-person and virtual visits,” to accommodate the various scenarios in which in-person visits may be preferred or necessary, but many will still likely choose the convenience and greater flexibility of virtual sessions.
Dr. Gupta serves or has served as a speaker or member of a speaker’s bureau for AbbVie, Acadia, Alkermes, Intra-Cellular Therapies, Janssen, Neurocrine, and Otsuka, and serves as a consultant/on an advisory board for Intra-Cellular Therapies.
The Psychopharmacology Update was sponsored by Medscape Live. Medscape Live and this news organization are owned by the same parent company.