Another point to dig into - WHY does CMS want to restrict telehealth in Medicare? There must be some rationale or interest they have in restricting telehealth payment. If we understand what that reservation is, then lobbying & public comment efforts could be more effective.
Well said - it always about the incentives. A pessimistic take: It could be around decreasing line item costs for outpatient behavioral health treatment. A less pessimistic take: It could be about reducing strain on an already strained group of clinician specialists.
By succumbing to the allure of tele therapy our profession is ignoring what we have learnt as a specialty over decades. That much is communicated by seeing a person in their entirety and not just a close up of a pimple on their face as they sit before a screen, TD ridden hands and legs flailing unseen. To see a patient in person once or twice a year is the very least we should expect. While you may say some treatment is better than no treatment , I would argue in psychiatry , with the perils and risks of unnecessary polypharmacy that in fact in many instances , no treatment causes less harm than some tele treatment. Just look at how many unnecessary BZDs and stimulants are prescribed over tele and you’ll see the damage our profession is causing to humankind.
We're in total alignment. There are a subset of patients, primarily those obtaining psychiatric care, and specifically those prescribed treatments with either a high risk of misuse (e.g., benzodiazepines or stimulants) or requiring particularly close monitoring (e.g., FGAs), who benefit from in-person care. I'm hopeful that the DEA will heed to common sense in delivering its updated rules for telehealth controlled substance prescribing, and actually increase regulation and rigor.
However, for the elderly patient with a mild to moderate, uncomplicated depressive or anxiety disorder meeting with a psychotherapist weekly, why force the patient to see their therapist in person once per year? This creates many barriers for the patient who lives in an area with a dearth of mental health clinicians, and reduces the efficiency captured by capacity pooling and cross-licensing (more than 100 million Americans live in a mental health workforce shortage area) - https://data.hrsa.gov/topics/health-workforce/shortage-areas.
The onus should be on clinicians to practice safely and appropriately, and recommend in-person care when indicated, instead of the federal government arbitrarily mandating it for the 67 million Americans covered by Medicare.
AS the former national VP for BH at one of the largest insurers I completely agree re positive impacts of telehealth- I would add that this channel is also ideal for advancing the goal of payment for value, as the measurement is far easier with a standardized communication channel (ie telehealth) and this in turn should allow for more rapid separation of signal from noise.
I'm not sure that outpatient, virtual psychotherapy often results in patients presenting to the hospital for testing. In fact, the data repeatedly demonstrate that patients with anxiety or depressive disorders who receive outpatient treatment actually present to the emergency and hospital less, resulting in improved quality of life and decreased total cost of care: https://connectwithcare.org/wp-content/uploads/2021/12/Evernorth-Behavioral-Health-Analysis-Nov-2021.pdf
Another point to dig into - WHY does CMS want to restrict telehealth in Medicare? There must be some rationale or interest they have in restricting telehealth payment. If we understand what that reservation is, then lobbying & public comment efforts could be more effective.
Well said - it always about the incentives. A pessimistic take: It could be around decreasing line item costs for outpatient behavioral health treatment. A less pessimistic take: It could be about reducing strain on an already strained group of clinician specialists.
By succumbing to the allure of tele therapy our profession is ignoring what we have learnt as a specialty over decades. That much is communicated by seeing a person in their entirety and not just a close up of a pimple on their face as they sit before a screen, TD ridden hands and legs flailing unseen. To see a patient in person once or twice a year is the very least we should expect. While you may say some treatment is better than no treatment , I would argue in psychiatry , with the perils and risks of unnecessary polypharmacy that in fact in many instances , no treatment causes less harm than some tele treatment. Just look at how many unnecessary BZDs and stimulants are prescribed over tele and you’ll see the damage our profession is causing to humankind.
We're in total alignment. There are a subset of patients, primarily those obtaining psychiatric care, and specifically those prescribed treatments with either a high risk of misuse (e.g., benzodiazepines or stimulants) or requiring particularly close monitoring (e.g., FGAs), who benefit from in-person care. I'm hopeful that the DEA will heed to common sense in delivering its updated rules for telehealth controlled substance prescribing, and actually increase regulation and rigor.
However, for the elderly patient with a mild to moderate, uncomplicated depressive or anxiety disorder meeting with a psychotherapist weekly, why force the patient to see their therapist in person once per year? This creates many barriers for the patient who lives in an area with a dearth of mental health clinicians, and reduces the efficiency captured by capacity pooling and cross-licensing (more than 100 million Americans live in a mental health workforce shortage area) - https://data.hrsa.gov/topics/health-workforce/shortage-areas.
The onus should be on clinicians to practice safely and appropriately, and recommend in-person care when indicated, instead of the federal government arbitrarily mandating it for the 67 million Americans covered by Medicare.
AS the former national VP for BH at one of the largest insurers I completely agree re positive impacts of telehealth- I would add that this channel is also ideal for advancing the goal of payment for value, as the measurement is far easier with a standardized communication channel (ie telehealth) and this in turn should allow for more rapid separation of signal from noise.
I'm not sure that outpatient, virtual psychotherapy often results in patients presenting to the hospital for testing. In fact, the data repeatedly demonstrate that patients with anxiety or depressive disorders who receive outpatient treatment actually present to the emergency and hospital less, resulting in improved quality of life and decreased total cost of care: https://connectwithcare.org/wp-content/uploads/2021/12/Evernorth-Behavioral-Health-Analysis-Nov-2021.pdf