When the COVID-19 outbreak hit Massachusetts, Governor Charlie Baker quickly stepped in to improve access to medical services by requiring all insurance companies in the state to allow providers “to deliver clinically appropriate, medically necessary covered services to members via telehealth.” On March 17, 2020, as part of a bipartisan emergency COVID-19 Congressional spending bill, the Centers for Medicare & Medicaid Services (CMS) temporarily relaxed several requirements in order to facilitate the provision of and payment for telehealth services to Medicare patients.
In a paper to be published in General Hospital Psychiatry, Justin Chen, MD, MPH Medical Director of the Ambulatory Psychiatry Services at MGH, Wei-Jean Chung, PhD, and colleagues take a look at preliminary data on the use of telemedicine for outpatient care. The outpatient department shifted from under 5% virtual visits in March 2019 to over 97% virtual visits in March 2020. In addition, productivity actually increased by about 22%, with approximately 6,100 outpatient visits in April 2020 compared to about 5,000 visits per month during the preceding five months.
While telemedicine is by no means new, it has not been widely adopted in Massachusetts. Many healthcare providers who have typically delivered in-person care have not been comfortable making the transition or did not have access to HIPAA-compliant software and devices for virtual visits; however, perhaps the greatest barrier to telemedicine in our state has been the unwillingness of insurance companies to cover and adequately compensate for virtual visits.
For several years, the Department of Psychiatry at MGH, Janet Wozniak, MD has been part of a multidisciplinary team looking at the feasibility of telepsychiatry in an academic medical center. While research on telepsychiatry is still emerging, it appears that psychiatric assessments performed using telepsychiatry are reliable, and preliminary studies indicate that clinical outcomes using telepsychiatric interventions are similar to conventionally delivered treatment.
Our experience with telemedicine over the last few months has shown clearly that telehealth has the ability to improve efficiency and expand access to mental health services. Telemedicine would undoubtedly benefit a large number of patients well beyond the duration of the COVID crisis.
So What Happens to Telemedicine After COVID?
Several weeks ago, the Massachusetts State Senate unanimously passed the Putting Patients First Act (Bill S.2796), a piece of legislation which will increase access to health care, protect patients, and enhance the quality of care Several elements of this bill could make a huge difference in patients’ access to mental health services. The bill:
- Requires insurance carriers, including MassHealth, to cover telehealth services in any case where the same in-person service would be covered. It also ensures that telehealth services include care delivered through audio-only telephone calls, and requires reimbursement rates to match in-person services over the next two years.
- Eliminates “surprise billing,” the unfair practice of charging patients who are unaware they received health care services outside of their insurance network for costs that insurance carriers refuse to pay.
- Expands the scope of practice for several health care professionals, increasing patient access to care. The bill would allow registered nurse practitioners and psychiatric nurse mental health specialists to practice independently as long as they meet certain education and training standards.
COVID-19 forced us to take a crash course in telemedicine, and most mental health providers are pleased with how well it does work. It’s by no means perfect, but it does help us to provide ongoing care to our patients in a time of crisis.
Given our recent experience with telemedicine, we can more easily imagine how telemedicine could be readily used to engage and provide treatment to more patients, especially those living in areas where there is limited access to care. At the present time in the United States, there is a huge gap between the mental health services we are able to provide and the clinical needs of our population. While this bill, and telemedicine in general, does not solve these long-standing deficits in mental health services in our state, the bill is a step in the right direction in terms of improving access to care.
The Putting Patients First Act now moves to the House of Representatives for consideration.
Read More:
Abrams J, Sossong S, Schwamm LH, et al. Practical issues in delivery of clinician-to-patient telemental health in an academic medical Center. Harv Rev Psychiatry. 2017;25(3):135–145.
This review provides an overview of the topics of technology, legal and regulatory issues, clinical issues, and cost savings as they relate to practicing psychiatry and psychology via virtual visits in an academic medical center.
Chen JA, Chung WJ, Young SK, Tuttle MC, Collins MB, Darghouth SL, Longley RM, Levy R, Razafsha M, Kerner JC, Wozniak J, Huffman JC. COVID-19 and Telepsychiatry: Early outpatient experiences and implications for the future. Gen Hosp Psychiatry. In Press.
Donelan K, Barreto EA, Sossong S, Michael C, Estrada JJ, Cohen AB, Wozniak J, Schwamm LH. Patient and clinician experiences with telehealth for patient follow-up care. Am J Manag Care. 2019 Jan;25(1):40-44. Free article.
Schwamm LH, Erskine A, Licurse A. A digital embrace to blunt the curve of COVID19 pandemic. NPJ Digit Med. 2020 May 4;3:64. Free article.
Schwamm LH, Estrada J, Erskine A, Licurse A. Virtual care: new models of caring for our patients and workforce. Lancet Digit Health. 2020 May 6;2(6):e282-5.
