telepsychiatry while living outside the US

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BobbyB

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do you think it will ever be feasible to live outside the US while seeing patients through webcam?

have you ever considered using telepsychiatry in that capacity?

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It may be possible; it is done in radiology; difference being we are dealing with a lot more data in telepsych (realtime audio and video vs. static image stacks), and lag/latency becomes more of an issue the further you are from the client (although this has become less of an issue with current bandwith availability). The patient would have to receive your services in the state you are licensed to practice in.
 
It may be possible; it is done in radiology; difference being we are dealing with a lot more data in telepsych (realtime audio and video vs. static image stacks), and lag/latency becomes more of an issue the further you are from the client (although this has become less of an issue with current bandwith availability). The patient would have to receive your services in the state you are licensed to practice in.

all good points

i think the possibilities for telepsych are great. multiple clinics run by NPs who will conference you in on the more complicated cases.
 
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In the way it is practiced now, I don't see why not.
 
Should we be worried about telepsychiatry bastardizing the field? Wouldn't it make it easier for employers to hire different providers in place of a physician looking for a good job?
 
Ryan-Haight act makes in-person more desirable.
Thanks for the info. I'm aware of the effects of teleradiology on radiology and I know telemedicine exists for psych, so I was curious.
 
This piqued my interest. How would one go about finding a reputable telepsychiatrist?
 
Should we be worried about telepsychiatry bastardizing the field? Wouldn't it make it easier for employers to hire different providers in place of a physician looking for a good job?
I'd be more worried of teletherapists and telelifecoaches in those fields than I am of telepychiatrists robbing me of mine. Standards of care are not waived in telemedical encounters. There is a reason that the large scale roll-outs of telepsychiatry (the VA and several prison systems come to mind) are done with a physician and nursing staff on site on the other end. The job adverts for telepsychiatry are typically consultative in nature, reporting to a FP or ER doc on the other end. If there was a viable market for modalities in which you skyped to walking well patients with a credit card from the comfort of their own homes, you'd already see it.

And check the states you are living in to see about the laws and licensing requirements. They vary quite a bit.
 
I practice some telepsychiatry, though all within the US.

While I have thought before how nice it would be to work while on a nice Caribbean vacation, I do know that as part of my malpractice insurance application I had to identify my office location to my insurer as part of my policy application. I suppose that one could just lie to their insurer, but I'd hate to see what would happen if you had a negative outcome. Also, even with good technology, I've lost live video connection in session a number of times, necessitating me to continue the session via telephone until the video feed came back up.

I suspect trying to do this internationally would be frustrating.
 
Anyone aware of telepsychiatry being done with insurance?
 
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Anyone aware of telepsychiatry being done with insurance?

I do telepsych two days per week, all paid by private insurance. There are some states that have laws of parity (i.e. they have to pay telepsych the way they would an in-office visit) and there are some that don't.
 
I practice some telepsychiatry, though all within the US.

While I have thought before how nice it would be to work while on a nice Caribbean vacation, I do know that as part of my malpractice insurance application I had to identify my office location to my insurer as part of my policy application. I suppose that one could just lie to their insurer, but I'd hate to see what would happen if you had a negative outcome. Also, even with good technology, I've lost live video connection in session a number of times, necessitating me to continue the session via telephone until the video feed came back up.

I suspect trying to do this internationally would be frustrating.
How profitable is it? Do you go by insurance or do you charge a set fee per hour?
 
I do telepsych two days per week, all paid by private insurance. There are some states that have laws of parity (i.e. they have to pay telepsych the way they would an in-office visit) and there are some that don't.

Which states have parity so that they pay tele psychiatry the same as in office visits? My understanding is that MediCare only pays for tele psychiatry if the patient is in an underserved area.
 
I do telepsych part-time for a CMHC in an underserved area and charge the agency by the hour as a contractor.

The hourly rate I receive is not on the high end, but it is reliable and the work is much easier than my "day job." (mainly because the support staff are much better).

The CMHC does all of the billing (mostly medicaid, but some medicare).

I enjoy it, but I wouldn't be able to do telepsych as a full-time gig as it would get quite boring to stare at the screen that much.
 
I do telepsych two days per week, all paid by private insurance. There are some states that have laws of parity (i.e. they have to pay telepsych the way they would an in-office visit) and there are some that don't.


Which states are more telepsychiatry friendly in terms of licencing
 
Which states are more telepsychiatry friendly in terms of licencing
I think the best answer here is the states that it is easy to get a medical license in. The fly-over states seem to be pretty quick. Most states you have to have a license in where the patient is located, if that helps.
 
Does anyone know if full time telepsychiatry can be practiced on a J1 waiver (while living in non-J1 location) or if someone without a visa can practice telepsychiatry from outside the US (of course having had US credentials)?
 
Cms requires an individual, who is providing telemedicine to Medicare/Medicaid pts, to be physically in the USA.
 
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What if you wanted to provide care to as an out of state provider? For instance, I live in Florida but want to do telepsych in Oregon or New York.
When I contacted the local DEA offices they all require providers to be affiliated with a healthcare business that already has DEA registrants in the states I'm interested in, or require me to be in their states with a physical address. And that I couldn't see patients at their home via telemedicine.

Which means the only option is to be in contact with a facility in those states and see patients in those offices via telemedicine while I'm physically in Florida?
 
If there was a viable market for modalities in which you skyped to walking well patients with a credit card from the comfort of their own homes, you'd already see it.

I wonder how much business psychiatrists are getting on Breakthrough.com and similar sites. Most of the providers are master's level therapists but there are some psychiatrists.

I'd be more worried of teletherapists and telelifecoaches in those fields than I am of telepychiatrists robbing me of mine.

Works both ways. A telehealth social worker from outside the US tried to recruit me to take on a case when it became apparent the client was in a crisis that warranted mandated reporting. I said no thanks. Can't say they didn't try to send me business, though.
 
I have done telepsychiatry full time for the last 15 months in various states from home. It can get quite isolating.
 
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I have done telepsychiatry full time for the last 15 months in various states from home. It can get quite isolating.

Do you need a separate DEA in each state?
How do you handle concerns about suicide or medication side effects such as TD? Is the video quality good enough to see TD or motor abnormalities?
Which companies do you recommend? Do they take 30% of collections?
 
Do you need a separate DEA in each state?
How do you handle concerns about suicide or medication side effects such as TD? Is the video quality good enough to see TD or motor abnormalities?
Which companies do you recommend? Do they take 30% of collections?

Yes, you need a seperate DEA in each state, but sometimes the site will pay for it. Also if you finish up an assignment, you can just transfer the DEA from state to state. I have 3 DEA numbers and am letting one lapse because I only have a need for two at the moment. I do this at a CMHC which has nursing staff, other onsite psychiatrists, social workers etc. If I need to, I file petitions/baker acts to send them to the hospital involuntarily (for suicidal intent/cutting) and depending on the state, the police comes to get them for transport. I don't want to divulge any specific companies because these jobs can be hard to find. I ask to be paid as a contractor by the hour, whether the patients show or not. I don't have to deal with collections. A lot of patients are uninsured. I also don't rx stimulants at all and taper pts off benzos when I see someone is on them. This mentality can create a challenge in finding a job.
 
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Yes, you need a seperate DEA in each state, but sometimes the site will pay for it. Also if you finish up an assignment, you can just transfer the DEA from state to state. I have 3 DEA numbers and am letting one lapse because I only have a need for two at the moment. I do this at a CMHC which has nursing staff, other onsite psychiatrists, social workers etc. If I need to, I file petitions/baker acts to send them to the hospital involuntarily (for suicidal intent/cutting) and depending on the state, the police comes to get them for transport. I don't want to divulge any specific companies because these jobs can be hard to find. I ask to be paid as a contractor by the hour, whether the patients show or not. I don't have to deal with collections. A lot of patients are uninsured. I also don't rx stimulants at all and taper pts off benzos when I see someone is on them. This mentality can create a challenge in finding a job.

Just to clarify, if working multiple sites in one state, only need 1 DEA?
 
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