Anyone already doing tele-psychiatry from abroad?

[Bluecheese]

Is there anyone doing tele-psychiatry from abroad? I know this has been discussed before, but the answers always seem a bit wish-washy, so I'm curious if anyone who is actually doing it can comment (or who knows of someone who is doing it). I'm interested in living in Europe, at least part time, as my family is there, and I imagine there would be demand from rural hospitals and perhaps from EDs at night that need a nighttime psych consult.

Thanks

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[pramit]

Is there anyone doing tele-psychiatry from abroad? I know this has been discussed before, but the answers always seem a bit wish-washy, so I'm curious if anyone who is actually doing it can comment (or who knows of someone who is doing it). I'm interested in living in Europe, at least part time, as my family is there, and I imagine there would be demand from rural hospitals and perhaps from EDs at night that need a nighttime psych consult.

Thanks

Hello Bluecheese,
I am in a similar situation. Let me know if you have had other leads since your post. I am also looking for these answers and will update you if I find something.

 

[psychattending]

I have a graduate who is doing such a thing. He is Greek and is now back in Greece. He covers several ERs in the US.

 

[MacDonaldTriad]

I know nothing about this, but it seems to me you could be practicing from the moon so long as you have a license in the state the patient is in and your insurance knows what you are doing.

 

[PsyDr]

Facilities seeing CMS patients require that the teleprovider be within the United States and/or her territories. Seeing these patients while physically located abroad is against CMS guidelines. I know most people say it doesn't matter, but there are those pesky rack teams.

 

[PistolPete]

Didn't know this. Maybe the guy that's in Greece is seeing privately insurance patients through telepsych? Although it seems like only Medicare/Medicaid currently pay for telepsych services for patients who are in underserved areas.

 

[psychattending]

Didn't know this. Maybe the guy that's in Greece is seeing privately insurance patients through telepsych? Although it seems like only Medicare/Medicaid currently pay for telepsych services for patients who are in underserved areas.

Don't know much about the specifics with my graduate except that I have filled out hospital privilege forms for him to do the work.

 

[deleted736562]

Didn't know this. Maybe the guy that's in Greece is seeing privately insurance patients through telepsych? Although it seems like only Medicare/Medicaid currently pay for telepsych services for patients who are in underserved areas.

Most of the companies that have websites and advertise over the net say doctors can work from anywhere as long as they have a license in that particular state.

I'd also love to hear from someone with actual experience.

 

[deleted736562]

I have a graduate who is doing such a thing. He is Greek and is now back in Greece. He covers several ERs in the US.

Was he in the US on a visa? And does he require a visa to pursue something like this? Thanks for the info!

 

[digitlnoize]

Most of the companies that have websites and advertise over the net say doctors can work from anywhere as long as they have a license in that particular state.

I'd also love to hear from someone with actual experience.

Certain states have weird laws though. I know Virginia says that to treat a patient in Virginia the doctor also has to be physically present in Virginia. Not just a license.

It's stupid. But I think there's at least one other state with this stipulation.


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[Trismegistus4]

I know nothing about this, but it seems to me you could be practicing from the moon so long as you have a license in the state the patient is in and your insurance knows what you are doing.

No way. Network latency from the moon is too high to allow a live video feed.

Facilities seeing CMS patients require that the teleprovider be within the United States and/or her territories. Seeing these patients while physically located abroad is against CMS guidelines. I know most people say it doesn't matter, but there are those pesky rack teams.

Rent office space in a US Consulate?

 

[keifernny2]

It seems as though telemedicine software easily could track your IP address unless you're using a VPN, so there would be a paper trail for anyone outside the us.


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[Shikima]

I've heard through a guy who hears of a guy living in Europe and seeing people in ERs and whatnot via vtel. Effectively is the "night shift" guy.

 

[psychattending]

Was he in the US on a visa? And does he require a visa to pursue something like this? Thanks for the info!

He was on a J-1 when he was a resident. I would think he would not have a visa now since the main point of a visa is to enter into the country.

 

[perox123]

Facilities seeing CMS patients require that the teleprovider be within the United States and/or her territories. Seeing these patients while physically located abroad is against CMS guidelines. I know most people say it doesn't matter, but there are those pesky rack teams.

Does that rule pertains to facilities that deliver Medicaid services through managed care? Where I work most pts have Medicaid HMO and not straight Medicaid.

I think billing issues could be a primary reason why some facilities wouldn't allow providers to be practicing while abroad. But again this is confusing as information is conflicting from different sources. I have also heard about providers covering ER through telepsychiatry but again I think this something about billing through ER vs straight outpatient practice.
I would like to hear about this more as well.

 

[perox123]

He was on a J-1 when he was a resident. I would think he would not have a visa now since the main point of a visa is to enter into the country.

Probably he has H1 visa as otherwise he wouldn't be able to be employed within usa.

 

[PsyDr]

Does that rule pertains to facilities that deliver Medicaid services through managed care? Where I work most pts have Medicaid HMO and not straight Medicaid.

I think billing issues could be a primary reason why some facilities wouldn't allow providers to be practicing while abroad. But again this is confusing as information is conflicting from different sources. I have also heard about providers covering ER through telepsychiatry but again I think this something about billing through ER vs straight outpatient practice.
I would like to hear about this more as well.

Telemedicine, when paid for by cms, requires the patient to be in a specific type of facility. Cms also requires the provider to be inside the USA or her territories at the time of service. Then there are the relevant state laws. Medicaid has some different rules due to the difference in states.

Why these rules were made is about as understandable as why any other cms rules are made. I could make guesses, about legal interactions between foreign jurisdictions, federal procurement laws. Treaties, etc.

I happen to know about this stuff because a recruiter called me for a telepsych job repeatedly. I am licensed as a prescribing psychologist but have never practiced because I make more money doing forensics. Had my office people look into the liabilities and found the cms rulings. Confirmed with a healthcare attorney. 95% of the telemedicine companies blatantly say you can live anywhere on their websites. This is incorrect. Many say you're seeing Medicare people at home, which is contrary to cms rules.

 

[psychattending]

Probably he has H1 visa as otherwise he wouldn't be able to be employed within usa.

That would be incorrect. He had a J1 visa. Then worked for the VA system after residency.

 

[pramit]

Any other leads on this issue? I am reaching out to a few Telepsych companies this week and will loop back if I get any new information. I will be transitioning back to India (hopefully permanently) in 4-6 months and hoping to have a part time (1 day/week) job when I do.

 

[YesHaldol_NoXanax]

Certain states have weird laws though. I know Virginia says that to treat a patient in Virginia the doctor also has to be physically present in Virginia. Not just a license.

It's stupid. But I think there's at least one other state with this stipulation.

Also in Florida, the doctor is required to also be in Florida. Stupid.

 

[YesHaldol_NoXanax]

Any other leads on this issue? I am reaching out to a few Telepsych companies this week and will loop back if I get any new information. I will be transitioning back to India (hopefully permanently) in 4-6 months and hoping to have a part time (1 day/week) job when I do.

this is also my goal in the long run. to do telepsych, and have a bunch of time shares in condos around the world. apparently, FL and virginia, you need to be in the same state as the patient. don't know other than that. There's a cross-state telepsychiatry organization that's budding up now that you can call to ask these questions now.