COVID-19 & Clinical Practice Changes?

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cara susanna said:
I have been told by numerous people that you cannot bill multiple codes for phone sessions, sadly.
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We received the same guidance. Only E/m eligible providers can use extension codes. Yet another way we end up with unbillable work. Trend anyone?
 
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Therapist4Chnge said:
Insurance companies have WAAAAAAAY better lobbyists who are WEEEEEELL compensated to make sure we get screwed.
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We need to have lobbyist draft picks like they do in sports. I'd watch the 2020 APA lobbyist draft pick. Might get a few more people to pay attention.
 
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It's like baseball in the lobbyist world, no salary cap, you just have to pay them. Unfortunately, we are cheap, and don't like to pay anyone. So, when we see ourselves getting screwed in reimbursements, we have only ourselves to blame. :)
 
So I've been on full telework for several weeks now and am emotionally planning for resuming some in-person activities over the next month or two as restrictions may or may not be lifted. I'm wondering if any of my hospital based colleagues wear scrubs...or if you're considering switching to them? I know the risk of surface based infection seems to be low, but I have a certain ick factor I can't get over and I thought having dedicated work clothes I wouldn't have to burn at the end of the day might reduce my anxiety a little. Thoughts/advice?
 
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PsychPhDStudent said:
So I've been on full telework for several weeks now and am emotionally planning for resuming some in-person activities over the next month or two as restrictions may or may not be lifted. I'm wondering if any of my hospital based colleagues wear scrubs...or if you're considering switching to them? I know the risk of surface based infection seems to be low, but I have a certain ick factor I can't get over and I thought having dedicated work clothes I wouldn't have to burn at the end of the day might reduce my anxiety a little. Thoughts/advice?
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We have a dedicated COVID unit at my hospital (max-security forensic). The assigned psychologist has since begun wearing a full on surgery outfit. I have yet to go that far, just sticking with hand-sanitizer all throughout the day. I know for him it has led to reduction in distress, so do what works for you.
 
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PsychPhDStudent said:
I'm wondering if any of my hospital based colleagues wear scrubs...or if you're considering switching to them?
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Nope. Even with video and phone appointments only, staff have attempted to go with a nice pair of dark jeans and a nice top, but management quickly reprimanded folks for that. If scrubs ever happened, **** would go down.
 
AbnormalPsych said:
Nope. Even with video and phone appointments only, staff have attempted to go with a nice pair of dark jeans and a nice top, but management quickly reprimanded folks for that. If scrubs ever happened, **** would go down.
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If I were still in a hospital setting, I'd want full PPE if I had to deal w any patients right now. No argument for in-person treatment would be considered w/o full PPE. With that said, def scrubs bc of cleaning and being able to toss easily.

My life > My job
 
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PsychPhDStudent said:
Just kind of surprised. Must be hospital culture differences. I'm forever in hoodie.
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In non-COVID times, my colleague got reprimanded in the hall for wearing a sweatshirt when she was cold on top of work clothes. At my current hospital, I have definitely seen people wearing jeans. In one VA, I heard men were just recently allowed to stop wearing ties on the daily. And we were recently told not to wear bandanas as makeshift masks so that we don't look like bandits (true story). It's all over the place. And I agree with @Therapist4Chnge, if I have to go in any time soon, people's opinions will go out the window...safety first for me!
 
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PsychPhDStudent said:
I'm wondering if any of my hospital based colleagues wear scrubs...or if you're considering switching to them?
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Prior to being sent home for telework, I was immediately stripping down and putting all clothing directly into the washing machine, giving a quick Lysol spray to my shoes, and wiping down their soles with bleach and then taking a shower. I would do the same, with or without scrubs.
 
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Has anybody been doing therapy in PPE? Especially groups? Can one even adequately project your voice across a room with social distancing practices enacted while wearing a mask, which the most recent VA memo indicated is now required for inpatient/residential settings?
 
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AbnormalPsych said:
Can never be too careful, hospital bandits are the real deal.
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Well, I do consider this the ideal time to rob a bank cause everyone is wearing masks, so perhaps a PPE caper after that.
 
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Sanman said:
Well, I do consider this the ideal time to rob a bank cause everyone is wearing masks, so perhaps a PPE caper after that.
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My bank is just doing drive through for simple transactions, and if you need something more involved (loans, mortgage) you have to make an appointment, they've got this figured out. So they can avoid the criminal actors. But, who knows what will happen now that a bunch of red hat wearing *****s are gathering in groups with flak jackets and assault weapons for...reasons.
 
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If you're trying to rob a bank, you're doing it wrong. Average haul is something like $5k and it's potential federal time.

All these *****s who scam CMS initially get paid. I'm sure you could move to Belize, start your scheme, immediately transfer your proceeds into crypto, and take home a few million. You just could never set foot in the states, or any extradition country. Which means it's like a lot of Africa, the serbian countries, and the bad parts of the middle east for the rest of your life.

Damn people, if you're gonna ruin your life, do it for something big.
 
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Our VA has moved to casual clothing (jeans, sweatshirts, etc) for now.
 
PsyDr said:
If you're trying to rob a bank, you're doing it wrong. Average haul is something like $5k and it's potential federal time.

All these *****s who scam CMS initially get paid. I'm sure you could move to Belize, start your scheme, immediately transfer your proceeds into crypto, and take home a few million. You just could never set foot in the states, or any extradition country. Which means it's like a lot of Africa, the serbian countries, and the bad parts of the middle east for the rest of your life.

Damn people, if you're gonna ruin your life, do it for something big.
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I thought that Cuba was the go to escape for medicare fraudsters, especially in S. Florida. Just hop on your boat named "E Z Money" and make the 90 mile trip to freedom with your millions.
 
cara susanna said:
Our VA has moved to casual clothing (jeans, sweatshirts, etc) for now.
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I have personally moved to whatever the hell I want to wear given that I am mostly making phone calls from home at this point.
 
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Sanman said:
I have personally moved to whatever the hell I want to wear given that I am mostly making phone calls from home at this point.
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We're still coming into the office, with the exception of a few people who've been approved for telework.
 
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In New York, we’ve been shut down and working from home for over a month at this point. Makes sense though, we’ve been hit very hard here. We’ve held off on NP assessment for some time, but unfortunately our billable hours have been low (no one wants an assessment right now). So we are beginning teleNP soon.
 
PsychPhDStudent said:
Are you wearing PPE? Just curious. I'm assuming not?
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We're encouraged to wear surgical masks when we aren't in our offices. It's not a hard and fast rule though, unless Employee Health mandated you to specifically.

I should add though that we're in our own building so we don't even have Primary Care appts here. It's only OPMH.
 
cara susanna said:
We're encouraged to wear surgical masks when we aren't in our offices. It's not a hard and fast rule though, unless Employee Health mandated you to specifically.

I should add though that we're in our own building so we don't even have Primary Care appts here. It's only OPMH.
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Ahh, that is interesting. My VA has no such building. MH has the majority of one floor in the hospital and many specialty psychologist offices are scattered around the hospital in clinic and inpatient areas. Perhaps why we moved to tele-health so quickly. We also generally lack office space for staff and were moving more toward tele-health for this reason prior to the pandemic.
 
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First day back in the hospital/clinic today.

Definitely very strange testing in PPE (mask, face shield, etc.) but my evals are relatively short, so it went rather smoothly. No more waiting areas in our clinic too - patients have to wait outside, get a text when the appointment is ready, go straight to an exam room and then leave immediately after. Most annoying part was the face shield continuing to fog up.
 
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Hey everyone,

I was wondering if I could get some advice. I’m graduating this year (phd clinical psychology) and considering going home (out of the country) during this pandemic, but have a post doc starting September in California. I’m wondering if anyone knows whether I could do therapy work remotely from out of state/country if I can’t get back into the country by September because of any travel bans? I wouldn’t be licensed, so would be operating under supervisors licensed in California.
 
You CANNOT be physically located outside of a state in which you are providing services, if you are not licensed there.

You DOUBLE CANT provide services out of country. Like that’s a straight up federal crime. Not a civil action.
 
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Also, doesn't this state have a requirement for % of face to face supervision hours anyways? Sounds like a bad idea all the way around.

From the CA BOP website:
The primary supervisor provides a minimum of one hour of direct, individual, face-to-face supervision every week during which the trainee accrues hours. (Section 1387(b)(4))
 
trialanderror said:
Hey everyone,

I was wondering if I could get some advice. I’m graduating this year (phd clinical psychology) and considering going home (out of the country) during this pandemic, but have a post doc starting September in California. I’m wondering if anyone knows whether I could do therapy work remotely from out of state/country if I can’t get back into the country by September because of any travel bans? I wouldn’t be licensed, so would be operating under supervisors licensed in California.
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Yeah, definitely don't do that.
 
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I second everyone here, but feel free to check with the BOP for confirmation.
 
foreverbull said:
I second everyone here, but feel free to check with the BOP for confirmation.
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If you’re gonna look at second opinions, also look up CMS rules about telemedicine billing.

The us government isn’t keen on allowing a bunch of mbbbs guys from undeveloped countries billing $100MM to Medicare. Which is why they strictly prohibited overseas telemedicine stuff. Unfortunately, most idiots including the APA’s ces didn’t bother to look this up, or consult actual attorneys.
 
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Yeah, while some rules about state to state practice have loosened in these times, I have seen zero loosening of international rules. Also second @PsyDr , the BOP will have zero idea about this stuff, it's definitely a federal law issue, not a local jurisdiction issue.
 
trialanderror said:
Hey everyone,

I was wondering if I could get some advice. I’m graduating this year (phd clinical psychology) and considering going home (out of the country) during this pandemic, but have a post doc starting September in California. I’m wondering if anyone knows whether I could do therapy work remotely from out of state/country if I can’t get back into the country by September because of any travel bans? I wouldn’t be licensed, so would be operating under supervisors licensed in California.
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Agree 100% with what those above have said: do not do this. In addition to all the questions, concerns, and uncertainties regarding inter-country telehealth practice, there's also the issue of your supervisor providing supervision across international borders. I'd have a hard time believing CA would allow a supervisor to supervise someone providing telehealth from another country, even if the patient were located in CA (but full disclosure: I've never asked the CA Board about this,). And beyond that, I have to think your and/or your supervisor's malpractice carrier would also balk at the idea.
 
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AcronymAllergy said:
Agree 100% with what those above have said: do not do this. In addition to all the questions, concerns, and uncertainties regarding inter-country telehealth practice, there's also the issue of your supervisor providing supervision across international borders. I'd have a hard time believing CA would allow a supervisor to supervise someone providing telehealth from another country, even if the patient were located in CA (but full disclosure: I've never asked the CA Board about this,). And beyond that, I have to think your and/or your supervisor's malpractice carrier would also balk at the idea.
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It's a good way for the carrier to void your policy and throw you under the bus (rightfully so) if something were to happen.
 
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SportsNeuroPsych said:
First day back in the hospital/clinic today.

Definitely very strange...
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In person appointments are feeling a bit strange to me also. As I've shared elsewhere, I've been going into my pp 1.5 days/week to conduct teletherapy since this all began. I see a small caseload (~10 clients/week), and one client has come in person the past two weeks.

I am surprised how awkward I feel....it's kind of hard to describe, but for the past ~2 months the only humans I have been in the same room with are my wife and kids. And now this client. They are in a similar situation -- having only spent time with their spouse and children. I don't know...just feels strange and makes me curious if others are experiencing anything similar as we slowly resume in-person appointments? And what it will feel like to eventually return to crowded restaurants, movies, sports...
 
calimich said:
In person appointments are feeling a bit strange to me also. As I've shared elsewhere, I've been going into my pp 1.5 days/week to conduct teletherapy since this all began. I see a small caseload (~10 clients/week), and one client has come in person the past two weeks.

I am surprised how awkward I feel....it's kind of hard to describe, but for the past ~2 months the only humans I have been in the same room with are my wife and kids. And now this client. They are in a similar situation -- having only spent time with their spouse and children. I don't know...just feels strange and makes me curious if others are experiencing anything similar as we slowly resume in-person appointments? And what it will feel like to eventually return to crowded restaurants, movies, sports...
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At least for testing, I can't see going back to in person in the next few weeks. Our state is seeing an increase in ICU and non-ICU hospitalizations. Additionally, my hospital has transitioned several med-surg units into COVID beds. Seeing someone for ~45 minutes in a small-ish room is one thing, being in there for ~2 hours is another.
 
I don't know that I see a return to in-person testing anytime in at least the next couple weeks, either. And I'm in a pretty gung-ho for back-to-work state. I'll probably have forgotten how to administer everything by the time I get back to it.

I've still been coming into the clinic pretty much full-time, and we've had some in-person training and meetings, so that'll probably help the testing feel a bit less odd. Although I still think the first patient or three will be a bit awkward, especially as we figure out how to integrate whatever contact precautions will be needed.
 
My fiance's department went back last week and is doing full testing. It's definitely odd and almost impossible to implement contact precautions.
 
Luckily I am full salary right now with little oversight, so I can pretty much unilaterally make decisions. If pressured to go back to full testing right now as we experience a marked day over day increase in cases/hospitalizations, I'd just resign, or threaten to go to the local news with e-mails and the statements from liability insurance carriers regarding certain services.
 
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I'm still teleworking but my VA facility is now requiring all staff and visitors to wear a face covering (and providing it for those who don't bring their own) if they are in the hospital.

There's no date for when in-person, non-emergent medical appointments will resume so I have to imagine that mental health (besides NP) is even further away from resuming in-person care.

For context, my state's numbers are still rising and we have not hit our anticipated peak ICU/vent/etc use yet.
 
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summerbabe said:
I'm still teleworking but my VA facility is now requiring all staff and visitors to wear a face covering (and providing it for those who don't bring their own) if they are in the hospital.

There's no date for when in-person, non-emergent medical appointments will resume so I have to imagine that mental health (besides NP) is even further away from resuming in-person care.

For context, my state's numbers are still rising and we have not hit our anticipated peak ICU/vent/etc use yet.
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Our VA facility is now requiring masks as well.
 
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Our VA is starting to talk about "return to the new normal" but I see that as challenging as most of our work is not done individually. The cynic in me thinks that they want to be monitoring us more closely - but I have been liking working from home/telehealth and it is making me seriously consider looking into alternate roles so that I can continue WFH.
 
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