In person visits

[Attending1985]

Who’s back to in person visits? My organization is forcing us back into face to face visits much to everyone in my departments anger.

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[Stagg737]

Our clinics are still mostly doing telepsych, but patients have had the option to be seen face to face for several weeks now.

 

[Sushirolls]

Currently still doing 100% Telemedicine.

I'm still milling around the idea of opening up the choice of in office in September, but requiring the UDS patients to be in office. I got my distancing with chairs for 6ft, already a limited human traffic office, masks, sanitizer, medical grade wipes, and sink for hand washing.

I'm bringing my assistant/receptionist back to the office next week. She had been telecommuting from home.

 

[WisNeuro]

Similar to Stagg, our MH clinic patients have the option for both telemedicine or in-person for therapy and med management. I think for patients considered high risk, there has to be some compelling rationale to bring them in, though.

 

[romanticscience]

I'm doing in-person Tues/Thurs for long-term biweekly therapy patients. Mon/Wed/Fri all telepsych.

 

[birchswing]

Who’s back to in person visits? My organization is forcing us back into face to face visits much to everyone in my departments anger.

What do they think the benefit is? Are patients clamoring for it?

 

[Monocles]

What do they think the benefit is? Are patients clamoring for it?

Maybe fears of decreased reimbursement in the future? As far as I know majority of patients have been loving virtual visits. Revenue should be up for depts as no show rates plummet.

 

[calvnandhobbs68]

Maybe fears of decreased reimbursement in the future? As far as I know majority of patients have been loving virtual visits. Revenue should be up for depts as no show rates plummet.

lol I've had so many telemedicine no shows I'm pretty sure my no show rate is as bad or worse as my in person no show rate. Half the patients not even picking up their phones or picking up and being like "oh no I forgot about this appointment, I can't do it right now".

Also, at the beginning of things, had a lot of phone only appointments until video calls became more intuitive for patients. Telephone only doesn't reimburse equivalent to in-person like video does.

 

[MLT2MT2DO]

Who’s back to in person visits? My organization is forcing us back into face to face visits much to everyone in my departments anger.

Are you actually a resident? If so I'm sorry do your best to suck it up, mask up, and social distance.

If you're not a resident...you should consider you have all the cards and you even asking this question is embarrassing to our profession.

 

[Monocles]

If you're not a resident...you should consider you have all the cards and you even asking this question is embarrassing to our profession.

Not OP but I'm curious. Can you explain more?

 

[Merovinge]

Who’s back to in person visits? My organization is forcing us back into face to face visits much to everyone in my departments anger.

I prefer in-person visits as a CAP (long forum post coming on this topic at some point). While my organization tried to push more televists, I find about 50-60% of my families prefer in-person and 40-50% prefer televisits (all my existing patients are given the option to choose either at their preference).

We have temp checks for all patients/staff, require masking for everyone, 1 visitor/parent max per patient, and support staff lysol down every chair/room anytime a single patient sits in one. Sadly my collection of toys has been stripped entirely away. My exam rooms are fortunately large enough that my patients sit >6 feet away from me as well. For my ASD patients unable to mask we have these ridiculous looking face shields for staff to wear. I'm in a very low base rate COVID area, so I expect I would have different thoughts based on where I live.

 

[Attending1985]

So my manager tells me that telehealth is being covered at 70% of in person. I’m in MN. Is this true? My understanding was reimbursement for telehealth was equal to in person.

 

[Sushirolls]

Some insurance have ~70% rates, there is truth in that. But some have 'volunteered' for parity, others were required depending on state.

 

[Old&InTheWay]

I hate televisits, both as a treating physician and for my own personal therapy (which I put on hold until it can be done face to face again). I've met many patients in the past few months who have quit going to appointments (of all kinds) for the same reason. Being physically near and present with patients is in itself therapeutic. You literally can't even make eye contact on zoom. You can't tell whether pauses in the conversation are real or a glitch. There's no way to have a natural, flowing conversation; it might as well be over CB radio. The telephone is way better than videochat, at least there's no lag and it has a semblance of intimacy. Why is everyone pretending like a zoom meeting is in any way a satisfactory replacement? The conversation should be around how to get back to face to face visits ASAP as safely as possible.

 

[Attending1985]

Some insurance have ~70% rates, there is truth in that. But some have 'volunteered' for parity, others were required depending on state.

What about psychiatrists that do all telehealth? I see a lot of these jobs advertised. Do they pay less due to this?

 

[shahseh22]

I prefer in-person visits as a CAP (long forum post coming on this topic at some point). While my organization tried to push more televists, I find about 50-60% of my families prefer in-person and 40-50% prefer televisits (all my existing patients are given the option to choose either at their preference).

We have temp checks for all patients/staff, require masking for everyone, 1 visitor/parent max per patient, and support staff lysol down every chair/room anytime a single patient sits in one. Sadly my collection of toys has been stripped entirely away. My exam rooms are fortunately large enough that my patients sit >6 feet away from me as well. For my ASD patients unable to mask we have these ridiculous looking face shields for staff to wear. I'm in a very low base rate COVID area, so I expect I would have different thoughts based on where I live.

I'm 100% CAP and I absolutely love the televisits. No way am I doing in person visits ever again unless I decide to work inpatient. We are also in a COVID hotspot so that does partially influence my decision.

 

[Sushirolls]

What about psychiatrists that do all telehealth? I see a lot of these jobs advertised. Do they pay less due to this?

Partly, but mostly because they are an employer and their business model is to make you dig for coal and to churn thru patient volume. They don't care if you deliver quality, they want volume.

 

[shahseh22]

So my manager tells me that telehealth is being covered at 70% of in person. I’m in MN. Is this true? My understanding was reimbursement for telehealth was equal to in person.

Insurance companies are evil, they will find any way to reimburse less.

 

[Attending1985]

Some insurance have ~70% rates, there is truth in that. But some have 'volunteered' for parity, others were required depending on state.

I did some searching and there was a statute passed in 2015 in MN which required equal reimbursement for telehealth and in person visits.

 

[Attending1985]

I'm 100% CAP and I absolutely love the televisits. No way am I doing in person visits ever again unless I decide to work inpatient. We are also in a COVID hotspot so that does partially influence my decision.

I really like telehealth as well

 

[hallowmann]

We started transitioning back to in-person in June, and for the past couple weeks there's been a big push to do as much in person as possible mainly for revenue. The VA is still all telepsych. Same with the community health center we rotate at.

 

[Mass Effect]

If you're not a resident...you should consider you have all the cards and you even asking this question is embarrassing to our profession.

Oh come on. There's no need to be nasty. No one's in the mood to look for another job in the midst of a pandemic.

I hate televisits, both as a treating physician and for my own personal therapy (which I put on hold until it can be done face to face again). I've met many patients in the past few months who have quit going to appointments (of all kinds) for the same reason. Being physically near and present with patients is in itself therapeutic. You literally can't even make eye contact on zoom. You can't tell whether pauses in the conversation are real or a glitch. There's no way to have a natural, flowing conversation; it might as well be over CB radio. The telephone is way better than videochat, at least there's no lag and it has a semblance of intimacy. Why is everyone pretending like a zoom meeting is in any way a satisfactory replacement? The conversation should be around how to get back to face to face visits ASAP as safely as possible.

No one is pretending Zoom is better than in-person, but it absolutely 110% IS satisfactory considering the alternative is potential infection.

 

[Stagg737]

Maybe fears of decreased reimbursement in the future? As far as I know majority of patients have been loving virtual visits. Revenue should be up for depts as no show rates plummet.

A common problem I see is that many of our lower-income patients do not have access to telehealth options as they own flip phones or don't own cell phones at all. I've also had patients who either couldn't figure out how to use the apps or the apps just didn't work and they ended up being phone encounters. I think that overall where I'm working revenue is probably down, as I'd say at least 50% of my visits in at least one clinic end up being over the phone.

There's no way to have a natural, flowing conversation; it might as well be over CB radio.

This is also a huge problem. I've found that with telehealth the patients and I end up accidentally interrupting each other far too frequently, occasionally to the point of awkwardness or completely breaking the flow of the encounter. I do some of my more dramatic patients not being in person, but overall it's been more of a detriment than convenience.

We started transitioning back to in-person in June, and for the past couple weeks there's been a big push to do as much in person as possible mainly for revenue. The VA is still all telepsych. Same with the community health center we rotate at.

Our clinics are the opposite (academic, VA, and community clinics), strongly encouraging patients to continue with telehealth at this time and only doing in-person if specifically requested or when necessary.

 

[Sushirolls]

I really like telehealth as well

And the usual saga for psychiatry is getting this to be enforced. But then the devil is in the details of the laws. There are different classifications of health insurance. Some may be under the nuances of the state laws, others may not. This is something I haven't dug into too much, and would have been a big time suck.

 

[birchswing]

I had been doing telehealth for a long time before the pandemic with my therapist. When I did see him in person at his older office, I would lie facing away from him. It wasn't on purpose as if I was trying to emulate the traditional psychoanalytic repose. I just felt more comfortable that way.

When we moved to telehealth at first by phone, it was fine. Then he said for billing he had to use a service. I didn't care for staring at him let alone a grainy version of him, so I turned off the video and kept the sound on. Too distracting to stare at someone.

I asked him lots of questions about Doxy.me that he didn't have answers to.

His answer as to why we were using it was that it was 1) Free and 2) It *said* HIPAA compliant so that gave him the appearance of having done his due diligence. He admitted he had no idea what the company was, why it was free, etc.

I frankly don't trust these companies giving away their products for free. I tried reading Doxy.me's privacy policy, and the end user policy (the one for the client) basically says any privacy related matters are a question for the doctor. But the doctor in this case was not clued in nor did he want to be clued in.

I would trust Facetime much more. It's not it's free to run video servers—that's a lot of money and infrastructure. They have to be getting something out of it. Apple gets revenue selling hardware so they make Facetime available. I don't know what Doxy.me is getting.

And don't get me started on Zoom, which is largely run out of China. I would not trust Zoom for anything. Zoom shut down the account of people residing in the US for discussing Tiananmen Square because they said it broke local laws--even though they were in the US when discussing it. How did they know what they were discussing?

 

[clozareal]

I've heard of some psychiatrists and therapists moving to fully outdoor practices in a private courtyard where there's enough space from the separated outdoor waiting area that it can be private. Both parties would be wearing a mask even when outdoors, but at least it's face to face and can offer a bit more of a human connection than video.

Although it isn't the same as an in-office, no mask session, this type of model sounds like a more appealing option for some than doing video appointments that's contingent on internet connection, privacy in a home that might not offer it due to kids and other family members, or working technology. It would depend on having access to this sort of place though.