Is international telepsych a thing / possible ?

[MoonCheese]

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[TexasPhysician]

I haven’t seen this happen. While it sounds fantastic, it is probably a logistical nightmare. You’d need the equipment on both sides, good Wifi, continued staff on both ends, and ability to source meds routinely.

 

[Ironspy]

I've seen programs where you provide tele psych supervision to midlevels in developing countries which is more logistically feasible:
A Resident-Based Telepsychiatry Supervision Pilot Program in Liberia. - PubMed - NCBI

 

[futuredo32]

I met someone training at the Michigan Psychoanalytic Institute who was from China and he was doing it US to China, but I know it's probably very different from the US to another country.

 

[Achillees]

What about the reverse? From abroad into US? I understand you probably have to be licensed in the state you'd be practicing in.

 

[Extralong]

You have to be on US soil to do telepsych for US population

 

[Shufflin]

I use a transporter machine. Transporters convert a person or object into an energy pattern (a process called dematerialization), that "beams" me to a patient, maybe 1000 miles away, where I'm reconverted into matter (rematerialization), and after I'm done I just "beam" back to my house.

 

[TexasPhysician]

I use a transporter machine. Transporters convert a person or object into an energy pattern (a process called dematerialization), that "beams" me to a patient, maybe 1000 miles away, where I'm reconverted into matter (rematerialization), and after I'm done I just "beam" back to my house.

Which model works best? I was thinking about getting the Beam2001Q.

 

[TexasPhysician]

You have to be on US soil to do telepsych for US population

I think that is only for government plans. Commercial plans I believe still allow telepsych from outside the US. The problem would be finding a telepsych company that only utilizes commercial plans.

 

[Extralong]

I think that is only for government plans. Commercial plans I believe still allow telepsych from outside the US. The problem would be finding a telepsych company that only utilizes commercial plans.

I guess I got a different answer, but I cannot find anything online.

My understanding, when I spoke to various telepsych companies, they did not allow doing this outside the USA. This includes if you are in vacation outside the US and want to continue your clinic. I think it has something to do with application of HIPAA, how to enforce HIPAA and deal with violations, the data that is streaming, and the internet provider.

Additionally, some of the companies chose to only take applicants that live in the same state for Telepsychiatry; but that’s only a choice.

 

[clausewitz2]

I guess I got a different answer, but I cannot find anything online.

My understanding, when I spoke to various telepsych companies, they did not allow doing this outside the USA. This includes if you are in vacation outside the US and want to continue your clinic. I think it has something to do with application of HIPAA, how to enforce HIPAA and deal with violations, the data that is streaming, and the internet provider.

Additionally, some of the companies chose to only take applicants that live in the same state for Telepsychiatry; but that’s only a choice.

HIPAA is the trashcan excuse in medicine whenever a system or company wants to justify not having to deal with something. "Oh, it's HIPAA." no. There are HIPAA compliant platforms for doing this, although they are not cheap. HIPAA does not expressly forbid this in any regulations or proposed regulations that I have ever seen.

The real reason as mentioned in previous threads about this is that Medicaid/Medicare do not pay for any care of any kind provided outside of the United States (with very, very limited exceptions, like being on a boat is in US territorial waters or you are travelling between Alaska and the US and are passing through Canada). To the extent private insurers often follow Medicaid and Medicare's lead, probably some of them also will not pay for this. It is a hassle regardless if they are accepting those insurances for seeing other providers in their system and have to figure out a way to screen you specifically out of the pool of providers they may be matched with.

 

[Extralong]

HIPAA is the trashcan excuse in medicine whenever a system or company wants to justify not having to deal with something. "Oh, it's HIPAA." no. There are HIPAA compliant platforms for doing this, although they are not cheap. HIPAA does not expressly forbid this in any regulations or proposed regulations that I have ever seen.

The real reason as mentioned in previous threads about this is that Medicaid/Medicare do not pay for any care of any kind provided outside of the United States (with very, very limited exceptions, like being on a boat is in US territorial waters or you are travelling between Alaska and the US and are passing through Canada). To the extent private insurers often follow Medicaid and Medicare's lead, probably some of them also will not pay for this. It is a hassle regardless if they are accepting those insurances for seeing other providers in their system and have to figure out a way to screen you specifically out of the pool of providers they may be matched with.

I can see you are very angry at HIPAA or the government insurance, or something deeper that we will not unravel. j/k
The telepsych companies are not allowing this, due to the statements above that I have provided. Am I in support of this, totally, but that’s a completely different convo.

 

[deleted736562]

I can see you are very angry at HIPAA or the government insurance, or something deeper that we will not unravel. j/k
The telepsych companies are not allowing this, due to the statements above that I have provided. Am I in support of this, totally, but that’s a completely different convo.

This is wrong. There are definitely companies that are willing to hire psychiatrists wanting to work overseas. Usually it's in the ED setting cause hospitals are willing to take the costs.

Also nothing can stop you from doing cash only telepsych overseas.

The reverse is also possible. I personally know a few who are doing it. It depends on what country you want to see patients in (are you licensed there? what are the regulations?...etc).

 

[Extralong]

This is wrong. There are definitely companies that are willing to hire psychiatrists wanting to work overseas. Usually it's in the ED setting cause hospitals are willing to take the costs.

Also nothing can stop you from doing cash only telepsych overseas.

The reverse is also possible. I personally know a few who are doing it. It depends on what country you want to see patients in (are you licensed there? what are the regulations?...etc).

I’m not sure if we are talking about the same stuff. I’m referring to doing Telepsychiatry from outside the US seeing patients in the US. My experience includes calling and speaking with several telepsych companies hosting psychiatrists included hearing the same answers: have to be on US soil to do US telepsych due to all the above.

If you guys wouldn’t mind sharing a company or two that would allow being abroad while treating patients in the US, that would be great.

 

[PsyDr]

Cms requires providers using telemedicine to be physically within the USA or her territories. Because you are considered a cms provider by default, even if you have never enrolled or signed a single piece of apparel, have to opt out of cms every 2-3 years using specific language in the letter. Cms also prohibits cms providers from accepting cash payments from cms enrolled patients, even if everyone agrees to this situation. These rules also apply in cms facilities.

Failure to adhere to these cms policies can have legal consequences including civil penalties and criminal charges. Think that’s stupid? Remember that cms says that they consider underbilling to be fraud.

Keep that in mind when these telepsych companies tell you it’s fine to be abroad.

 

[Shufflin]

Which model works best? I was thinking about getting the Beam2001Q.

Yah well I thought it was the Berzerker-9000x, you know the platinum one they only made like 4 models of, well it crashed on me after I teleported to China. I had to catch a plan back home. Yours is prob better.