Is it time to go back to normal office hours or telemedicine?

[nrmp]

What are your thoughts on given risk of getting exposed more by face to face visit VS continue telemedicine and give up some revenue?

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[Sushirolls]

I'm thinking early September for face to face. Required for AIMs visits, UDS visits for stimulants and suboxone, and initial consults. I recently ordered a bunch of face masks. Already was well stocked on hand sanitizer. Office already has a bathroom with a sink. Order more cleaning solution to augment current supply.

All other follow ups will get to choose if in office or telemedicine. Patients living in different state have to come back to office.

*if some government declaration roles back the telemedicine across state lines rules sooner, then my out of state people need to come in sooner.
*if pay parity isn't there for telemedicine, I might stop offering it. My state however passed a law declaring pay parity for telemedicine, but there is an exception to ERISA? plans or non-ERISA plans, which I really have no clue which ones these are which can skimp on payment.

I think I read UHC will end their Covid-19 emergency status 7/24, and I suspect they will revert back to being their ... usual quality.
I attempted to ask another insurance company, and they got back to me saying they had no idea if/when payment would change even in the context of my state passing the parity law.

 

[liquidshadow22]

Why are UDS patients requiring in person visits? Can't they just get a utox done at an outside laboratory?

 

[liquidshadow22]

Is there any expected reform to the Ryan Haight act post covid?

 

[Sushirolls]

Why are UDS patients requiring in person visits? Can't they just get a utox done at an outside laboratory?

They could....

However, my office has me +/- my assistant. That's far less people than an outside laboratory exposure. My office has greater ease of access. I result the specimen in real time and incorporate it into clinical decision making during the appointment. That is quality of care. And respectful of patients time resource in not referring to an outside lab, and my UDS cup has the substances of concern on it I want not what just happens to be available at an outside lab. I also generate a tiny, extra source of revenue that doesn't go to a Big Box Shop.

 

[Sushirolls]

Is there any expected reform to the Ryan Haight act post covid?

I've heard talk, but I won't believe it until its signed and codified in law.

 

[TexasPhysician]

Is there any expected reform to the Ryan Haight act post covid?

Unlikely

 

[calvnandhobbs68]

They could....

However, my office has me +/- my assistant. That's far less people than an outside laboratory exposure. My office has greater ease of access. I result the specimen in real time and incorporate it into clinical decision making during the appointment. That is quality of care. And respectful of patients time resource in not referring to an outside lab, and my UDS cup has the substances of concern on it I want not what just happens to be available at an outside lab. I also generate a tiny, extra source of revenue that doesn't go to a Big Box Shop.

Yeah, completely eliminate the pain in the butt of "oh man doc I totally forgot to go get the UDS done". Nope, drink some water for me if you need to, pee in this cup here and then we can talk about it right now if anything unexpected shows up. Similar to going to get labs done...like 1/5 people I send for labs actually get them done in the timeframe we want.

 

[nrmp]

I hope insurances continue to pay post July since it has started spiking again. I have my employers pushing for more face to face slowly but I guess for you guys being your own boss it's a big freedom

 

[randomdoc1]

Humana extended cost share waive to end of 2020 and BCBS extended their waive to 9/13/20 and Medicaid in our state permanently made it so members can get Tele visits in their home. I’m sticking to telemedicine unless specific circumstances such as needing AIMS, get weight, person just can’t figure out technology or TMS cases. We are using cloth masks, reusable isolation gowns, gloves and keeping people spread apart. So in office traffic in my office will stay low. Especially as long as insurances keep paying. I’m also keeping tabs on what the big hospital systems are doing and it looks like they are doing a similar approach.

@Sushirolls, I hate UHC. They are so big and so evil. They love sneaking me some underpayments intermittently. I bet that’s how they made 14billion profit.

 

[WisNeuro]

I hope insurances continue to pay post July since it has started spiking again. I have my employers pushing for more face to face slowly but I guess for you guys being your own boss it's a big freedom

Contact your state practice association. We're working with a bunch of the other healthcare orgs in our state to lobby for continuation of payments for telehealth, as two of the big ones here have signaled that they want to end reimbursement soon. Our cases have been going down, but it'll be a mess as we go through waves of infection and have to go through a rollercoaster of reimbursement/no reimbursement for such services.

 

[comp1]

It's kind of terrifying that you guys are feeling pressure to return to face to face because the insurance companies aren't authorizing payments for telemedicine at the same rate. At my VA, we are maintaining telemedicine for everyone except those who cannot do it and have no plans to change any time in the near future. I had hoped that was everywhere. COVID hasn't exactly gone away and psych is uniquely situated to still be able to provide great care while not adding to the burden of infection.

 

[oldiebutgoodie1211]

It's kind of terrifying that you guys are feeling pressure to return to face to face because the insurance companies aren't authorizing payments for telemedicine at the same rate. At my VA, we are maintaining telemedicine for everyone except those who cannot do it and have no plans to change any time in the near future. I had hoped that was everywhere. COVID hasn't exactly gone away and psych is uniquely situated to still be able to provide great care while not adding to the burden of infection.

so what do you recommend people do when reimbursement by insurance is cut for telehealth?

 

[comp1]

so what do you recommend people do when reimbursement by insurance is cut for telehealth?

I think the advocacy ideas above are great. I didn't mean any judgement on providers' part. We all have to eat.

 

[randomdoc1]

so far looks like most insurances have extended into end of September and some for all of 2020. United just extended into 9/30/2020 (with cost share waive and everything) and we all know how generous they are.