Telehealth is done for?

[forchinet121]

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So apparently CMS is going to require in person visit initially for all telehealth patients? And then insurance will follow? So if you can’t do an in person visit you won’t be able to do telepsych..isn’t this the death of telepsych?

 

[StayOnTop]

No, DEA is requiring an in person appointment first for controlled substances, unless a referring provider first sees them. If you don't do controlled substances, telehealth continues like nothings has changed.

 

[forchinet121]

No, DEA is requiring an in person appointment first for controlled substances, unless a referring provider first sees them. If you don't do controlled substances, telehealth continues like nothings has changed.

People are telling me CMS which covers Medicare also posted their rules which say they require in person visit for ALL visits

 

[StayOnTop]

People are telling me CMS which covers Medicare also posted their rules which say they require in person visit for ALL visits

My understanding is that Congress extended CMS' medicare telehealth rules for two more years.

 

[forchinet121]

My understanding is that Congress extended CMS' medicare telehealth rules for two more years.

Yes but after that you will need to see everyone in person? That will be the death of telepsych right?

 

[StayOnTop]

Yes but after that you will need to see everyone in person? That will be the death of telepsych right?

There has been no determination as to what will happen after those two years. Chances are they'll just delay it another two years.

 

[forchinet121]

There has been no determination as to what will happen after those two years. Chances are they'll just delay it another two years.

Oh why are people freaking out then? This doesn’t sound that bad then thanks for the insights

 

[liquidshadow22]

No, DEA is requiring an in person appointment first for controlled substances, unless a referring provider first sees them. If you don't do controlled substances, telehealth continues like nothings has changed.

So the same doctor that does the first in person visit doesn't need to be the same person that continues the prescriptions going forward?

Any good links to info on these regulations?

 

[allantois]

Almost no one in psych takes Medicare as is

 

[calvnandhobbs68]

Almost no one in psych takes Medicare as is

 

[splik]

So we're good until 12/31/2024. After that CMS requires an in person visit within 6 months and annually thereafter. the exemptions are FQHC and RHCs.
see: Telehealth policy changes after the COVID-19 public health emergency | Telehealth.HHS.gov

This has no impact on what commercial insurance does. many states have telemedicine parity laws so if you are a state which has that, telemedicine is here to stay. If not, chances are that insurance is already not covering telehealth anymore. 40 states have telemedicine parity laws last i heard.

 

[jbomba]

 

[Jules A]

What about those started on controlled substances via tele during the Haight waiver? Will they now need to be seen in person x1?

 

[clausewitz2]

What about those started on controlled substances via tele during the Haight waiver? Will they now need to be seen in person x1?

There appears to be a provision for a 180 day transitional period for these people but yes they will still need to be seen or get a referral from a medical provider who has seen them in person.

 

[whopper]

I want any new patient coming into my office anyways at least the first visit.

 

[forchinet121]

I want any new patient coming into my office anyways at least the first visit.

Many of us don’t have an office and want to continue to do strictly telehealth

 

[allantois]

Many of us don’t have an office and want to continue to do strictly telehealth

Which you can

 

[forchinet121]

Which you can

Not if Medicare forces in person visits and insurance follows their lead

 

[allantois]

Not if Medicare forces in person visits and insurance follows their lead

There’s enough psychiatrists not in the Medicare system that it doesn’t really matter what medicare does. I don’t think insurance will stop covering telepsych

 

[forchinet121]

There’s enough psychiatrists not in the Medicare system that it doesn’t really matter what medicare does. I don’t think insurance will stop covering telepsych

I really hope youre correct, it would be very stupid for Medicare to do it and screw over the elderly

 

[jbomba]

There’s enough psychiatrists not in the Medicare system that it doesn’t really matter what medicare does. I don’t think insurance will stop covering telepsych

Don't the parity laws preclude this?

 

[clausewitz2]

Don't the parity laws preclude this?

In states where they exist, which is unfortunately not all of them. I do think the laggards are going to see more legislative action about this before the end of the year, though.

 

[TexasPhysician]

What about those started on controlled substances via tele during the Haight waiver? Will they now need to be seen in person x1?

Yes plan on it. I’m already moving all tele health patients to be seen 1x in person.

 

[clausewitz2]

I already require people I am going to prescribe stimulants to to make an appointment for a dedicated ADHD eval with me and even if I think they have ADHD, require that they identify objective benchmarks for treatment before I write the script anyway. not so hard to add in "and go get a letter from your PCP referring you to a psychiatrist, I'll need that before I can prescribe anything."

 

[Jules A]

Yes plan on it. I’m already moving all tele health patients to be seen 1x in person.

Good idea. I don’t have too many but only do one day on-site so best to get started now.

 

[Jules A]

I already require people I am going to prescribe stimulants to to make an appointment for a dedicated ADHD eval with me and even if I think they have ADHD, require that they identify objective benchmarks for treatment before I write the script anyway. not so hard to add in "and go get a letter from your PCP referring you to a psychiatrist, I'll need that before I can prescribe anything."

How are you determining this before their initial evaluation? I get a fair number of kids who have been seen and diagnosed with ADHD by a psychologist so I often get that report with their intake docs prior to eval. Those are generally the only ones I have advance knowledge as to what medication they will likely require.

 

[clausewitz2]

How are you determining this before their initial evaluation? I get a fair number of kids who have been seen and diagnosed with ADHD by a psychologist so I often get that report with their intake docs prior to eval. Those are generally the only ones I have advance knowledge as to what medication they will likely require.

I don't, if at initial eval ADHD comes up as a possible diagnosis I schedule them for a subsequent 60 minute appointment for me to do a semi-structured interview. Not the most efficient revenue wise but the kind of flexibility I went into private practice for.

 

[smalltownpsych]

To be honest, kind of glad that there is some pushback against telemedicine. I use it occasionally for established clients but since it is not as effective as in-person and my patients lives and quality of life are extremely important to me, not a big fan of a reduced dose of treatment.

 

[littlefred]

To be honest, kind of glad that there is some pushback against telemedicine. I use it occasionally for established clients but since it is not as effective as in-person and my patients lives and quality of life are extremely important to me, not a big fan of a reduced dose of treatment.

I have done both telehealth and in-person (of course). I believe there is a lot lost using telehealth platforms (structure, respect to providers and their time... like patients smoking/drinking/driving/working on their house or car while doing telehealth appointments was rather common etc)
The selling point of it being convenient and expanding services for people that wouldn't get services feels overstretched to me...

I could list many metaphors about why telehealth is inadequate but you get my drift.

 

[Stagg737]

This is going to be a nightmare for my clinic and I will likely just stop prescribing controlled substances all together. A not insignificant number of patients I see (patients 6+ hours away with nearest psychiatrist being 3+ hours away) end up being patients with ADHD for most of their lives who were never treated who have benefited significantly from starting low doses of stimulants. I'm talking patients now holding down jobs and and improved home interactions with children after starting, not "man I feel so much better with Adderall!" So basically I'm going to have to see them, have them see their PCP in-person again for a specific referral, then see them again just to trial a stimulant?

I've been in the process of transferring many patients back to PCP anyway from the previous docs who ran this clinic ran it more like a continuity clinic (which it was never meant to be), but for patients I've been continuing to see to stabilize further before sending back to PCP this may just expedite the process.

 

[calvnandhobbs68]

This is going to be a nightmare for my clinic and I will likely just stop prescribing controlled substances all together. A not insignificant number of patients I see (patients 6+ hours away with nearest psychiatrist being 3+ hours away) end up being patients with ADHD for most of their lives who were never treated who have benefited significantly from starting low doses of stimulants. I'm talking patients now holding down jobs and and improved home interactions with children after starting, not "man I feel so much better with Adderall!" So basically I'm going to have to see them, have them see their PCP in-person again for a specific referral, then see them again just to trial a stimulant?

I've been in the process of transferring many patients back to PCP anyway from the previous docs who ran this clinic ran it more like a continuity clinic (which it was never meant to be), but for patients I've been continuing to see to stabilize further before sending back to PCP this may just expedite the process.

Yeah I could see that being the easiest way to approach this if you have a bunch of stableish ADHD patients. Coordinate with the PCPs a bit, basically tell them you're sending the patients back to them but if they want to re-refer to you, they can do that if they've seen the patient in person and can document a specific referral back to you. You should be cleared at that point then cause they've had the in person exam.

 

[milesed]

It looks like there are some changes being proposed- What the latest DEA Proposed Rule Means for Telemedicine Prescribing of Controlled Substances — Nixon Gwilt Law