telepsychiatry

[randomdoc1]

So, in the process of taking that leap of starting my own gig and tele psychiatry is looking more appealing to incorporate. It'll allow me to expand my potential patients to more rural areas. Does anyone have experience with this?
1) How was the process in negotiating rates with insurance panels to get this approved, especially Medicare?
2) Anyone have any recommendations on the best platforms/softwares? I was looking at Mend, it looks great but a common theme in the reviews is that there can be a lag/echo. However, this does not seem specific to Mend. Even in the VA system, I hear there is a lag. Or does anyone know of any platforms that run more smoothly? Everyone says that Skype is great but I'm not sure about the HIPAA compliance.
3) What if the patient is on an antipsychotic? How exactly do you do an AIMS? Apparently other specialties, including primary care manage somehow, so there's probably a way to figure this out.

While getting my plan ready for my own practice, I've already potentially recruited a psychiatrist to join me, and one who I am very confident in, thanks to the possibility of tele psychiatry. He's out in a neighboring state but we trained in residency together.

---

Members don't see this ad.

 

[PistolPete]

Following

 

[randomdoc1]

I just hear crickets...lol

 

[splik]

1. this will be state dependent. in my state insurance companies have to pay the same for telemedicine as for in person visits. more states are passing such legislation. medicare will not pay for telepsychiatry to patient's homes. they have to be at a clinic or something at the other end and they also place other limits on what geographical locations they will cover patients in. see: HRSA - Medicare Telehealth Payment Eligibility Analyzer
2. the platforms you use have little to no effect on the quality of the connection, which is related to the quality of the connection. if they are in the middle of nowhere then the quality is likely to be poorer. I use Zoom and Jabber. Both are fine. I use Zoom to do evaluations out of state and in patients' homes. if you are going to do "home visits" with telepsych then you need to very carefully screen patients to make sure they are appropriate. in my case, I do the initial eval in person and would require periodic in person evaluations, but as I cant cope with seeing pts i try to avoid establishing a dr-pt relationship. i use Jabber to do evaluations across town. I've also used Jabber in corrections. both are reasonable. Telemedicine Solution - Simple, Free, and Secure | Doxy.me also seems popular but i havent used it. Skype is not secure and so should not be used for telepsychiatry unless you have an exclusively cash only practice (where HIPAA does not apply).
3. you dont need to touch a patient to do an AIMS. i'm not sure what your question is, you'd observe the patient the same way you would normally! as long as you are able to see the whole patients you can do an AIMS.

 

[TexasPhysician]

Not legal in my state without assigned sites. Initial visit must be F2F or at designated staffed sites.

Lag issues are a problem. Quality is not as good. My patients prefer F2F. Telepsych is more of an add-on in outpatient for select patients.