Telepsychiatry

[Yellow mellow]

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How difficult is it to start your own telepsychiatry from home ? I’m getting out of government psychiatry and just need to have some independence.

 

[dl2dp2]

It's easy to set up. The hard part is recruiting patients. How do you plan to market your practice? Do you plan to compete with 100000000 of NP practices who are advertising on instagram *right now* nonstop to write you stimulants for $20 a pop?

I actually think the key toward independence is exactly the OPPOSITE of telepsychiatry. Telepsychiatry is one of those things that large systems will easily be able to build out and scale very quickly and turn into the mcdonalds of mental health. Why should they hire you when they can hire some random person anywhere in the country and pay half as much? Why would a lower-middle-class patient pay cash for you vs. a nurse practitioner when they can't even tell who is who?

However, no large facility will be able to replicate the intimate one person one office experience. That will stay and thrive. In fact, I think that'll get MORE expensive. In-person care will become even more of a luxury item. Coupling that with new toys, i.e. injections, office based meds (Spravato), TMS, etc.

 

[Bartelby]

Interesting thoughts sluox. I think telepsychiatry would have a great niche as a convenience for in-person patients (making a mix for some sessions) but agree in PP directly finding telepsych patients seems potentially more difficult.

If you are really committed to telepsych from home some companies offer such positions, bit as discussed in another thread seem to take a very generous chunk of earnings given the low overhead.

 

[littlefred]

Do you plan to compete with 100000000 of NP practices who are advertising on instagram *right now* nonstop to write you stimulants for $20 a pop?

I thought that the Ryan Haight act prevented prescription of scheduled drugs without a face to face meeting?

I know that during the coronavirus pandemic this requirement has been waivered for buprenorphine (wouldn't know about other scheduled drugs)... I wonder if the waiver will continue indefinitely, then inevitably bad outcomes will happen and then new more strict regulations will be put in place.

 

[dl2dp2]

I thought that the Ryan Haight act prevented prescription of scheduled drugs without a face to face meeting?

I know that during the coronavirus pandemic this requirement has been waivered for buprenorphine (wouldn't know about other scheduled drugs)... I wonder if the waiver will continue indefinitely, then inevitably bad outcomes will happen and then new more strict regulations will be put in place.

R-H is suspended categorically by COVID!!

 

[littlefred]

R-H is suspended categorically by COVID!!

Right, but your original quote is misleading. No NP "tele" pill-mill was able to prescribe stimulants at "$20 a pop" without circumventing this law in the past, unless these pill-mills cropped up in the past month?

 

[dl2dp2]

Right, but your original quote is misleading. No NP "tele" pill-mill was able to prescribe stimulants at "$20 a pop" without circumventing this law in the past, unless these pill-mills cropped up in the past month?

*Many* cropped up in the last month on my Instagram.

 

[nrmp]

Are you guys still doing tele-medicine or has started office back to normal? What are your thoughts?

 

[liquidshadow22]

R-H is suspended categorically by COVID!!

are there any cases of physicians being reprimanded for prescribing controlled substances without an in person visit?

This seems like a very difficult thing to actually review especially for a cash practice. There would need to be someone auditing your clinic visit notes to see if the visit was in person. Obviously if you are prescribing in a far away state, it would be obvious but I don't see how this could be tracked if prescribing through telemedicine in the same state.

 

[dl2dp2]

Look, if I'm doing someone's telemedicine med management intake and he is on heroin and wants to be on Suboxone, or is detoxing off alcohol and needs to be on Klonopin, does R-H matter? Does being "reprimanded" matter?

Your jobs is to be a good doctor and, in these cases, actually save some lives. Worry about this first, and then worry about regulations. If anyone ever "reprimands" you, you can keep your shoulders back and head up in a deposition or the witness stand--or in front of Congress.

 

[TexasPhysician]

are there any cases of physicians being reprimanded for prescribing controlled substances without an in person visit?

yes

 

[liquidshadow22]

yes

Can you expand on this by any chance or have any sources?

 

[TexasPhysician]

Can you expand on this by any chance or have any sources?

It’s easier than you think. Patients or family members can report you after a bad outcome. Phones have gps now to help prove locations. Telehealth apps log your time. Your scheduler saves patient slots.

A friend of mine had her X license permanently revoked and extra CME hours were added to ensure it doesn’t happen again.

There is a federal law against this. Do it routinely, have a bad outcome, and you risk federal charges.

 

[calvnandhobbs68]

Look, if I'm doing someone's telemedicine med management intake and he is on heroin and wants to be on Suboxone, or is detoxing off alcohol and needs to be on Klonopin, does R-H matter? Does being "reprimanded" matter?

Your jobs is to be a good doctor and, in these cases, actually save some lives. Worry about this first, and then worry about regulations. If anyone ever "reprimands" you, you can keep your shoulders back and head up in a deposition or the witness stand--or in front of Congress.

Eh I much prefer my suboxone intakes to be in person anyway but that's just me. Do almost all home inductions and I like to make sure they really understand the instructions for home induction. Telepsych for me so far has had too many stupid variables (poor connections, crappy audio/video, cutting out mid visit and having to reconnect) that make it difficult to give good anticipatory guidance. Also impossible to do a real physical exam and vitals which you're supposed to be doing for all inductions (ex. might miss the giant infected injection site on their forearm that you need to tell them to go to the ED to address first).

@TexasPhysician has it right that there are very clear laws against this that are gonna be difficult to defend against when RH gets reinstated.

I agree with you though sluox, I think telepsych is gonna become the McDonalds of psychiatry. I have patients already asking me when we're going back to in person appointments, I honestly think at least half the patients much prefer in-person visits. Had a C+A intake ask me how I could diagnose their child accurately without seeing him in person. Especially private pay patients start asking themselves whey they're paying all this money to talk to someone on Zoom.

 

[liquidshadow22]

It’s easier than you think. Patients or family members can report you after a bad outcome. Phones have gps now to help prove locations. Telehealth apps log your time. Your scheduler saves patient slots.

A friend of mine had her X license permanently revoked and extra CME hours were added to ensure it doesn’t happen again.

There is a federal law against this. Do it routinely, have a bad outcome, and you risk federal charges.

Xlicense was revoked simply for prescribing a controlled substance through telemedicine? There was no other foul play?

 

[TexasPhysician]

Xlicense was revoked simply for prescribing a controlled substance through telemedicine? There was no other foul play?

No other issues.

 

[Sushirolls]

Speaking of RH Act. Any word as to if/when its suspension will be back in force?

 

[liquidshadow22]

No other issues.

That's ridiculous. The legal system is absurd. Mind saying how in this case it came to light?

 

[birchswing]

Have you all had any change in impression/diagnosis seeing patients via telehealth vs. in-person?

I had a tele-health appt with my PCP and I think he was a bit taken aback to see me calm and collected, which I am definitely not when I leave the house and by the time I get into a doctor's office. The appointment went so much easier. Of course, there are limits to what you can do via telehealth. Maybe one day we'll have in home robot surgeons, hehe. Psychiatry is probably one of the better suited for telehealth. Teledentistry doesn't work so well.

 

[cookymonster]

Reviving this thread to ask: as someone thinking of trying telepsych, can anyone share which telepsych companies they've had good experiences with? and which ones have not been good?

There are a whole slew of them when I do a random google search and I'm not sure how I would start besides cold calling 3 or 4 of them and sending them my CV. I haven't seen specific companies discussed when I searched the forum.

 

[liquidshadow22]

Teladoc rates seem decent.. Anyone have experience with them?

 

[the5thelement]

Teladoc rates seem decent.. Anyone have experience with them?

No personal experience but plenty of bad reviews online.

 

[Yoyomama88]

No personal experience but plenty of bad reviews online.

From psychiatrists?