Clinicians who use telemental health services must be able to determine when it is appropriate to use remote technologies and when face-to-face encounters are needed. If a patient complains of physical discomfort, such as chest pain, the practitioner must understand that an in-person physical examination is necessary. One study of 32 cases found that telephone communication was a root cause of catastrophic medical outcomes and malpractice settlements amounting to more than $12 million (Agboola & Kvedar, 2016). Before beginning telemental health services, practitioners should first review the client’s history, potential risks, available technologies, and comfort with using technology. If individuals are not appropriate for telemental health services, clinicians should provide or refer clients to alternative options, such as face-to-face sessions.
Telemental health services offer convenience to the patient, but they also present challenges in the continuity of care and the patient–practitioner relationship (Daniel & Sulmasy, 2015). For example, if telemental health services are used for single crisis incidents or consultations, members of the regular healthcare team may not have knowledge of the telemental health visits, prescriptions that may have been written, or recommendations for follow-up. One avenue for practitioners is to offer integrated healthcare options that include telemental health consultations and visits in addition to face-to-face availability. Telemental health visits can be offered during after-hours times to increase convenience and client access. Practitioners reinforce the importance of ongoing relationships with their clients by offering the convenience of different modalities and tools for treatment.
CHALLENGES
In one study of telemental health programs in the U.S., Lauckner and Whitten (2016) interviewed 33 telemental health program administrators, 27 of whom were still operating. Among those whose telemental health programs were discontinued, the administrators revealed several reasons that particular telemental health programs were discontinued. ● They were not intended to be a long-term project. ● The agency ran out of funding. ● The needs of the on-site clinic changed. Administrators offered the following explanations for telemental health programs that were successful. ● There was a high demand for the services and high patient enrollment. ● There were good relationships between providers, administrators, and rural health workers. ● There was strong community integration and support. When asked what they needed to continue, the interviewees responded that they needed more funding, expanded offerings or telehealth uses, extra staff with more training, and improved or extended technology. Funding Issues Agency administrators and practitioners can be faced with many challenges when providing telemental health services. A common hurdle is funding. Programs often secure startup money through grants, but reimbursement issues are barriers to sustainability (Lambert et al., 2016; Lauckner & Whitten, 2016; Lustgarten, 2017). Some third-party payers have historically not reimbursed for telemental health services or have been inconsistent about reimbursement (Lerman & Quashie, 2016; Lambert et al., 2016; Lauckner & Whitten, 2016). Originating sites incur costs, including Clinical Issues Some providers of telemental health services complain of the high number of clients who miss their appointments. Similar to traditional face-to-face sessions, managing client no-shows is a challenge that impacts not only the therapeutic process but also the financial sustainability of services (Lambert et al., 2016). Examples specific to telemental health include some telemental health vendors selling access to telemental health equipment to psychiatrists and other behavioral health providers on an hourly basis; when clients do not attend appointments, the providers may still have to pay the telemental health vendor for the use of the service. In addition, if clients have unpaid balances, the providers still must pay the vendors. Equipment maintenance is another issue that must be clarified between vendors and service providers. Therefore, it can be essential to discuss no-show payment policies
equipment, broadband access, use of space, and staff time to help clients get set up, compared to distant sites, where the provider is located, which can bill for services (Lambert et al., 2016). It is unclear how exceptions for telemental health during the COVID-19 pandemic will generalize in the future; however, it does appear that many of the overhead costs will remain reduced due to the increase in available, cost-effective avenues for providing HIPAA-compliant telemental health. Currently, Medicare reimburses live video services. Audio-only services are currently covered by Medicare as well; however, these provisions are based on changes made during the COVID-19 pandemic, and it is unclear if these provisions will be permanent. Medicaid coverage varies by state, but most provisions align with Medicare practices. It is important to note that for private insurance, some reimbursement standards vary based on permanent telehealth policies versus temporary COVID-19 reimbursement policies (Billing for Telebehavioral Health). Regulatory oversight for telemental health reimbursement is established by each state. Twenty-four states and the District of Columbia have enacted laws that mandate coverage of telemental health services by private health insurance companies (Lambert et al., 2016). Similarly, facility fee payments also vary by state. Unfortunately, there is not uniform coverage across health plans, including Medicare and Medicaid. Often, the reimbursement rates from federal, state, and private payers do not cover the full cost of telemental health services (Lauckner & Whitten, 2016; Lambert et al., 2016). Some states have started to allow telemental health practice across state lines, for example, through the Psychology Interjurisdictional Compact. when individuals consent to telemental health services (so that they are aware that they will have to pay for the session, even if they miss it, to cover the costs associated with the session if that is the case). Some clinicians report discomfort using telemental health technology (Lambert et al., 2016). Some report concerns that it is more difficult to establish and maintain client rapport over video compared with face-to-face treatment (Lerman & Quashie, 2016). Some clinicians report that it is difficult to balance practice schedules with a telemental health schedule (Lerman & Quashie, 2016; Lambert et al., 2016). They report a lack of time for preparation and establishment of routine services (Martin-Khan et al., 2015). In addition, some agencies may lack the additional staffing needed to support telemental health services (Lauckner & Whitten, 2016). To address these issues and to ensure that
EliteLearning.com/Social-Work
Book Code: SWFL1825
Page 135
Powered by FlippingBook