COVID-19 brings new sense of urgency to supporting telepsych with permanent reforms
Winston Churchill famously said, “Never let a good crisis go to waste.” While there is certainly nothing good about the coronavirus pandemic, it has catalyzed the transformation of how we care for those with mental illness and substance use disorders.
The concerns of this patient population during the crisis are unique. According to a recent study from Yale University, those with behavioral health issues fear not being able to manage their condition due to the disruption of services, running out of medication, and social isolation. They also worry about contracting COVID-19, losing income and affording testing or treatment. Such stressors may contribute to worsening symptoms of underlying addiction or mental illness.
Fortunately, much of psychiatric care can be delivered remotely and the behavioral health field had decades of experience with telemedicine when COVID-19 struck. The regulatory changes in response to the crisis have accelerated hospitals’ and health systems’ adoption of telemedicine nationwide. This has allowed patients to receive the care they need, when they need it, in the most appropriate setting for the times.
Hundreds of CMS waivers now provide essential and much-needed flexibility to conduct and, importantly, to receive reimbursement for virtual visits with patients in a wider range of settings and geographies. Additional changes through the U.S. Drug Enforcement Administration allow psychiatrists (for the first time) to use telemedicine to prescribe controlled substances for patients with substance use disorders.
The result has been a dramatic transformation of psychiatric care in just the past few months. Across the nation, more than 95% of ambulatory psychiatry is now delivered virtually. A majority of consults and emergency room and inpatient care visits are now facilitated by video interviews to reduce the risk of exposure for physicians and others, wherever possible.
These developments are good news for health systems in urban Appalachia like Carilion Clinic that are still dealing with the opioid epidemic. What we began three years ago as a pilot program to extend mental health and substance abuse treatment to our rural family medicine practices has blossomed into a full-fledged telepsychiatry program.
We now see all psychiatric patients— from pediatric to elderly—across our footprint via telemedicine, with providers and patients reporting high levels of satisfaction. Nearly all addiction treatment is delivered virtually, and we are prescribing electronically after video or telephone visits. A new Recovery Support Line and online peer support groups provide additional guidance, and we are working to implement virtual group psychotherapy, which is critical for many patients.
Despite steep declines in overall volume in other parts of our health system, psychiatry visits are up simply because many of the barriers patients previously faced getting to their appointments, such as arranging childcare and transportation, no longer exist.
Health systems face fewer barriers to delivering care, as well. With the CMS waivers in place, we’re able to bill for services conducted via telehealth by a broad range of providers. Most of our appointments are by telephone, however, because many of our patients have limited access to computers or smartphones and broadband technology.
With regulatory barriers removed, we have made significant progress. Now that the telemedicine genie is out of the bottle, we must make lasting policy changes to improve access and deliver better care for the growing number of patients who need it. We hope CMS will adopt the current waivers as part of a comprehensive overhaul to reflect the need for healthcare that serves people in the most appropriate setting, including their homes.
While the pandemic has exposed many vulnerabilities in the U.S., it has also shown how we can collaborate in new ways to support one another, something that might not have happened had it not been asked of us. So, I am hopeful for our future. I am confident that we will emerge—both as a nation and as a field—smarter, better and stronger.