Recent government actions enable telepsychiatry
To our Fellow Healthcare Providers:
We realize that the world of mental healthcare is shifting rapidly due to SARS-CoV-2 and COVID-19 (the former is the name of the virus and the latter is the disease it causes). It is likely that the pandemic will have a significant effect on mental illness patients and on their families, caretakers, and providers. For those who are mentally healthy, there will be enormous stressors, and some people will be tipped into frank mental illness. It is too early in the epidemic to know the full effect on mental health and wellness in the U.S., but it is clear that the delivery of mental healthcare is changing rapidly to electronic means of delivery, commonly known as telepsychiatry. Telepsychiatry can be delivered synchronously (meaning real time communication with a provider) but also can be delivered asynchronously, for example via chat with a therapist.
Telepsychiatry’s evidence base is ample, and outcomes have been measured in the following areas: feasibility, validity, reliability, satisfaction, costs, and clinical outcomes. The American Psychiatric Association notes that “With a robust evidence base that shows telepsychiatry leading to improved outcomes and higher patient satisfaction ratings, policy makers, payers and providers are increasingly considering ways to implement and use telepsychiatry”. To this end, the APA provides substantial resources for its members in the form of a Telepsychiatry Toolkit.
Recently, a daily newsletter called “Simple and Practical” published a webinar featuring Dr. Peter Yellowlees, Past President of the American Telehealth Association. Dr. Yellowlees is a pioneer in the delivery of telemedicine, which he has been practicing for 30 years. He provides many helpful insights into the delivery of telepsychiatry.
Recent Government Actions
Until now, Medicare would only pay for telemedicine care for established patients, meaning a patient who has been seen at least once by that clinician, and in certain situations, e.g., for patients living in rural areas. The Centers for Medicare & Medicaid Services (CMS) has specifically said that during the emergency, it will NOT enforce the previous "established relationship" requirement for telemedicine. Also, patients had to travel to a local medical facility to get telehealth services and could not receive telehealth services in their homes. But, during the COVID-19 crisis, Medicare will temporarily pay for telehealth services for patients without requiring them to travel to a healthcare facility.
The CMS website notes: "A range of healthcare providers, such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers, will be able to offer telehealth to Medicare beneficiaries. Beneficiaries will be able to receive telehealth services in any healthcare facility including a physician’s office, hospital, nursing home or rural health clinic, as well as from their homes." Under this new waiver, Medicare can pay for office, hospital, and other visits furnished via telehealth across the country and including in patient’s places of residence starting March 6, 2020.
A list of billable codes for telepsychiatry is available from Genomind Customer Service at 877-895-8568.
Also, during the current Public Health Emergency, HHS has waived certain HIPAA sanctions and penalties against a covered hospital that does not comply with certain aspects of the HIPAA Privacy Rule.
Secretary of Health and Human Services (HHS) Alex Azar issued a Modification of Requirements Under Section 1135 of the Social Security Act that waives or modifies certain health care laws and regulations in connection with the COVID-19 pandemic. This “1135 Waiver” applies nationwide and took effect on March 15 at 6:00 p.m., but its applicability is retroactive to March 1, 2020. The 1135 Waiver applies for a period of 60 days (subject to extension by the Secretary for successive 60-day periods) or for the duration of the COVID-19 national emergency (if earlier), except the waiver of the HIPAA Privacy Rule described below applies for only 72 hours following a hospital’s implementation of its disaster protocol. Importantly for telemedicine, HHS and CMS waived requirements that physicians and other health care professionals hold licenses in the State in which they provide services, if they have an equivalent license from another State (and are not affirmatively barred from practice in that State or any State a part of which is included in the emergency area).
Genomind Can Help
One of the limitations of telepsychiatry is the inability to perform a buccal swab for pharmacogenetics (PGx) testing in the provider’s office. Now more than ever, it is important to select medicines that are most likely to be well tolerated and effective. Testing with Genomind’s PGx product was shown to decrease costs and save precious resources, which are currently in short supply.
To help you provide precision medicine for your patients, Genomind has initiated Express Ship-to Patient service. Upon a provider’s order, we will ship a Genomind Professional PGx Express™ kit directly to the patient. Patient DNA is obtained via a fast and painless buccal swab, and results are returned to you within 3 business days of receipt in our lab. Genomind will absorb the shipping costs in both directions. This service will greatly facilitate our customers’ ability to deliver valuable insights via telepsychiatry. As ever, Genomind provides complementary PGx consults with its in-house team of PharmDs and PhDs, whose full-time job is pharmacogenomics. Consults may be scheduled on your Genomind Portal and are also obtainable on-demand.
In order to use the Express Ship-to-Patient option, you will need a Clinician Portal login if you don't have one already. Download instructions are included in a clickable PDF here.
How to Get Started with a Telepsych Platform
There are many Telepsych platforms available today, but you very likely already have access to some free platforms. These include:
- Facetime for anyone using Apple iPhones/iPads
- Google Hangouts for anyone with a Gmail account or Android phone
- Skype is a teleconference app that can be used on your desktop, laptop or smartphone. You can create a free account and make free domestic calls. https://www.skype.com/en/get-skype/
- ZOOM is a teleconferencing app that can be used on your desktop, laptop or smartphone. You can create a free account or upgrade to a paid package. https://zoom.us/pricing
*Genomind does not endorse any of these platforms but would like to identify some options to enable Telepsychiatry. The Genomind Medical Affairs team is available to help you setup these platforms for your practice. They can be reached at Consultrequest@genomind.com.
Genomind is here to help.
For more information, contact customer service at 877-895-8658 and email us at the link below.
Daniel Dowd PharmD David S Krause MD