There were nice posts this weekend on Steve Daviss’s blog and ShrinkRap regarding the new regulations in Maryland for doing telepsychiatry with patients in the public mental health system. (The state calls this “Telemental Health,” which seems like an odd word to use given that I think “Telepsychiatry” is used by most other people.)
We’ve had a lot of snow for Maryland this year, and getting around has been a challenge.
Dr Daviss points out that the current regulations would preclude him using telepsychiatry from his home to an inpatient unit and billing Medicaid, primarily because the regulations are totally focused on institution to institution situations where each site is basically a mental health facility or a medical facility, not where either the doctor or the patient is at home.
It’s like Maryland has just caught up to the fact that videoconferencing software exists after it’s been around for decades, but totally ignores the reality that lots of people have access to something like Skype. Hello! It’s the 21st century now. I’m aware that the public mental health system has a lot of economically disadvantaged people in it and that not all of them have Skype at home. However, I’m sure that some do because having a computer is a lot like having a car these days; it’s pretty hard for most people to live without one, even if you’re poor. Yeah, some people in the public mental health system don’t have telephones either, but the majority do.
There is also a “degree of separation” issue going on here. Although I’ve certainly met people who didn’t know exactly what Skype is, I haven’t met very many who don’t know someone in their family who uses it. I suspect that there are plenty of people in the public mental health system who could get some kind of access to Skype if they really wanted to, and if it could save them a long bus trip to a clinic in the inner city, why shouldn’t they be able to do that? If you think about it for a second, giving someone a $30 webcam to use with their computer at home is really nothing. If they get a blood test for screening or a medication level, that costs more than a webcam. Even in the public mental health system I haven’t heard of anyone being begrudged a basic metabolic panel.
I could speculate on whether this would help the no show rate in public mental health clinics (usually astronomically high), but I don’t know if it would really make a difference there.
The situation Dr. Daviss talks about is very striking. Here, he’s got Skype (or something like it, I assume) at home. Why shouldn’t he be able to Skype in to an inpatient unit and do his examinations? I can’t think of any good reason why he shouldn’t.
A few years ago I was one of two attendings on the inpatient service during a blizzard, and ending up being snowed for the weekend at the hospital. I did a little psychiatry, but a lot of paperwork because other doctors couldn’t get in and I was stuck there anyway. The normal contingent of attendings on the weekend was five, so having only two there stretched things pretty thin. The drag wasn’t really being stuck in the hospital or taking care of sick people, it was doing boatloads of routine paperwork so the hospital could get paid from payers like Medicaid.
It was a weekend, so I was covering for other people, and didn’t know any of the patients. It’s hard for me to think that my care of most of the patients in the hospital was better than it would have been if the attending responsible for the ward that month would have been able to Skype in, take care of the routine stuff for the patients he or she already knew, and leave the real emergencies to me.
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