Telebehavioral Care Must Be Where The Patient Is – Everywhere

By: Geoffrey Boyce

Telehealth’s adoption has skyrocketed over the course of the pandemic. Although telehealth was a lifeline for many and filled in the gaps in our healthcare system, you cannot help but wonder where do we go from here? Despite its accelerated adoption, will telehealth have the same staying power after the public health emergency ends? The evidence and anecdotes point to a resounding ‘yes,’ especially when it comes to behavioral care.

Over the past 13 years in the industry, I’ve witnessed firsthand how telehealth has transformed the delivery of behavioral care. Research has long proven that telebehavioral care is just as effective as in-person care and checks out with higher retention rates. The COVID-19 crisis created an opportunity for telehealth to demonstrate its value without some of the traditional challenges that once limited its widespread adoption.

In early 2020, many laws and regulations were either temporarily instituted or suspended to promote, encourage, and legalize virtual treatment for behavioral health conditions. HIPAA flexibilities, 1135 waivers, and interstate allowances rolled out so that people could continue with their behavioral care provider, or pick up a new one, amid worsening mental health conditions nationwide. Even the DEA temporarily lifted multi-state registrations and the Ryan Haight Act fell under an exemption, which allowed psychiatrists and other prescribers  to issue controlled substance medications without the usual requirement of seeing them in person – critical for both child psychiatry and addiction medicine.

The temporary telehealth allowances focused on making sure that patients could be seen at home. That is why industry groups, such as the American Telemedicine Association, are advocating at the federal and state levels to keep and expand these laws. Nearly 75% of providers say that no or low reimbursements would hinder them from offering telehealth after the pandemic if the current expansions do not remain.

Yet as waivers expire, and we emerge from home with a new location-agnostic reality, we must realize that telebehavioral care’s place has to be where the patient is — everywhere. Telebehavioral care’s place is in the home, the hospital, the PCP’s office, the community clinic and more. To truly serve patients’ mental health needs, telehealth regulation must support care across the now-expanded continuum.

The story of one New Jersey mother illustrates the need for expanded access to telebehavioral care. Despite having at-home virtual care and medication for her adolescent son struggling with autism spectrum disorder and suicidal tendencies, this mother ended up in an emergency department to save her son from suicide twice.

The first time, she and her son waited for days in an emergency bed for her son to be seen by a social worker, not a psychiatrist — a common occurrence as hospitals shoulder the burden of the nationwide mental health crisis amid a shortage of behavioral care professionals. On the mother-son pair’s second visit, the hospital had implemented a telepsychiatry program that allowed her son to be seen in just a matter of hours by a psychiatrist who evaluated him and sent him home with a concrete treatment plan and next steps.

The second visit was made possible by legislation that allowed for the psychiatrist to see the patient virtually along with the appropriate authority to make the right placement decision, while also requiring reimbursement for that care. These hospital EDs are just one setting in need of behavioral care support. Data shows that one out of every four primary care visits in the U.S. are for mental health conditions. FQHCs regularly serve populations with higher incidences of behavioral care needs. In short, pro-telehealth legislation does not just expand patients’ access to behavioral care clinicians, it expands other providers’ access too.

Telehealth is a lifeline for so many of the patients that are often left behind by our healthcare system. It is crucial to extend the telehealth-friendly regulations well after the COVID-19 crisis has passed so that there can be broader, timelier, and more convenient access to the scarce resource of behavioral care. Ensuring that physicians, psychiatrists, clinics, hospitals, and other healthcare providers offering telehealth continue to be paid and allowed to practice virtually is one of the ways that our industry protects telehealth’s future and secures a permanent place for the vitally important behavioral care Americans need — wherever and however they need it.

 

Geoffrey Boyce
CEO, Array Behavioral Care

Geoffrey Boyce is the CEO of Array Behavioral Care, the leading telepsychiatry service provider in the United States with a mission to transform access to quality behavioral care. Boyce is a leader in telemedicine advocacy, education, and reform initiatives. He serves as a national voice promoting telemedicine and telepsychiatry and regularly interacts with state and local healthcare regulators and administrators. In 2017, he received the Industry Leader Award from the American Telemedicine Association and is currently an active participant in several ATA Special Interest Groups and Workgroups including: the Telemental Health SIG and the controlled substances prescribing and telehealth workgroup. He also serves on the advisory board of directors for the Mid-Atlantic Telehealth Resource Center (MATRC). In 2018, he was appointed to the New Jersey Telehealth Review Commission. Boyce frequently speaks about the potential of telemedicine and the best practices for establishing new programs.

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If you are in crisis, call the National Suicide Prevention Lifeline, a free, 24-hour hotline at 1.800.273.8255. If your issue is an emergency, call 911 or go to your nearest emergency room.