Telehealth is defined as the use of electronic information and telecommunication technologies to provide care when the patient/client and the doctor or other medical provider aren’t in the same place at the same time. Telehealth has been evolving over the past half century, and its efficacy has been shown in many areas of medical care including psychiatry and psychology. Both the American Psychiatric Association and the American Psychological Association have provided guidelines and guidance for their members in providing care via telehealth. Yet, telehealth was used minimally in Indiana until March of this year when COVID-19 put a pause on in-person appointments except for the most critical health and mental health concerns.
There were several factors that limited the use of telehealth prior to COVID-19. The first, and perhaps biggest barrier to the widespread use of telehealth, was the fact that most insurance carriers did not reimburse their members for telehealth services. That barrier was overcome through emergency orders at the state and federal levels to permit telehealth and for insurance payers to reimburse telehealth services at the same rate as in-person services. It is anticipated that insurance coverage for telehealth services will decrease once the pandemic is over.
A second barrier to the widespread use of telemedicine was reticence by both medical providers and patients to attempt to use technology for medical care. The reality of COVID-19 has pushed all of us to develop comfort in the use of technology that we could not imagine prior to the pandemic. Most of us have remained connected to our friends and family through FaceTime, Zoom or other videoconference platforms. We have learned to access our medical providers, insurance companies, and other businesses through these platforms as well. Even for those who are not digital natives, use of technology has become increasingly more comfortable. We anticipate that patients/clients will continue to be comfortable with and desire the ability to use telemedicine for some of their health care needs even after the pandemic subsides.
A third barrier for psychologists has been licensing issues. Psychologists are licensed by state boards and the licenses do not generally allow practice across state lines. Most governors relaxed those regulations for their states when the COVID-19 restrictions were put in place in March 2020. This has allowed psychologists in Indiana to continue to see their patients who are located in other states. However, it is anticipated that that state regulations that allow psychologist to practice across state lines will be limited after the pandemic is past. Indiana is in the process of proposing legislation to join PSYPACT, the Psychology Interjurisdictional Compact. PSYPACT is an interstate agreement that allows psychologists to practice telepsychology or offer in-person services across participating state boundaries without having to get licensed in other states. The goal of the compact is to reduce regulatory barriers and increase access to mental health care. While this process may take several years to enact in Indiana, it will allow patients/clients to continue mental health care with their established mental health provider when they are relocated or on vacation.
Overall, our experience with telehealth at CRG has been a positive one. There have been some real benefits of conducting therapy and medication management sessions via telehealth that go beyond the social distancing mandates during COVID-19. We have found that it is easier to get multiple family members together for sessions, with parents and spouses able to join remotely. It is often more comfortable for some of our patients to be in their own environments. We have been able to meet pets, see children’s bedrooms and toys, and meet extended family members. Families do not need to take a half day or full day off for an appointment. And traffic on I-465 does not cause stress in arriving on time for appointments. Once we are on the other side of the pandemic, we anticipate continuing to offer telehealth to our patients as determined appropriate by each provider and patient. However, the issue of insurance reimbursement will likely need to be investigated by each family and may require advocacy by patients in order to see change in reimbursement patterns.