Frequently Asked Questions
Q: What is telepsychiatry?A: It is the use of two-way, real time, interactive audio and video to provide and support psychiatric care when distance separates the provider and the patient.
Q: Why is there a need for telepsychiatry?A: Over the past twenty years there has been staggering growth in the demand for all types of healthcare services, especially in behavioral health evaluation and medication management, resulting in a shortage of qualified practitioners to provide the needed services. Geographically, there is an imbalance between need and available services; some communities are over-represented, other communities suffer without an available pool of professional staff to provide the services that are desperately needed.
A 2006 report by the American Medical Association (AMA) found that the supply of U.S. psychiatrists shrank 27 percent between 1990 and 2002 yet physician staffing industry data indicate that demand increased by 16 percent over that same time period. At the same time, the aging of the psychiatrist population is also negatively impacting access. Almost half (46%) of the more than 40,000 U.S. psychiatrists are 55 years or older, compared to approximately 35% of all U.S. physicians, according to the AMA.
Q: What does the research say about telepsychiatry?A: The following are excerpts from select articles:
An Article in Psychiatric Services (June 2007, 58:836-843) stated: Psychiatric consultation and short-term follow-up can be as effective when delivered by telepsychiatry as when provided face to face.
Steven E. Hyler, M.D., and Dinu P. Gangure, M.D., reviewed 12 studies published since 1995 on the costs of telepsychiatry projects implemented in the United States and other countries and concluded that seven of the 12 studies showed that telepsychiatry is financially viable in selected settings. (July 2003 Psychiatric Services 54:976-980).
A review of 68 publications concluded the prospective, empirical literature provides evidence that patients and care providers are satisfied with this mode of service delivery. The review also discovered preliminary evidence suggesting that some disorders, such as depression, can be effectively treated via such technology. (Monnier, Knapp, and Frueh, Psychiatric Services 54:1604-1609, December 2003).
Q: Is the equipment and/or software expensive?A: FasPsych will provide your organization with video teleconferencing software, to connect patients with FasPsych practitioners, at no cost. If your organization prefers to use another way to connect, affordable refurbished video teleconferencing equipment is available for purchase. FasPsych can provide you with vendor information should you need assistance. Most organizations are able to secure a camera and video monitor at a very reasonable price. There may be an additional monthly fee associated with accessing the internet via a T-1 line or fiber connection depending upon the bandwidth currently available at your office or facility.
Q: Is the equipment complicated?A: Once the equipment has been properly installed it is not difficult to operate. The staff at your organization can familiarize themselves with the equipment and learn to executive basic tasks such as:
- Turning the equipment on and off
- Placing a call
- Muting the call
- Adding a new IP address
- Positioning the camera and
- Adjusting the lighting
Q: What problems have you had in the past?A: The most frequent barrier to telepsychiatry is lack of bandwidth. Some areas do not have adequate bandwidth to sustain a quality picture this can result in pixilation and poor sound quality. While the FCC has approved over 400 million to improve connectivity much of this infrastructure has not yet been installed so organizations must check with their high speed internet carrier to ensure they have adequate upload and download speed to conduct telepsychiatry. Minimum bandwidth for telemedicine is 364K upload. It is generally recommended that it is significantly higher than this if the patient site will be drawing on the bandwidth for other functions such as site staff internet capability.
Depending upon the circumstances by which telepsychiatry is introduced to an organization's culture; staff resistance may present a challenge. FasPsych will work with your organization to provide education and training in order to minimize the possibility staff will find telepsychiatry to be an undesirable solution to your staffing needs.
Q: Is telepsychiatry HIPAA compliant?A: The video teleconferencing equipment used for telepsychiatry provides standards based embedded encryption in order to facilitate organizational HIPAA compliance. The National Institute of Standards & Technology in Washington D.C. currently supports 128, 192 and 256-bit keys and encryption blocks. This Advanced Encryption Standard (AES) encryption algorithm enables providers of telepsychiatry to proactively secure patient health information while providing clinical services or transferring patient health information. The equipment used for telepsychiatry meets current standards.
Q: What type of license is required to provide telepsychiatry?A: The practitioner must be licensed in the state where the client is physically located and receiving services. For instance, if the patient is in Texas, the doctor must be licensed in Texas even if he/she is working in California. FasPsych can provide practitioners licensed in most states. Please contact us to determine if we have a personnel licensed in your state. If we do not, FasPsych will aggressive recruit staff to meet your needs. We are often able to obtain staff quickly because location is not a factor.
Q: Are there licensing challenges?A: Some states do not allow APRNs to work independently. In states where this is the case a physician must be assigned to supervise/collaborate as required. The requirement for physician oversight does result in difficulty utilizing APRNs in certain states.
Currently 24 states have joined the interstate compact which allows registered nurses to provide care in any of the participating states as long as one of the compact states has issued the individual an RN license with multi-state privileges. States which do not participate therefore require APRNs to obtain both the RN license and APRN license prior to delivering clinical care.
Most states do not have a specific telemedicine license and require a full license in order to provide services to clients receiving services in those states. Several states have very difficult licensing requirements which may result in greater delays to rendering services if we do not currently have a practitioner available in that state.
Q: Will Medicare, Medicaid and private insurance companies pay for telepsychiatry?A: Medicare reimburses for psychiatric evaluation, medication monitoring and several other services as long as the patient site is located within a Health Professional Shortage Are (HPSA). Currently, approximately 40 states use Medicaid funds to pay for telepsychiatric services, and some private insurance carriers pay as well. Since FasPsych is reimbursed by your organization on an hourly basis, it is your responsibility to bill your payer sources for the services we provide. With regard to Medicaid and private carriers, FasPsych can provide general information as to which types of services are usually reimbursable if provided via telepsychiatry however; approved codes vary by state and carrier therefore FasPsych recommends that organizations conduct additional research to ensure correct billing.
Q: Does FasPsych provide APRN supervision if my state requires this?A: FasPsych practitioners work at an independent level however they are instructed to follow the chain of command at your organization. Ultimately, with regard to clinical or patient site administrative protocol, they report to your medical director, or the highest ranking clinical administrator.
If your state or facility mandates that Advance Practice Registered Nurses (APRNs) be supervised by, or have a collaborating agreement with, a physician; your organization is responsible for making the necessary arrangements and for providing the physician. In instances where a physician is not available at the patient site, FasPsych will try to recruit a physician to provide this service.
Q: Is telepsychiatry really more efficient than traditional face-to-face services?A: Yes:
- You will only pay for hours directly related to client care, or for training required by your organization. You will not pay for practitioner vacation days, sick days, time spent obtaining continuing medical education (CME) hours or travel time. FasPsych practitioners do not accrue any paid time off (PTO) and are not eligible for benefits related to the Family and Medical Leave Act (FMLA).
- FasPsych practitioners are specifically screened to ensure they are the top in their field and that they work efficiently, meaning that once a placement is made, they will follow your organization's clinical, administrative and productivity related protocols.
- FasPsych does not require potential contractors to purchase a minimum number of hours therefore; organizations need only buy what they need.