Telepsychiatry Update

Have I really been using Skype for patient encounters for five years or more? Let me review my experience.

I use videoconferencing only for routine patient follow-up encounters. I have never conducted an initial psychiatric evaluation outside of an office setting. No payer has yet reimbursed a patient for a videoconference encounter, but patients like it so much that a few regularly forego reimbursement to avoid the trek to my office. A few live hours away and have found no other physician they want to work with locally.

I schedule the encounters when I can work from home. This has enabled me to markedly reduce my office hours (and expenses). Patient locations have varied from home or office to parks and parking lots, vacation rentals, and even one driving his car (albeit very slowly -- even so I do not recommend this) on the Interstate. A few may have originated from boats.

I require monthly patients to come to the office at least every third encounter, quarterly patients every other. However, sometimes we have to choose between a Skype encounter today and an office encounter in a week or more, a clear advantage over office alone.

I schedule Skype encounters 30 minutes apart, which makes for some wasted time when they only last 10 minutes or less, but I can always use the time for housekeeping. Although detractors have expressed concern about security we never actually state even the patient’s name or diagnosis. Mostly we speak in general terms.

With my direct pay practice model some patients pay in advance at office visits, but I have discovered a way to store encrypted credit card numbers which allows us to avoid a phone call to get the card number after the videoconference. Patients pay the same fee for office and Skype encounters.

If either the patient or I are not online at the appointed time, or if we have technical problems, we use texting to get on track. In most cases we can reschedule later in the day so the patient can avoid paying a no-show penalty.

Patients who get random drug screens have the odds increased at the next office encounter.

I can only think of one instance where we decided to switch to an office visit. I still like to start new medications only during office encounters.

I predict that those who rigidly insist on conducting all patient encounters face-to-face in an office, while pretending that telephone encounters enjoy some kind of exempt status, will go the way of the horse and buggy. Their criticism usually arises from ignorance and fear. They will likely accept this technology only after they have seen a patient harmed by delayed attention to a problem while waiting for an office appointment.

Videoconferencing remains superior to telephone and adequate for many patient encounters while saving time, fuel, travel risks associated with office encounters. Physicians and subscribers will shun payers who continue to refuse to reimburse for videoconference encounters.


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