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April 03, 2020
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APA calls for loosened telepsychiatry video requirement to increase care access during pandemic

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Bruce Schwartz

The American Psychiatric Association sent a letter to CMS on Thursday requesting that it relax the video requirement for delivery of telepsychiatry services.

The association suggested the move would allow patients without internet access, or those who have older phones that lack a camera, to receive medication management and individual therapy with their clinician during the COVID-19 pandemic, according to an APA press release.

“We have heard from many psychiatrists whose patients are only able to call into appointments, because they don’t have access to online technology,” Bruce Schwartz, MD, APA president, said in the release. “Even if we can’t physically see our patients, we can provide medication management and psychotherapy. We must be able to provide care to our patients in a way that respects current guidelines on social distancing. Now is the time for CMS to revise the rule so that all people with serious mental illness and substance use disorders can access the vital care they need.”

According to the APA, the pandemic has forced increasing numbers of Americans to use telemedicine to access care. CMS has loosened requirements so that individuals receiving Medicaid and Medicare can use telemedicine as a link to health care; however, vulnerable individuals, particularly the elderly and those with serious mental illness, continue to face technological obstacles to care, including lacking required video technology or living in areas without reliable broadband access.

Last week, the APA released results of a national poll that suggested nearly half of Americans are anxious about the possibility of getting COVID-19, and nearly 40% are anxious about dying or becoming seriously ill due to the virus.

Hossam Mahmoud

Telemedicine, or telepsychiatry specifically, may mitigate COVID-19 risks and fears, according to Hossam Mahmoud, MD, MPH, senior vice president and medical director of the Scheduled Services and Inpathy divisions at the telepsychiatry company InSight + Regroup. In a previous interview with Healio Psychiatry, Mahmoud noted that in-home telepsychiatry does not differ much from a standard therapy session, underscoring the likelihood that even more patients can be reached with loosened technological restrictions.

“Clinicians should ensure that both they and their patients are comfortable with the technology, to troubleshoot if necessary and to have a backup plan if the technology fails,” Mahmoud said. “That becomes even more important when clinicians see patients at home. Although many patients might be comfortable with certain technologies, it's sometimes hard to get a crash course in a new mode of communication overnight when a patient hasn't used it before. Learning to do remote work is not that hard because telepsychiatry is basically psychiatry performed from a distance.”

Saul Levin

Saul Levin, MD, MPA, APA CEO and medical director, commended the “great steps” by CMS to ensure expanded access to care during the pandemic but noted the necessity of the APA’s letter.

“Our recommendation will ensure that those patients who still rely on older technology can access vital psychiatric services,” Levin said in the release. – by Joe Gramigna

Disclosures: Levin and Schwartz are employees of the APA. Mahmoud reports being senior vice president and medical director of a telepsychiatry company.