Increase in Teletherapy Due to the Pandemic
In February of 2020, before COVID-19 really hit our country, telepsychiatry was beginning to be widely available but only sporadically adopted,” says Dr. Jay Shore, a professor at the University of Colorado Anschutz Medical Campus and the chair of the American Psychiatric Association’s Telepsychiatry Committee.
“Now it’s been a tsunami. At the University of Colorado maybe 10% to 20% of [mental health] visits were over video before. Now, outside of inpatient stuff, we’re at like 100%.”
And that has been true pretty much everywhere else in the country as well, where therapy sessions have been happening either online or not at all.
In mid-May, the American Psychiatric Association surveyed its members as to how frequently they held tele-psych sessions before and after the onset of the pandemic. The results were striking, and worthy of giving considerable thought.
Prior to COVID-19, 63.6% of respondents did not use virtual sessions at all. After the onset of the pandemic, that figure plunged to just 1.9%. Conversely, before COVID-19 hit, only 2.1% reported using tele-psych 76-100% of the time. During the pandemic, that figure has soared to 84.7%.
And the migration from face-to-face to remote therapy for speech-language pathologists and occupational therapists hasn’t been much different. One shouldn’t think that this is strictly a mental health phenomenon.
4 Reasons Teletherapy will Flourish
At first glance, one might not be so impressed with this fundamental change, regarding it as no more than reactionary and temporary. However, while other areas of life are suffering from COVID fatigue with people hungry to return to “normal” as soon as possible, teletherapy may be quite different. There are several reasons to believe that teletherapy may become an integral component of our new reality.
While the migration to teletherapy began as a necessity, there are plenty of people who like what they’re experiencing. The convenience is difficult to beat: a 50-minute session is a 50-minute session, not an hour and a half as the client or therapist spends all kinds of time just getting to and from the appointment.
The time factor is especially important in rural communities that were mental health deserts before COVID—with the nearest therapists located in the big city, a considerable drive away. Breaking down the geographic barriers can make the difference as to whether or not a person receives therapy at all.
2. Continuity of Care
Teletherapy also facilitates more enduring therapist-client relationships. If your family relocates to another city, you can always find another doctor to tend to your physical ills, but you didn’t spend years confiding your most intimate secrets to your cardiologist or ophthalmologist and now need to begin anew with a different practitioner.
However, when it comes to your psychologist, it’s an entirely different matter. “The advantage [of teletherapy] is clearly that you get to have continuity of care,” says Lori Gottlieb, a Los Angeles-based psychotherapist and author of the book, Maybe You Should Talk.
Accompanying the meteoric growth of teletherapy has been the increasing challenge of implementing digital health solutions, particularly telehealth and teletherapy, within the patchwork setup of both federal and various state regulations. These often confusing and at times contradictory regulations have made it difficult for providers and telehealth vendors to offer solutions on a large scale, in particular across state lines.
However, in the current state of public emergency, both the federal and various state governments are recognizing the need to ease prior restrictions and expand telehealth availability to help patients receive care at home; this helps limit the spread of COVID-19 by further enabling social distancing and freeing up providers’ brick-and-mortar hospitals and clinics to treat COVID-19 patients.
The creation of the Psychology Interjurisdictional Compact (PSYPACT), as well as many other national associations such as the Audiology & Speech-Language Pathology Interstate Compact (ASLP-IC) in the audiology and speech-language realm that are working to develop cross-state practice models, is encouraging and exemplary of how things are changing. And there are those in the field who believe that, once these changes are made, they will become permanent.
If teletherapy is going to have a bright, post-pandemic future, it will depend on more than just the acceptance of patients and providers. As is the case with so many other things in the U.S. healthcare system, it all boils down to “who will pay.” During the pandemic, Medicare, many state Medicaid programs, and several commercial insurers have loosened rules or permitted waivers to cover telehealth sessions.
In the realm of telemedicine, there has been a dramatic increase in overall access to care—increasing 40-fold in some parts of the country during the pandemic—which is, in and of itself, a powerful argument for maintaining the system. In August, the CMS (Centers for Medicare and Medicaid Services) issued new guidelines that provide physicians nine new billing codes to cover telemedicine going forward.
And just as the multifold increase in teletherapy across the spectrum has mirrored increases in telemedicine, so too are disbursements beginning to follow suit. In March 2020 the CMS—the main government insurer—had said it would begin to pay for telehealth visits on a much broader and consistent basis “for the duration of the COVID-19 Public Health Emergency.”
Medicare and Medicaid, which together cover about a third of all Americans, would consider these virtual visits to be on a par with traditional doctors’ appointments and would reimburse doctors accordingly. And as goes Medicare, so go many private health insurers, such as Cigna and Blue Cross Blue Shield. This recent development alone could be a game-changer.
The Future is Now
The rapidly changing environment of teletherapy has some in the clinical community convinced that not only is teletherapy the future of mental health, but that the future is now. “I think that anyone who tries to prognosticate comes across as a fool,” says Shore. “But what I can say is that we will never be the same, we won’t go back to where we were.”
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