Interplay of genetics and loneliness
Interplay of genetics and loneliness
Telepsychiatry in the U.S.
In light of COVID-19, telehealth and telepsychiatry has become mainstream for patient treatments. However, the growing need of telepsychiatry in the geriatric population is not met with comprehensive legal framework nor insurance policy.
Envisioning that telepsychiatry as a major platform for the treatment of geriatric population experiencing social isolation, we address the issues of telepsychiatry from the providers' perspective in the legal hurdles and private versus public sectors sections. We also address issues from the users perspective in the insurance and technology literacy sections.
Legal hurdles
Lack of unified regulations on telepsychiatry in different states and prescription regulation
Private vs Public sector
Private sectors are more prepared for transitioning to telepsychiatry in comparison to public sector
Insurance
Government reimbursement rate for telepsychiatry is low
Technology literacy
Elderly population has low technology literacy and ownership
The lack of unified regulations on drug prescriptions halt healthcare providers from moving to telepsychiatry platform. Court cases and The Ryan Haight Online Pharmacy Consumer Protection Act of 2008 have limited prescriptions of controlled substances without in person check-ups. In 2018, a special registration is approved by the federal government to allow prescription of controlled substance after registration with the US Drug Enforcement Agency.
An overall concern of psychiatriests are the lack of unified regulation on telepsychiatry licensure. Out of 20 states that have telehealth licensure, only 3 of them have licensure of telepsychiatry. The lack of stat-based malpractice liability leads to a lack of insurance companies that are willing to fully sponsor telemedicine. There is also an absence of substantial requirement and guidelines for patient informed consent for telepsychiatry
"Kaiser's telehealth system is well prepared for the outbreak" because of Kaiser’s unique system that has hospital, labs, and pharmacies all under one unit, which makes data transferrable and increases flexibility switching to the telehealth system. “Everything is telehealth now," and the telehealth use in Kaiser has gone up 90% in order to maintain social distancing. Kaiser's unified system also increases the convenience of cross talks between departments, which is not the case in other and most public hospital systems.
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The preparedness of a private system for telehealth is reassuring for those who are insured under a company like Kaiser; however, with a growing elderly population insured under Medicare, the preparedness of telehealth in public hospital systems is not so optimistic
Among all Medicare beneficiaries, 1.5% of them have utilized telepsychiatry. This low usage reflects the incomplete reimbursement plan of current Medicare system, thus calling for an examination of a practical guideline for reimbursement.
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A recent update on Medicare coverage of telehealth has changed in light of COVID-19. Medicare Advantage Plans indicate medicare beneficiaries pay the same 20% co-insurance with the medicare approved amount for all telehealth visits in contrast to restrictions of non-home based telemedicine visits.
As we see the increase dependence on telepsychiatry, it is crucial that this advantage plan is here to stay.
51% of younger seniors (65-69) own a smartphone while older seniors (70 and above) have lower 31% smartphone ownership. This same distribution applies to internet usage and broadband adoption. Seniors with higher household income and education levels have significantly higher rates of smartphone ownership, internet usage, tablet ownership, and social media usage. Thus, this recent research on seniors across the US shows a technology divide among seniors by age and by socioeconomic status which indicate the increasing usage of telehealth may negatively impact those who lack access to technologies.
A case study of Nava ho nation's perception of rural First Nations communities shows that 32% of the participants raise negative views of telemental health because human contact is an integral part of the First Nation culture. Cultural perceptions may prevent people from trusting the system and decrease usage of telemental health.
Sources:
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1. Kramer, G. et al. Legal, Regulatory, and Risk Management Issues in the Use of Technology to Deliver Mental Health Care. Cognitive and Behavioral Practice. 22, no. 3 (August, 2015): 258-268. https://doi.org/10.1016/j.cbpra.2014.04.008
2. Natoli, C. (2011). Telemedicine: Prescribing and the Internet. Center for Telehealth & e-Health Law. Retrieved from http://ctel.org/wp-content/uploads/2011/06/Telemedicine-Prescribing-and-the-Internet.pdf
3. Elliott, V. L. (2018). The Special Registration for Telemedicine: In Brief. EveryCRSReport.com. Retrieved from https://fas.org/sgp/crs/misc/R45240.pdf (2018)
4. Feke, T. (2020, April 3). Medicare and Medicaid Coverage for Telemedicine. verywellhealth. Retrieved from https://www.verywellhealth.com/medicare-and-medicaid-coverage-for-telehealth-4682549
5. Mehrotra,A. et al. Rapid Growth In Mental Health Telemedicine Use Among Rural Medicare Beneficiaries, Wide Variation Across States. HealthAffairs. 36, no.5 (May, 2017): 909-917. https://doi.org/10.1377/hlthaff.2016.1461.
7. Gibson, K. et al. Conversations on telemental health: listening to remote and rural First Nations communities. Rural and Remote Health. 11, no.2 (April 19, 2011):1656. www.rrh.org.au/journal/article/1656
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