Two weeks ago PsychOdyssey attended a talk at NAMI New York Metro about telepsychiatry, a new and fast developing field in psychiatry. The presenter was Mr. Samir Malik, Co-Founder and CEO of 1DocWay, a fascinating start-up telepsychiatry technology company.
Lack of access to psychiatry is an enormous problem, especially in remote areas. Existing telemedicine solutions are not adequate. They are neither scalable nor sufficiently service oriented. Malik’s company, 1DocWay, “brings the doctor’s office online”. It does so with these product features:
- Secure video chat
- Appointment scheduling
- Patient notes recording and filing
- Turnkey implementation
- HIPAA compliance
- Emphasis on ease of use
In the US today, over 80 million people live more than 60 miles from a psychiatric specialist. Malik believes this inaccessibility will drive enormous demand for telepsychiatric services. In just 5 years, Malik predicts the potential market for telepsychiatric services will reach $30 billion. As to connection security,1DocWay uses 256 bit encryption, which is the same as online banking facilities.
1DocWay believes that 85% of all psychiatric sessions can be done online. Major insurers, including Medicare, United HealthCare, Blue Cross, and Aetna, are now willing to reimburse doctors for telepsychiatry. Even Medicaid in all but one state now reimburses telepsychiatry services. And today 9 states—and very soon, 26 states—require commercial insurers to do so.
Working in over a dozen states with 70 registered clinicians, currently 1DocWay’s technology enables telepsychiatry for over 30,000 patients, of which 97% are Medicaid beneficiaries. Telepsychiatry is opening up new therapeutic horizons. Nearly 85% of 1DocWay’s patients were not seeing a psychiatrist previously. Pathologies that seem particularly suited to telemedical care include dual disorders and mood disorders, while phobias and thought disorders so far seem less well suited to it.
Psychiatrists are finding telepsychiatry a suitable compensation modality. Clinical outcomes of telepsychiatry appear from research to be as good as face-to-face consulations. Ancillary benefits include reduced institutional resource utilization, wider patient access, and reduced transportation and logistic constraints.
Legal issues are not insignificant, but they are addressable. Clinicians need to be licensed in those states where they provide care. In some cases under Federal domain, clinicians licensed in one state can practice in another state. With some exceptions, they also need to be credentialed by organizations for which they are providing care. Malpractice coverage remains needed for telemental health.
Indeed, 1DocWay’s biggest challenge is not technology or even regulation, but credentialing, e.g., the credentialing requirements of third party payers for providers and facilities that seek to participate with 1DocWay. Efforts to standardize credentialing, such as the Federal non-profit Council for Affordable Quality Health Care (CAQH) are somewhat helpful, but many hospitals think CAQH’s required credentialing data is not sufficient, which complicates 1DocWay’s enrollment efforts.
According the Malik, the states right now most favorable to telepsychiatry are California, Michigan, and Minnesota. Thanks to robust efforts of the University of Texas Medical Branch’s telehealth initiative, Texas has become the most developed telepsychiatry state. Unfortunately, the worst state for telemedicine is New Jersey, due to the Garden State’s lowest-in-the-country Medicaid rates and its hostile regulatory climate.
For families navigating the maelstrom, telepsychiatry represents an interesting modality that can increase a loved one’s services, especially in rural and other hard to serve areas. In time, telemedicine will also be useful for family members for modalities like family psychoeducation and social networking for solutions to common but difficult coping problems.
For further information about the emerging telepsychiatry market, University of Colorado Denver maintains a very helpful website on all things telepsychiatric at http://www.tmhguide.org/.