The coronavirus disease 2019 (COVID-19) pandemic is a seminal event that is precipitating radical transformative change to our society and health care systems. Social distancing, isolation, and deployment of suppression and mitigation strategies are directly influencing the morbidity and mortality rates of the pandemic.1 Remote communication technologies are being broadly deployed in all spheres of medicine to support these strategies while still delivering effective health care. Telepsychiatry, in the form of videoconferencing and other technologies, was uniquely positioned to push the field of psychiatry to the forefront of these efforts. Prior to the pandemic, telepsychiatry had built a strong scientific foundation and real-world evidence base, demonstrating its effectiveness across a range of psychiatric treatments, populations, and settings.2-5 Although previously leveraged temporarily in disaster response,6 telepsychiatry’s use in the COeither expanding or initiating direct clinician-home to patient-home services, and partially or fully virtualizing administrative operations. Implementation has occurred at a pace never experienced in telemedicine, with many large organizations fully virtualizing in a matter of days. Historically, full implementation of telepsychiatry, especially in large organizations, could take months to years. Rapid virtualization has shown that clinicians, patients, and systems can quickly adapt to telepsychiatry, although not without challenges and lessons learned. Previous barriers including regulatory constraints, system inertia, and general resistance to telepsychiatry have disappeared, at least temporarily; technical innovations abound as clinicians and organizations work to best configure telepsychiatry to current clinical needs and environments.
Historically, telepsychiatry has experienced a substantial evolutionary period with the expansion of the internet and the use of other technologies and peripheral devices that are ubiquitous to consumers and based largely on commercial uses and applications. Currently, in response to the COVID-19 emergency, there has been an unprecedented revolution in the telehealth landscape with the lifting of federal and state regulatory barriers to telemedicine and telepsychiatry. Such changes include the suspension of the Ryan Haight Online Pharmacy Consumer Protection Act of 2008, which placed restrictions on controlled substance prescription via videoconferencing, previously inadequately addressed despite years of advocacy for change by the telemedicine community. Rules around Medicare and Medicaid reimbursement, such as Medicare location requirements, have loosened to support and encourage videoconferencing and telephone-based services. Many states are creating COVID-19–specific exceptions no longer requiring psychiatrists and other mental health clinicians’ licensure in the state where a patient is physically located during a video session. These actions have been incredibly favorable and enabling for telepsychiatry and have been requested for years by the field.
The surge in use of telehealth has not been limited to psychiatry, and is being used in most primary care practice. Medicare and private payors have added appropriate CPT billing codes and allow for reimbursement. Reimbursement was an issue for providers, and previous restrictions in terms of distances for providers from patients were limiting factors in the use of telehealth.
The SARS-Covid-19 pandemic swiftly overran previous restrictions both by increasing efficiency of providers and allowing social distancing.
Telepsychiatry and the Coronavirus Disease 2019 Pandemic—Current and Future Outcomes of the Rapid Virtualization of Psychiatric Care | Global Health | JAMA Psychiatry | JAMA Network
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