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Telepsychology Best Practices: Maximizing Opportunities in Health Care Reform -- Part I -- Marlene Maheu)

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Telepsychology Best Practices: Maximizing Opportunities in Health Care Reform -- Part I …

Telepsychology Best Practices: Maximizing Opportunities in Health Care Reform -- Part I
American Psychological Association Annual Convention, August 9, 2014

To invite Dr. Maheu to speak to your group about these issues, please send an inquiry at www.telehealth.org/contact

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  • 1. Telepsychology Best Practices: I/ Iaximizing Opportunities in Health Care Reform AM ERICAN PSYCHOLOGICAL ASSOCIATION
  • 2. Disclaimer/ Disclosure - GOAL: Our goal is educational only. No warranty, guarantee, or representation is made as to the accuracy or sufficiency of the information contained in our presentation for your specific circumstance. ° YOUR PART: You are encouraged to seek practice- specific advice from your legal, regulatory, ethical and malpractice bodies before offering any online services or programs to consumers. Get all such opinions in writing, and have your informed, local, legal counsel review them for their full significance. ° We have no conflicts of interest with any groups identified in today's presentation.
  • 3. 6 Learning Objectives Explain at least three important features of health care reform and how it will impact the future of telepsychology in the next 2-5 years Name at least three essential elements covered by the APA’s 2013 Telepsychology Guidelines Explain how multi-cultural issues are relevant to telepractice. Name three factors of relevance to telepsychology when practicing over state or international borders. Describe at least one best practice when using assessment tools online. Discuss at least one best practice for successful reimbursement when delivering telepsychological services.
  • 4. ._ E--- E _-__. .T I Guests: Dr. David Luxton Dr. Fred Millan Dr. Joe McMenamin Dr. Sherry Benton I «K "C =35.. . ‘ ‘Q ” ~ T-. t:_-s-. v. . . I‘ If “£3? ‘It "I, t
  • 5. Housekeeping Schedule Restrooms Questions WiFi Twitter @te| epsychoIogy .1. . :. :3 x». . .' ll I. » . ‘L! ll! 5’ Iv ‘S, ’ '1‘ 3 4
  • 6. =— . .. ,_, . -, ..- _#. ,._ . __. ._. .;_ ‘M-E: :, — ' -, ; Guideline 1: Competence Guideline 2: Standards of Care Guideline 3: Informed Consent Guideline 4: Confidentiality Guideline 5: Security & Transmission Guideline 6: Disposal of Date & Info Guideline 7: Testing & Assessment Guideline 8: lnterjurisdictional Practice ‘=2 , ,,gsm, T-ii _ It
  • 7. I _ _. '_E . _ g, » What's going on? I 6 Technology -5 Healthcare e Psychology - Telepsychology
  • 8. Our planet is re-tooling - . } fie ,1./ ~* P" I N / .;= ' I . ~ , l/ ,; asls "if"/ o2 X,2-_/ 5v_, k/_v»! I_; g,. V. , _ y . psychology
  • 9. GLAGBEIZGEN . v, .. ... .-, .3; TRAVEL Aceucvwil “Somcplacc hot enough to melt fat the moment I step on to the beach! " Convenience is the new quality. Mark Bertolini, C hairman, C E0 and President of Aetna
  • 10. OCPM: Online Clinical Practice Management What's happening with Heath Care Reform?
  • 11. Triple Aim: Care, Health, and Cost . ..we call those goals the Triple Aim: : * improving the individual experience of care; ° improving the health of populations; and *> reducing the per capita costs of care for populations. ” The remaining barriers to integrated care are not technical; they are political. Berwick, D. M., Nolan, ‘I’. W. & Whittington, J. (2008). Health Affairs, 27(3), p. 759-769.
  • 12. Affordable Care Act Repercussions for Psychologists * Funding for private agencies will most likely be shifted to the expanding Medicaid programs to support Health Care Reform * Referrals to for ACA patients will most likely come from primary care physician's offices to: - large groups of practitioners — practitioners who work in physician's offices ° Integrated care - Patient—centered homes
  • 13. Affordable Care Act Repercussions for Psychologists * Small group and private practices likely to be squeezed out of marketplace — Large groups can contain costs across practitioners and clients * Success of private-pay model will most likely decrease over long term — If people have to pay for insurance, they are likely to want to use that insurance
  • 14. Affordable Care Act Repercussions for Psychologists * Shorter sessions / more clients / families * More documentation — Documentation will require proof of interventions being tied to the evidence-base ("treat-to-target”) — Oregon — ICD-10+ DSM-V * Organize documentation through Electronic Health Records (EHRs) — Standardize information for outcomes analysis and treatment refinement — BIG DATA(informatics)
  • 15. Affordable Care Act Repercussions for Psychologists * Increased reliance on master's level practitioners * Increased reliance on technology — Apps and other self help tools will proliferate — Required use of electronic health records (to measure outcomes) ° Decreased reimbursement for free—f| owing sessions and non- specific note—taking : Increased need for vision / graduate education and professional education
  • 16. Reducing Hospital Admissionsfor Ambulatory Care Sensitive Conditions People with mental illness are 2.3 times more likely to be admitted to hospital for AC SC ° Short and long—term diabetes ° Pediatric gastroenteritis * complications * Hypertension : Uncontrolled diabetes ° Angina without ° Lower extremity amputation - procedure am°“3 * Congestive heart failure * diabetic patients . LOW birth Weight * Perforated appendix . Dehydration ' Pediatric asthma ° Bacterial pneumonia ’ Adult asthma ° Urinary Tract Infection * Chronic Obstructive Pulmonary ° Disease Li Y, Glance LG. Cai X. Mukamel DB “Mental illness and hospitalization for ambulatorj. -' care sensitive medical conditions" Med Care. 2008 De(;46(12,1:12-'I956
  • 17. Potentially Preventable Hospital Readmissions among Medicaid Recipients with Mental Health and/ or Substance Abuse Health Conditions Compared with All Others: New York State, 2007 MichaeILindsey, Wendy Patterson. Kevin Ray, Patrick Roohan Table 1. Potentially Preventable Readmission (PPR) Rates per 100 At Risk’Admissions by Medicaid Recipient Health Condition at Initial Adm'ssion and Region: New York State, 2007 Recipient Health Initial Atfiisk pm hitial At Risk pm ‘ Admissions‘ Events’ Ram Admissions Events me Mental Health 5,303 79,315 as 10,523 131,931 3.0 SubstanceAbuse 4,111 35,578 11.6 5.634 54,869 _ 10.3 Mental Health and 13,043 ' 52,409 209 20,375 115,490 179 SubstanceAbuse Allothers 132,259 4.6 9.082 188,503 4.8 31o, o71 15,638 ' Non-excluded admissions followed by at least one clinically related readmission. ’ All inpatient events that were not excluded according to defined PPR cntena. https: //www. heaIth. ny. gov/ heaIth_care/ m anaged_care/ reports/ statistics_data/3hospital_readmissions_mentahea| th. pdf
  • 18. Mormmmwk counecnuo THE HEALTHCARE TECHNOLOGY COMMUNITY 0‘ Home ll-; «.s 5 Cc-evneniar. niie Pacers Ea. -nls Ir-lei-: ip Telehealth Gains Momentum In Obamacare Era ’ The Attordable care Act‘: focus on population health and cost-cutting . . - . . V‘. ' . i t g ', is encouraging providers and insurers to invest in remote healthcare ' "'6 1' 1 technologies. ‘MW’: J‘! F‘. :I= m . i: . '.i: h‘i: t1:t. '.I: i.‘i' —"N lw 'l: lN'. l'. It‘ Crowdfunding The Next HealthcareHit """‘ 1-. » M».
  • 19. 'I‘Hl<‘ J I - r 1;-. »i. -.'; ii~' v. “ 4 _. u¢$__; &4._* I I I " 5: ' Hillary Clinton | Tea party | John Conyers f ' POLICY REGULATION BLOGS BUSINESS CAMPAIGN OPINION VIDEO PEOPLE JOBS EVENTS TRANSPORTATION DEFENSE INTERNATIONAL IN THE KNOW REGULATION Senate to mark up RNC demands Female lawmakers finish Voting rights activists Employers threaten to highway bill independent investigation Afghan visit poised to party scrap retirement. .. ( ‘V’ I A ) HOME I POLICY I HEALTHCARE House Democrats push mental NOBODY DOES health alternative rr BEr| 'ER_ fin 'V, .t_, £4‘ E coivmsms 15 ByE| ISeVl¢becI(-D5C'E~‘v4G6WGFMEDT - ' House Democrats on Tuesday unveiled an allernalive lo a sweeping mental health overhaul from Republicans, lurlher complicating a reform push that was already at risk of failing The wide-ranging bill from Rep Ron Barber (D~AfIZ ) abandons a senes of aggressive and controversial
  • 20. House bill seeks to phase in Medicare coverage of telemedicine, remote patient monitoring By’JoIIlhOUmtocIt| Ju123.2014 than so s gem s2 Tape MediunTuehnihPlit/ Aad2oI4InnnbpIdunnnmhrlIg| Rep. (!mnflnmpom| Rep Mike Thonoaonitalatriodidheihlerilodoarielegllaionl Representatives Mike Thompson (D-Calii. ) and Glenn Thompson (It-Penn. ) are set to announce a new teleheaith bill soon. Lilte some oi Mike Thompson's previous teiehealth elforts. the bill seeks to amend the Title XVIII of the Social Security Act, the law that has long limited government-reimbursed telemedlcine to rural areas and specific use cases. As Jonathan Llnltous, CEO oi the American Telemedicine Association (ATA). has told Mobil-ieaIthNews in the past. when the Social security Act was passed telehealth was in its iniaricv and legislators. worried about abuse or that telemedicine wouldn't he cost-effective, limited Medicare and Medicaid coverage to very particular cases. Only patients in rural areas could be reimbursed for any telehealih service that required patient—piiysiciari interaction. for instance. Those types oi arbitrary restrictions have become increasingly obstructive lot teiernedlcine practitioners over the years. Rep. Mike Thompson (D—Caiii. ) Previous legislation has attempted a sweeping abolition of those restrictions — nap. Millie ‘niorripsorrs last effort. the The Telehealth Promouon Act oi 2012. med to amend the Social Security Act to assert that ielehealth must be covered in am! ‘ase in which the corresponding in- person treatment would he covered. That bill died in committee. .r " The current iorthcornlng hill. called the Medicare Telehealth Parity Act of 2014.. .} more measured. expanding the reach oi Medicare in telehealth slowly over ioiir years and establishing emcacy data requirements along the way. ‘ , currently, teleiiiediciiie can be reimbursed only in rural areas ‘—‘'areas that iall outside oi a designated metropolitan area. Six months after the passing of the bill. it would require Medicare to cover telemedicine in urban areas with a population oi 50,000 people or less, and would also expand the acceptable care sites from hospitals and doctors‘ oifices to include retail clinics as well. Two years after passing of the bill. coverage would expand to urban areas with a population between 50.000 and 100.000. and would add home telehealth to the acceptable care sites. It would also add outpatient services like speech therapy and physical therapy into the category oi reimbursable telehealth services. Finally. four years after the passing of the bill. reiernedicine would be reimbursable anywhere. regardless oi population. ‘ Much of the bill is concerned with remote patient nnnttoring: defined in the docurrient as home care specifically for people with chronic conditions. The bill would add a new subsection on remote patient monitoring to the very long portion oi the Social Security Mt that defines all the possible voirleuivioiexom Featured ntent Building the case against Apple developing a medical device In-Depth: Pharrna's digital health opportunities 10 digital health slanups that pivoted Exclusive: Covldlen acquires lloflarness-rrialter Zephyr Technology How Merck's innovation learn seeks business models beyond the pill ' WEBINAR II oigni Health 2014 Mloyau Review. Atrg21.2D'i4 2PMETl11AMPT(Freetoaunl! ) ' Maoiiouid clinical titiiia: How Mobile is Imovdlng Glricd Trlda. sen io.2ou eozioii. iiiA ' Halos 2.0 B! !! Aminl coiiteiviu: Sen 22-24.2014 saiiuciua. caiiroiriia ' Connected Health Syrnpooltrn: %23 -2‘. 2°14 BOIDILMA ' sxponuiiiai llhfiolrio iloimuiy rimou-oi NW 09 -12.2014 Hohl Del Coronado. SON Dione. CA ' 2014 ml-lodlh Stlnrnll. Deco? - 11. 2014 waehingnn. DcArea- 1'fioGIfloi'dNtboMlReaoillndConiIetllonCenbi
  • 21. Tom Goldstein l. IEmail Tom Posted Wed, July 23rd, 2014 10:19 am Bl0 3! P051 A1'ChiV8 » Commentary: The fate of the Obamacare subsidies in tlie Supreme Court Yesterday, two federal courts of appeals issued conflicting decisions on a major challenge to the operation of the Affordable Care Act (ACA). The stakes are huge. The rule at issue provides a big subsidy for millions of people to buy insurance. Without those subsidies, many Americans would not be required to buy insurance, including young healthy individuals that are so important to the insurance pool. The rule also determines whether employers have to comply with the upcoming mandate to provide insurance to their employees. Here is how the statute works. The ACA requires states to create “exchanges” -— essentially, marketplaces - for their residents to buy health insurance. But if a state refuses. the federal govemment will provide the exchange. The law then provides tax credits for people who need financial assistance. Without the subsidy, many people will not be subject to the ‘individual mandate” to buy insurance. An employer also is required to make insurance available only if its employees receive the subsidy. The Obama Administration has issued a rule saying that the tax credits are available for purchases not just under state exchanges but also in the roughly three dozen states in which the federal government provides the exchange. Roughly 5.4 million people have purchased insurance through the federal exchange, and almost ninety percent of them have received the subsidy. Many could not afford insurance without it. Here is the legal dispute. The law establishes a formula for determining the tax credits. It applies to insurance that is purchased through an exchange “established by the State. ” It does not mention the federal exchange. The challengers argue that this language is clear: the tax credits are available only for purchases through the state exchanges.
  • 22. HCR Is Creating an Environment that Is Ripe for "Disruptive Technology” Term coined by Harvard Business School professor Clayton M. Christensen to describe a new technology that unexpectedly displaces an established technology Betty Frieda“ Gloria Steinman ° 1963 book The Feminine Mi/ Liam ° Sought to have women be accepted in existing world ~ Sought to transform society
  • 23. Helpouts r psychotherapy for depression 3 9 Browse Helpouls v ‘ Your Helpoins v Helpouts for ‘psychotherapy for depression’ mqwmg mam ggwm Help for Depression and Bipolar No mm available . . is $200.00 {mil nieirixii you online review my records rim you rm. and pvcmdc you with lecOl1’fl| erd. I'i>0’| S lot irrorovinq you - Nut amdnbie on Psychotherapist Wants to Help You M 2, 2°, ‘ J, 5 00 W l v . i-- _ . . - , , . F! !! AIé"v'oi—tlte'd eneelinq frustrated or ineffective I" xlveimg your owls’ Ne YOIllflM|01|Il¥D$ c. ou-. rna you more D i i it t i 2! Learn Easy Skills to Stop Anger, Anxiety & D. .. No um-. available j ‘ii ' ‘V rm nowur | h(lDD¢0Dl£leafll! vt skills necessary In step anger . . ‘ ‘ _ decrement . lI| !€y ll. IL. lYt. |lI¢ XPIOIJUIKS mdictiom and (sou fiéwfi ‘ i i i i t I Mental Health Counselingffherapy No lime: av mu: j‘ "’ “ s4o. oo « into»-roe short to long mm intervention and awziance alone S‘ 00 mm £1.)CUC3l adv-cr perurrnng to VIIIIOUS live vssue ttttil . _ _
  • 24. Worlaw cw S‘ 1-» About Us t. 'ont. a<: ! Us Sgr Ir lR-rig ‘'0' vi": *"~H? _t_1r Industries Solutions & Products Support 9 Home - So l. 'lK)fi$ - Hen ! l'K: a'£- lncrease Access to Healthcare ~_. . I ' ' ' ' ' Healthcare organizations of all kinds are embracing telehealth. as a way to offer _ V EH5" 00 fiber-ll-on higher-quality care. As a result. they're discovering the benefits of Improved "__‘. -._. .'. .._ Gan Access to ‘run. -ne zm Exports diagnostics. faster treatments. and the ability to give patients better access to care in remote locations. Telemedicine is also enabling more stakeholders- from payers and suppliers to healthcare providers and pharmaceutical companies—to manage costs better. improve productivity. and increase service —'——" Improve . w —: b ly cl mlonn non | eVe| s_ -- ~ BL. ‘:1 your lnlnastngclure Me ct: n 5"CUFl? y and COmp-‘.1'1CP Pm '°' °°"”"“ W °' °°°""°"' if you're ready to take the next step in heaithcare. we're ready to help. By "‘°* *9 Y°“’ '°"""°""”“"’ implementing outtlng—edge telehealth solutions. your organization can connect patients with physicians and specialists they normally couldn't aooess. From remote health monitoring to virtual clinics. Verizon's telemedicine solutions will enable physicians to collaborate and consult with other health professionals- ’ ,1. 5 ‘ when and where they need to. In the end. that will translate into better ~ $3 I ‘ healthcare for everyone. S07‘/ tC6‘> and/ or leaturvi-~3 are not ava ‘able -r: .3 l ctxinlnesfloca . and may be procured from in-country prowdnrs n 5 mt countnesl we con: we to expand o-. r servlcr: -am lab ty Wound : h.= wor‘1o. P-ease consuil your Vvvtzon Err-arprise Sokitaors rr: 'p'>‘-.5-: ~'vt3?. ve for S"‘FVtCrf‘ av? :15‘ ly C0n‘. .i: l «.3 >
  • 25. iHea| .l: hBeat Reporting Technology‘; Impact on Health Care ! jQ_ll4E INSIGHT ERSPECTIVES '+' suns ,7 . Er. -Air. "3 new: NEWS ARCHIVE Privacy Issues. Remain Key Concem for Doctors Using Google Glass Ttiur'. d.‘iy, July 24. 2014 Although some health care professionals believe that Google Glass could be helpful in patient and surgery settings. patient pnvacy remains a cone concern, The Atlantic reports. TOPIC ALERT P ' s ' 45 Macy and BMW Google Glass in the Doctor's Office Click or tops: to loci. -we porioc-c orrnii; According to T779 Atlantic. there has been a 'n. Ish ol enthusiasm‘ for the device's possible applications in health care. Health IT vendors such as Augrriedix and Pnstlne are selling software for G specifically for physicians The software includes features such as 4- - Secure input and retrieval of patient data from electronic health records. - Video—based communications platforms. - Voice-controlled checklist applications. and o Voice-to-text some health care providers also are developing and testing applications for the device. For example. the FastTrar: k lnnovatior-i in Technology Program at Boston Childrerfs Hospital is creating ‘Glass Surge-on, ‘ an application that aims to advance and streamline the surgical process Patient Privacy Concems. Limitations Meanwhile. both hospitals and corisumer advocates have expressed concern about Google Glass's place in health care According to The Atlantic. physicians experimenting with Google glass ‘are sensitive to‘ possible HIPAA violations PICTURE OF HEALTH REPUSLISN -'l3. I'Cf 3 H’: .: ':n MULTIMEDIA MOST POPULAR RELATED ARTICLES EHR Company Develops Wearable Health Record‘ Google Glass App Jun 13.2014 Study: Google Glass Helpful in Meaith Care. but Drawbacks Remain Apr 17.2oi. : R. I. Hospital Launches First Real-Time ED Study of Google Glass M: irch10.2014 EVENTS ‘ , [1 Meaningiui Use Esseniialslor the Small Provioi; -r ilk‘? July so, Webrnar Al~IlMA' Clinical Docurv: -ntation improvement Summit Aug. 4-5, Washington, DC. Prepanrig for the Future of Meaningful Use Aug 13. Webiner View All . MOST COMMENTED EHRS. Other Health IT Key To Successful ACOS. Study inds
  • 26. OCPM: Online Clinical Practice Management Where are the opportunities in telepsychology for Health Care Reform?
  • 27. 1: «/
  • 28. I ' , Children's ' Hospitals
  • 29. Specialty Schools & Services ° Special Needs ° Autism ° Residential Treatment Centers — Drug & Alcohol — Other
  • 30. Rural Hospitals -as " . 3. O’ . p* f ’ . ‘v. ’
  • 31. Corrections Facilities
  • 32. Nursing Homes
  • 33. Home Health
  • 34. Employers . :.. ... / .
  • 35. Military & Veteran's 43’! Administration
  • 36. ValueOptions and American Well Partner to Deploy the First National Behavioral Telehealth Network am--_ 8'-~ Sgi NORFOLK. Va. and BOSTON. June 27. 2012 / PRNewswire/ — Valueoptionsg. a health improvement company that specializes in emotional wellbelng and recovery. and American Well‘''‘ today announced a partnership to bring critically-needed behavioral healthcere to patients wherever they are. whenever they need it. Using American WelI's industry-leading Online Care telehealth solution. ValueOptions will transform behavioral healthcare by ofiering members immediate. live and clinically meaningful consultations. With American Well technology. Valueoptions will develop a first-of-its-kind. national network of telehealth-enabled providers. Through Online Care. Valueoptions members will have secure and private access to skilled behavioral specialists from home. work or any location where they have lntemet connectivity. Telehealth removes many barriers to healthcare such as distance. mobility and time constraints and can help lessen the stigma sometimes associated with behavioral health. Online Care provides ValueOptions an efficient and convenient solution to dramatically enhance behavioral healthcare access and quality for its diverse membership. which Includes both commercial and public sector employees and their families: military servicemen and women and their dependents: as well as Medicaid. Medicare and dual eligible populations. ‘With over 130.000 provider locations. we have one of the nation's largest behavioral health networks. However. the reality is that there are still not enough providers to serve the growing demand for quality behavioral health services in every comer of the United States. Access to care is an issue for many. " said Heyvvard Donigan. president and CEO of ValueOptions. "Growing demand for telebehavioral health services is evidenced by the speed at which reimbursement is accelerating. Today. 34 state Medicaid programs have recognized the need and the value of telehealth services. These 34 states already reimburse for such services. and 14 states are mandating telehealth reimbursement. Additionally. we continue to witness increased demand for telehealth in the Federal marketplace as well as a growing interest in our commercial business segments. " "Online Care telehealth allows us to bring behavioral health directly to our members. " acids Dr. Hal Levine. chief medical officer of Valueoptions. "Whether location or transportation inhibits access. or perhaps a member is simply having trouble taking that important first step toward engaging available services. telehealth enables us to connect with the member where they are - not just where they are located. but where they are In mindset when it comes to seeking treatment. " Valueoptions will hamess telehealth to reduce the rate of missed appointments and increase compliance. Moreover, with Online Care. ValueOptions will build a more eflicient. more convenient model for care delivery that will complement existing in-person services. lead to better health outcomes for members. enhance the bottom line for providers, and eventually. reduce costs for the system of care.
  • 37. HRSA Hoire > Hi; -tilth IT '2 Ruirilflcrirzr-i lT T9-olbpii 2- li-t_i_9cu: tior . $hare| E‘, 91'] b What are Federally qualified health centers (FQHCS)? Federally qualified health centers (F QHCS) include all organizations receiving grants under Section 330 of the Public Health Service Act (PHS). FOHCs quality for enhanced reimbursement from Medicare and Medicaid. as well as other benefits. FQHCS must serve an underserved area or population. offer a sliding lee scale. provide comprehensive services. have an ongoing quality assurance program, and have a governing board of directors. Certain tribal organizations and FQHC Look-Alikes (an organization that meets PHS Section 330 eligibility requirements. but does not receive grant funding) also may receive special Medicare and Medicaid reimbursement. Resoumes: - ELeqitent|4LA5s: n_Que§_ucms. =it29.utJes1s: LaL| x.ou. aJi@es1Leam centers (FQHQW. - M HFatheeF’F- 8K8 - Ma 1 . . H - eoi re ii in Me a: R n H i PF -_13§JSBJI5’ - Megicam C_Iaims Promsis-ns1Manua| Ch. _9 -__RHC§/ FQHC§ (PQF - 242K§}t’? - The guide to Me_qlcarg_Preventatlve §ervic§_s for P'1¥§lCaH§ ELQ_Y_l§. ¢L$_8D§ §uopliers @ - IabLe42LE. eo. eLai| LEiznn: n_dealtb_Qet1teLQaia_Bx_$. taie.2Q91 LEDF_-6ilsBJ= <? . ggmgarisgn 9! RHC and FQHQ_PrQg_r_am; (PDF - 4Q; l_Kt1)c? J‘. ')}. i‘! JJ. |‘! S.; i"JJ This Site 3 Search About Health information Technology Toolboxes help health centers. safety net providers, and ambulatory care providers with electronic and online resources and technical assistance to improve patiantcare More> Stay Informed Register lg the fiealthfl’ and Quality i! ‘!! Rf. M.E. ‘ 9“ "9 ' Comments? E~rriail the Healt7iiT e-mail box, M‘-_-'I. B_!1‘_l (QB '1 emu
  • 38. Private Companies . Serving Consumers i On| ine* * ForefrontTe| ehea| th ° MDLive I * Securevideo * Virtua| TherapyConnect ° WeCounse| . . . . '1 . . . ,'. ... .,, .- . ‘, !""“. ,.n . v*’. r' ~ *¢$r'i. - H W’ , /5 V ~"‘ ' TMH Institute has partnered with some ofthese companies and will receive a referralfee if you mentionTMH| . You may also get an added discount.
  • 39. Migration Model Start with your current clients Select those who are reliable, have good support systems and with whom you have a good working relationship Consider their diagnosis Take the time to prepare them Plan in-person sessions at regular intervals Do not work through their secretaries or others
  • 40. OCPM: Online Clinical Practice Management Maheu, Pulier, Wilhelm, Mc Menamin & Bro‘; -.In-(onnoly, 2004 Step 1: Training Step 2: Referrals Step 3: Patient Education Step 4: Legalities Step 5: Assessment Step 6: Direct Care Step 7: Reimbursement
  • 41. OCPM: Online Clinical Practice Management Step 1: Training Step 2: Referrals Step 3: Patient Education Step 4: Legalities Step 5: Assessment Step 6: Direct Care Ste 7: Reimbursement
  • 42. Contractual & Grants Direct Services Governm ent Services US Department of Education Medicare Department of Corrections Medicaid (based on state) Department of Defense Veteran Health Administration Indian Health Service NIH, NIMH, SBIR, State Programs Bureau of Prisons in Department oflustice Private Foundations
  • 43. Reimbursement for Telem’en: Private Pa Fee for Service Private Insurance General These 16 states now mandate payment: California, Colorado, Georgia, Hawaii, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, New Hampshire, Oklahoma, Oregon, Texas & Vermont 9 13 more states are pending since Jan.1, 2013 Niche (smoking, drug/ alcohol etc. ) CPT code approval Boutique (high-end services, rich & famous) Self-help ItAppSlI
  • 44. OCPM Step 7: Reimbursement Medicare & Medicaid Reimbursement — Psychiatrists, Psychologists and Social Workers
  • 45. Medicare Billing and Reimbursement Limited to rural and Health provider Shortage Areas (HPSA) Modifiers: — ”GT” for interactive audio and video telecommunications system — ”GQ” for store—and—forward applications Failing to use appropriate modifier code may constitute Medicare fraud Debate about how to identify location of services Many billing services bill inapprorpriately
  • 46. OCPM Step 7: Reimbursement * Medicare & Medicaid Psychiatrists, Psychologists and Social Workers — Use specialty CPT codes with modifiers — Insurance fraud can have severe consequences
  • 47. Reimbursement ° Medicare & Medicaid already pay for VTC. Many 3rd party carriers do, too. 0 O O Require HIPAA compliance Designated sites Rural areas Get Telemedicine Reimbursement Handbook or TMI Institute course Not to the home yet, but such reimbursement is coming soon — new proposal in CA by Senator Mike Thompson is being proposed now
  • 48. Medicare Billing and Reimbursement Limited to rural and Health provider Shortage Areas (HPSA) Modifiers: — ”GT” for interactive audio and video telecommunications system — ”GQ” for store—and—forward applications Failing to use appropriate modifier code may constitute Medicare fraud Debate about how to identify location of services Many billing services bill inappropriately
  • 49. Center for Con Health P°l'CY About CCHP What isTelehealth? CATelehealth Policy CCHP Projects — Home I CCHP Projects / rational Telehealth Resource Center - Policy CCIIP PIOJICTI I2.“’. .:. "", ;.. '7.'$'. §’. £'. ‘.‘. '.: "c. '1.‘” State Telehealth Laws and Reimbursement Policies Tddrnltllulddufriphhlntt R€pOl"t AForurnforAduncln¢ ""°"'°""""""“'" In Feb. 2013 CCHP released a so-state scan Ndondfddluldl n-sum of telehealth laws, regulations and c'""" Pm’ reimbursement policies. lstate Telehealth Laws and Reimbursement Polltles R290‘! This report offers policymakers. health advocates, health care professionals and others with an interest in telehealth a mac“ 3"“, N“ summary guide of the most recent Information available about how each of the 50 states (and the District of Columbia) Taidnnith Model sumo: defines. governs. and regulates the use of ‘telehealth’ or 'teiemedicine" technologies in the delivery of health care T‘“'°""'”'°"" “"'c" services. Most remarkable about mis report is that every state Tfiacu Q A. ___“ has its own unique set of telehealth policies. some states have nope: incorporated policies into law. while others have addressed issues such as definition. reimbursement policies. iloensure requirements etc. In their Medicaid Program Guidelines. in some cases we even discovered inconsistencies with policies within the same state. m. ‘v". "" Clidt here to download a . pdf version of the report. or visit the National Telehealth Policy Resource Center's Survey: Federal Health website to view an interactive map of state telehealth laws. regulations and policies. Agencies i-tampered by 1
  • 50. To download, go to this webpage: Telehea| th. org / CPA2013 American Telemedicine Association PAYING FOR TELEMEDICINE IN THE UNITED STATES A Concise Review from ATA CEO, Jonathan Linkous
  • 51. Telehealth Reimbursement Resources * Centerfor Telehealth and e-Health Law (Ctel) * U. S. Department of Agriculture Rural Utility Services Grant * Office for Advancement of Telehealth (OAT) — Telehealth Resource Center Grants — Telehealth Network Grant Programs — Congressionally—Mandated Telehealth Grants * HRSA Telemedicine Reimbursement Report — htt : www. hrsa. ov telehealth ubs reimbursement. htm * TeleMental Health Institute, Inc. — www. te| ehealth. org/ reimbursement
  • 52. Telehealth Reimbursement Resources ° Large Insurers — Anthem Blue Cross Telehealth Guidelines ° htt : w2.anthem. com bcc state tm info TM POM 2. 2 090911.pdf — Blue Shield Description of Telehealth Services & List of Telehealth Providers ° https: //www. blueshie| dca. com/ bsca/ find-a- provider/ te| ehea| th. sp
  • 53. Individuals 8: Families Employers & Organizations Health Can Proieslonab Producers About Us News 8: Analysts E Menu Log In I Register Contact Search Q - Click to open Menu - Aetna Health Cara Prohssbonals Clinical Policy Bulletins Aetna Clinical Policy Bulletins Our clinical Policy Bulletins (CF83) explain the medical, dental and pharmacy services we may or may not cover. They are based on objective, credible sources, such as the scientific literature. guidelines, consensus statements and expert opinions. Mallul (fluid Policy Iuldius » Dental Olnlul Pulley Iulhtlns > Hamlin cllnlcal Pclky Iullatlm > Clinical Poucv Iulletlm FAQ > -. I . 7 News A look It the future or Modlcnld: on with Pamda Scdmak
  • 54. States Requiring Insurance Reimbursement For Telehealth 8 - Telemedicine Below are the individual states in the US. that require some form of reimbursement for services provided by telehealth (usually for serices delivered via video teleconferencing or 'VTC")). - 6 . ... _.. ... ... ..__ T°9°>‘. °5"P! -'N- ? °°°“9!-"9‘-‘”- Maine Oregon California Colorado Georgia (complications) Hawaii Kansas Kentucky Louisiana Texas (Medicaid) Oklahoma Virginia New Hampshire Maryland Michigan Massachusetts Arizona Montana New Mexico Mississippi Idaho Kentucky (Medicaid) http: //telehea| th. org/ mandated-states Keep informed by getting our newsletter: http: //telehea| th. org/ newsletter-signup
  • 55. http: //www. americanbar. org/ content/ dam/ aba/ administrative/ healthlaw/ ehea| th_te| ehe a| th_proposed_ru| e.authcheckdam. pdf - - - Health Law Section AL ; I.CA. N lLAlA'~J(XJAIlL‘-N Re: Proposed CY 2014 Physician Fee Schedule eHea| th privacn & Impacts Telehealth Services . 3,, ¢, ,n, o,, ,2, Me, Securit Interest Grou Chair: Date; ]u| y 9, 2013 Deborah C. Hiser Vigg-§! _]gi[§: Clay J. countryman Linda Abdel Malek E Clinton R. Mikel Proposed CY 2014 Physician Fee Schedule Impacts Telehealth Services By: Clinton R. Mikel Yesterday, CMS released a pre-publication proposed rule, Policies under the Ph sician Fee Schedule Clinical lahorato Fee Schedule and Other Revisions to Part B for CY 2014 (2013-16547) (the “Proposed Rule"). Among other topics of interest to the eHea| th IG, including proposed revisions to the EHR Incentive Program, the Proposed Rule contained significant proposed revisions related to Telehealth Services. Ex ands Clarifies Eli ible “Ori inatin Site" Locations By way of bi iei bacl<gi'ouiici, in oidei to be reimbursed for certain enumerated Telehealth Services by Medicare, providers must meet the primary requirements contained at 42 C. F.R. §410.78 (Telehealth Services). In short summation, these requirements include:
  • 56. OCPM: Online Clinical Practice Management Ste 1: Trainin Step 2: Referrals Step 3: Patient Education Step 4: Legalities Step 5: Assessment Step 6: Direct Care Step 7: Reimbursement
  • 57. z Telehealth Definitions Behavioral Telehealth Telehealth vs. Technology? Eheahh Telemedicine * Telemental Health Telepsychology Online Counseling Online Therapy mHealth Telecounseling
  • 58. Telehealth vs. Telemedicine Telehealth Regional l li_‘-{lllll Pl'iC)i‘C':3ix| C)lifi l’lC3llll [r; lLit; iLii; iii Information Sharing Administration Te| ernediCine Consumer Education Public [v; ili, i-atirgiii Health Rr; ‘:; i‘: -.'i i‘i_ li Homeland Security
  • 59. Real-Time Telemedicine / Remote dQCtO1.exammeS a Patient i11ni1'al ER gets benefit of ioatie11t‘s inner ear from a 10031 Care Plus remote remote location consultatio11witl1 specialists.
  • 60. Benefits of Traditional Video—Based Te| ehealth* Increased client satisfaction Decreased travel time Decreased travel, child & elder—care costs Increased access to underserved populations Improved accessibility to specialists Reduced emergency care costs Faster decision—making time Increased productivity / decreased lost wages Improved operational efficiency Maheu, Pulier, Wilhelm, McMenamin 8i. Bl'O‘. -’-. ‘l‘I-C0nl10llV. (2004). The mental health professional and the new technologies. Erlbaum, New York.
  • 61. is Video Teleconferencing (VTC) Effective? * Yes — Medicare & Medicaid required to pay ~ Outcomes are relatively comparable, especially for follow—up care (intakes are still a matter of state law) * Literature for specialty groups is sparser, but positive (pediatrics) — Also effective for supervision — Can improve some ways service is rendered - See www. te| ehealth. ORG/ bibliography ° BUT, traditional VTC isn't the same as Skype
  • 62. 9 Recent Supporting Research Godleski, Darkins & Peters reported in April of 2012 that hospital utilization in psychiatric populations at the Veterans Administration were decreased by an average of 25% since the use of telehealth. It is worthy of note, however, that: — This study focused on c/ inic—based, high—speed videoconferencing and did not include any home telehealth encounters. Mental health patients were referred for telecare by clinicians. Typically, te/ emental health services were provided remotely at community—based outpatient clinics by mental health providers of all disciplines located at larger parent VA hospital facilities. Equipment consisted of either room or personal desktop videoconferencing units transmitting at 384 kbps or greater. Godleski, L. Darkins, A. & Peters, J. Outcomes of 98,609 U. S. Department of Veterans Affairs patients enrolled in telemental health services, 2006-2010. Psychiatric Servcies, 63(4). 383-385.
  • 63. Recent Supporting Research Backhaus and colleagues (May, 2012) reported in their abstract of a meta—analysis that: * 821 potential articles were identified, and 65 were selected for inclusion. - The results indicate that VCP is feasible, has been used in a variety of therapeutic formats and with diverse populations, is generally associated with good user satisfaction, and is found to have similar clinical outcomes to traditional face-to-face psychotherapy. — Videoconferencing psychotherapy: A systematic review. Backhaus, Autumn; Agha, Zia; Maglione, Melissa L. ; Repp, Andrea; Ross, Bridgett; Zuest, Danielle; Rice-Thorp, Natalie M. ; Lohr, James; Thorp, Steven R. Psychological Services, Vol 9(2), May 2012, 111-131. doi:10.1037laOO27924
  • 64. '_V£. ".-’l“L'IC. .i S: ‘n. ‘(-. I: the pe‘~! :.' ti. --. -r. ..i-. M2. ‘. :i v, ‘u. 2. III L1: 00:. .~I. tifi‘ . .‘v2N2i: Videoconferencing Psychotherapy: A Systematic Review Autumn Backhaus Zia Agha VA S. m Diego He. ilthc. ire System. San Diego. VA San Diego lleallheure System. San Diego. Cslifomia Culifomizi and L'r. i1:rsity of Cttlifornia. Sun Diego Melissa L. Maglionc, Andrea Repp, Natalie M. Rice-Thorp Bridgett R055, and Danielle Zucst University of C. tlifomi. i. San Diego VA Sttn Diego llcalthcnre Systeztt. San Diego. Culifomia James Lohr and Steven R. Thorp VA Sm Diego lle. ilthe; tre System. Center of lixccllenoe for Stress md . lent. 'il Health. Sm Diego. California ztnd llniversity of Califontia. San Diego [n(£l'ldUJl. ' with mental health problerris m; i_v ftce barriers to accessing effective psychothcnipies. Videoconferencing technology. which allows . iudio and video infor- mation to be shared C0tlCUfl'¢I'. ll)' across geographictil distzinccs. offers an '. illCfl‘. '.lll'C that may improve Ltceess. We conducted ".1 S)‘SlCmJUC literature review of the use of videoconferencing psychothenipy (VCP). designed to address l0 specific questions. including Ihentpeutie types/ forrruts that have been implemented. the populuuons with which VCP is being used. the number and types of public. tt: ons related to VCP. and . i'uil; ible satisfaction. feasibility. and outcome duu related to VCP. After electronic searches and reviews of reference lists. 821 potential ilfllCl¢S were identified. and 65 were selected for inclusion ‘lite results indicate that VCP is feasible. has been used in J ’. ll'lCl)' of theripeutic form. iLs and with d1’¢f. ‘C populations. is generally . .LOCl2llCd with good user s; i:isf. ictio: :. and is found to have slmlldf clinicztl outcomes to tr'. tdition. il f: tcc-to-face psychotherapy. Although the number of articles being published on VCP has increased in recent years. there remains it need for additional l. irge-scale clinical lnL1lS to further ; :sse. s the eflicucy and effectiveness of VCP. A’r_im'ord. r.' tclcticaiili. i: I:nu: r.'. .tI hc. L‘L*i. tclet: :editinc. sideownfcreritr. }‘)t2h0(b. 'l; t;. V_‘
  • 65. .. .. . ... ._c-. _. Table I Empirical Studies U ncontrof led studies Aulhofis) 835: ct 11.. 2(1)! Bischoff cl «-1.. ZIXM Bose «:1 31.. 200! 'BoucI'. :n1 cl 1]. . 2G! ) Cowain. IX)! Dcizsch. er. al. . 23X! ) Eficx :1 11]. . ZIXJI Fmch en 11.. 3115 Oman :1 31.. I997 Goldficld 6-. B0-: .‘hIC. 1113 Griffndu ct 51.. 21136 Bill cl .11.. 2(X)l Himlc :1 1L 2&5 Kapbn. I997 Mmclunda & McLu: n. I998 Nclvxx 6: Bui. 2010 Oakcx at 1]. . 2008 Olmcr & Dcsmris. 2010 Pmsik ct n1.. 2(1): Shepard cl a! .. 21136 Show 8: . (anson. 2(X)I Simpwon. zoo: Simpson ct IL. 21!]! Simpson ct 1]. . 2003 Toddler :1 nl. . 2IXT7 ‘Fodder 8: Ksplux. 24107 —nu-5- onu--—nuuv«——aoua-new-an . _.. .r. - 7.. .. . . 7——j . ._V . .._o. .,. Non! -mdomizcd ooouollcd fllzditi Aul}|0f() Bouchud cl 11.. 2(1): Clm-ct :1 al. . 2005 Gcmuin :1 IL. XX? ) ‘Germain :1 . ':X. . 2010 Candy 8: Mclocr. 2N5 Husty-Bcrino. I998 Morgan :1 A1,. NIX! Simpson ct 413.. 211% Tucrk cl IL. 2010 N 2| IO 48 -36 H2 I66 86 6 47 Randomimd conlmlted swam Auzhoth) Day 6: Schneider. INN! Fmch. Moamicf. Yim cl AL. 21!)? N 50 38 'Fmch. Me-nnicr. Crubaugh cl al. . 203'] 38 Gluccknuf :1 ; l.. 2(X)2 '(‘nccnc :1 11.. 2010 King 1:1 3]. . 2&9 ‘Marmot c1 21.. 2(X)9 Mitchel‘. :1 ml. 2&1‘ Morhnd cl aI. . 2(! H Motlmcl cl :1. 20!! ) Nclwon. C! :l. . 2N3 Ruskin c! :2. 2(1)»! ' Study is cxcludcd {tom Lnalpis of rcscanzh Quntiom -3-6 due to havmg osctlapping samples aim anochcx study.
  • 66. Caution — Consider Context Online Norm vs. Standard of Care — No Contact with Other Treating Clinicians — No Authentication of s -, '. _ . . M . Consumer/ -‘ *‘"'“* Professional ti. *’/ iii‘ , l_ L — No Emergency Backup ~ V "“~: _———Nl Procedures ' Misunderstanding of Clinical Processes (suicide) Operating w/ o Needed Research for Unsupervised Settings
  • 67. 9 it %. Caution — Consider Context Online Norm vs. Standard of Care Mostly Email / Chat vs. Video Anonymity / No Patient Records Avoid Responsibility w/ Website Disclaimers No Clear Channels for Mandated Reporting
  • 68. ATA B. Patient Appropriateness for videoconferencing- based Telemental Health * To date, no studies have identified any patient subgroup that does not benefit from, or is harmed by, mental healthcare provided through remote videoconferencing. Recent large randomized controlled trials demonstrate effectiveness of te/ emental health with many smaller trials also supporting this conclusion. p9
  • 69. __ __. A___ # . __‘. __H. :_q¢‘? ; l l All Existing Legal & Ethical Rules Apply
  • 70. APA Telepsychology Guidelines Pros Cons * Legitimizes telepractice ° Can be used against us in a 0 Sets Court Of law 6 ~ Difficultto change — Time/ energy/ good will Sets groundwork for competencies to be identified and taught — Delays progress * Wording includes "any” in several places, rendering compliancea challenge
  • 71. l ') I-0 —- 3‘ $ ‘O % l 9 VI J-‘- U0 . _a IQ —- u- e—- v—- u—- e—- —- ‘O 3 l Os VI J-L KN GL'IDELI. 'ES FOR THE PRACTICE OF TELEPSYCHOLOGY Introduction These guidelines are designed to address the developing area of psychological service provision commonly knoun as telepsychology. Telepsychology is defined. for the purpose of these guidelines. as the proxision of psychological services using telecommunication technologies as expounded in the "Definition of Telepsychology. " The expanding role of technology in the provision of psychological services and the continuous development of new technologies that may be useful in the practice of psychology present unique opportunities. considerations and challenges to practice. With the advancement of technology and the increased number of psychologists using technology in their practices. these guidelines have been prepared to educate and guide them These guidelines are informed by relevant American Psychological Association (APA) standards and guidelines. including the following: Ethical Principles of Psychologists and Code of Conduct ("APA Ethics Code‘) (APA 20023. 2010). and the Record Keeping Guidelines (APA 2007). In addition the assumptions and principles that guide the APA’s "Guidelines on Multicultural Training. Research Practice. and Organizational Change for Psychologists" (APA.
  • 72. Guidelines for the Practice of Telepsychology These guidelines are designed to address the developing area of psychological service provision commonly known as telepsychology. Telepsychology is defined, for the purpose of these guidelines, as the provision of psychological services using telecommunication technologies as expounded in the ”Definition of Telepsychology. ” p1
  • 73. Guidelines for the Practice of Telepsychology Telecommunication technologies include but are not limited to telephone, mobile devices, interactive videoconferencing, email, chat, text, and Internet (e. g., self—help websites, blogs, and social media). p.3
  • 74. Development of the Guidelines Therefore, two of the most salient issues that the Telepsychology Task Force members focus on throughout the documentare the psycho| ogist’s own knowledge of and competence in the provision of telepsychology and the need to ensure that the client/ patient has a full understanding of the potentially increased risks to loss of security and confidentiality when using technologies. An additional key issue discussed by the task force members was interjurisdictional practice.
  • 75. Conclusion It is important to note, that it is not the intent of these guidelines to prescribe specific actions, but rather, to offer the best guidance available at present when incorporating telecommunication technologies in the provision of psychological services. Because technology and its applicability to the profession of psychology is a dynamic area with many changes likely ahead, these guidelines also are not inclusive of all other considerations and are not intended to take precedence over the judgment of psychologists or applicable laws and regulations that guide the profession and practice of psychology.
  • 76. Telemental Health Standards & Guidelines American Medical Association. (2000). Guidelines for Patient-Physician Electronic Mail American Counseling Association. (1999, 2005, 2013). ACA Code of Ethics American Mental Health Counselors Association. (2000). Code of Ethics of the American Mental Health Counselors Association, Principle 14, Internet On-Line Counseling American Psychological Association. (1997). APA Statement on Services by Telephone, Teleconferencing, and Internet, A statement by the Ethics Committee of the American Psychological Association American Psychological Association. (2010). Ethical principles of psychologists and code of conduct American Telemedicine Association. (2009). Evidence-Based Practice for Telemental Health American Telemedicine Association. (2009). Practice Guidelines for Videoconferencing—Based Telemental Health American Telemedicine Association. (2013). Practice Guidelines For Video—Based Online Mental Health Services. Australian Psychological Society. (1004). Guidelines for Providing Psychological Services and Products on the Internet British Psychological Society. (2009). The Provision of Psychological Services via the Internet and Other Non-direct Means Canadian Psychological Association. (2006). Ethical Guidelines for Psychologists Providing Psychological Services via Electronic Media Federation of State Medical Boards of the United States, Inc. , Report of the Special Committee on Professional Conduct and Ethics. (2002) Model guidelines for the appropriate use of the Internet in medical practice National Association of Social Workers. (1999), 2008). Code of Ethics National Board for Certified Counselors and Center for Credentialing and Education, (2001). The Practice of Internet Counseling. (2001) New Zealand Psychological Psychologists Board (2011). Psychology services delivered via the internet and other electronic media Ohio Psychological Association. (2010). Telepsychology Guidelines http: //telehealth. org/ ethical-statements
  • 77. inns: -; ‘_v. v_n, vlvnlv. ;.: Imaflu: -:: Inir; .|l; m_i_= id. .;a; sgy'al-sir3;fiiazkuiin. “P ‘i-i§£-‘- . . :n»: gr , a_r«': ;”1.l':1"&: i__n, uo, _ g . -risinieneéiferanliuéxgfiiliesié. a PRACTTCE GUIDELINES FOR VIDEO-BASED ONLIl, lE MENTAL HEALTH SERVICES May 2913 IIIIIIIIIIIII lIIIl II I I II I I I IIIIIII IIIIIIIII II II I I II II I I ”IIIIIIIiIIIIIIIII III II I IlIIIlIlIIlIIllI"'IIIII I I II ll____. I.. —-3-— A"“A 1 Amman Telemedicine Association '0 'rio‘, i=i‘i_ll’u'i: ;.~»-i. .‘. i~ -vflu‘i: x~ --L= .r: |:(:1:‘-- lllfilllz
  • 78. ATA Guidelines 2013 This practice guidelines document focuses on te/ emental health services delivered in real-time using internet based videoconferencing technologies through personal computers and mobile devices.
  • 79. ll . . l . ( . .. . _ .1 .1 .1. l . w. “ l.
  • 80. $ ’: ‘ A y('7l11:s9AM
  • 81. VIRTUALLY B THE CLINIC Bringing Interactive Technology to Be avroial Healthcare for Treatment and Training News Avatars May Help Children With Social Anxiety I)-ieiroriie fears 4 till i . /ir1u. )t reality tmnles Pl st) The Daily l lledlllltl tear Cll flyiiia with 'i D ‘-lll| llldl(. )l"- University of Alabama adds VR Exposure to School of Social Worlt Elanta Prol A‘-m. Tra. ior isn t .3 new»comer to using ‘. ‘R in Social war» and C9l‘l3.‘lOl'El health 3 e s :9-: -n warring mm ‘(El colleagues lire l: ’3l! lCl" Bi: iidnir: b' and former CEO hen Giaap tor »ear-5 $0 ‘. ‘Bl IS prc-ua to conlirm that we . silI be I3-3ll‘. ‘€l| |'ID 3 3.519-rn to Alabama tor use in the Schr: -cit of Social ‘-'-‘DIV Cl1‘: CP' CIUl ll'l€ ‘3E‘l3llS l‘l£'! E VR based Treatments get "Exposure" on Fox 5 virtualt. Better welcomed Nista Littl-Jlielc from -'-tlanta 5 For E ne‘. -.5 last week for a feature on VR case»: treatments Thanrs lxnstal Atlanta News -. ‘.‘eatnei Traffic and Sports I Fox : PRODUCTS COMPANY ADHD: Not just a school problem. Dimcuiiies wllh locus O~el3C1l'.1l‘. l'Y'lDlJlSIv‘é' '5': -l't3.‘lC/ TS anaincr-: -ssea Ei'V10ll/ Jl'l3lI93Cll‘. ll~i are >: cv'~irnon Svl'T'l[Jl’. ‘lT1S oi ~‘<llET‘llIOI'l Eielicrb“H. pei3ctim Disorder ii~DHDi These and other +‘-DHD smiptorns can usreai riauor. in -school However School -grades and : l’? h3V'lUlS are noting -uni, areas impacted anathei are often not even the most negaiivei, eftected Cniidreri with ll‘il5 disorder are also "icire llVE‘li to Stiller from speech
  • 82. squ- Wearable Computers (Google Glasses)
  • 83. <(( 'rE‘L§MH, nA¥HF, N_TH te| ehealth. org 69% I Perosonal Robots Group rnit media lab l , r Home Welcome to the Personal Robots Group K“) , -
  • 84. G Model ARIMU)-I $49; No.0! Pages I0 Contivnts lists . ivaiI. it>li. - . it Si, . f Artificial Intelligence in Medicine journalhomopagozi. -.. ».. . l . 'L_L)l‘l‘iL)tL '. uni-i Recommendations for the ethical use and design of artificial intelligent care providers David D. Luxton"-"-' ‘ lxpurnnmr ollsydiiatry und Behuiiorul Saeixes. Uiirvnsiry 0/Washington School or Medicine. Box 356560. Scuttle. WA 99195. Ulllffd Sruzrs ‘ Naflollfll Cenm/ or Irlclimtzh £1 Yrdinology (12). 9933 Wes: Hayes smet Aladiguii Anna }ouir Kine Lmu-slcfliold. laconic. WA 95431. United States ARTICLE INFO ABSTRACT Nndt‘ ’"“°'Y~ Oh; c¢'ti~r: This paper identities and reviews ethical issues associated with artiticul intelligent (are “‘‘“'‘“’d 27 ”““" 2°" pruvidcrs (NCPs) in mental health can: and other helping professions. Spccilic recommendations are Received in revised form 30 May 20H .44.. .. ... .. nude {or the development of ethical todcs, guidelines. and the design of AlCPs
  • 85. Electronic Health Record
  • 86. Q’ AMERICAN PSYCHOLOGICAL ASSOCIATION About APA Psychology Topics Hom Publications Psychology Help Center News&Evenls Research Ed SEARCHE IN News&Events v E Home » News 8. Events » Press Room » APA Response to Supreme Court Decision » NEWS 8: EVENTS - Psychology Newswire - APA in the News - Press Room Press Releases ~ Policy Statements News Responses Op-Eds Task Force Reports Videos APA Response to Supreme Court Decision on Affordable Care Act The decision of the U. S. Supreme Court to uphold the Affordable Care Act moves our country forward on the path to extending health coverage to tens of millions of uninsured persons, reducing health care costs and ending discriminatory insurance practices. Since the passage of the act two years ago, millions have benefited from health insurance coverage — including children with pre-existing conditions (including mental disorders). young adults who can now stay on their parents‘ health plan until age 26 and older adults via access to prescription drugs at affordable rates. Certain vital preventive services are now covered free of charge by private insurers. as well as by Medicare and a Prevention and Public Health Fund was created. Furthennore, when the state insurance exchanges go into effect in 2014, millions more individuals will have access to health coverage for mental and behavioral health and substance use services as “essential health benefits" and with the same level of access and coverage they enjoy for physical health services. The Affordable Care Act recognizes the importance of care that is focused on the urhnln nnmnn and rhaliuarnrl hu infnrdicr-inlinanl nnmmnnifI-h: end fsame nf hnalfh
  • 87. Future of Telepsychology, Telehealth, and Various Technologies in Psychological Research and Practice" from "Professional Psychology: Research and Practice, " Vol 43(6), Dec 2012, 613-621. Downloadable copy: www. te| ehea| th. org/ future Future of Telepsychology, Telehealth, and Various Technologies in Psychological Research and Practice Marlene M. Maheu Myron L. Pulier Joseph P. McMenamin Les Posen
  • 88. OCPM: Online Clinical Practice Management APA & ATA Guideline Summary Checklist
  • 89. GUIDELINES FOR THE PRACTICE OF TELEPSYCHOLOGY Competence of the Psychologist Guideline 1: Psychologists who provide telepsychology services strive to take reasonable steps to ensure their competence with both the technologies used and the potential impact of the technologies on c/ ients/ patients, supervisees or other professionals.
  • 90. GUIDELINES FOR THE PRACTICE OF TELEPSYCHOLOGY Competence of the Psychologist * Acquiring competence may require pursuing additional educational experiences and training, including but not limited to, a review of the relevant literature, attendance at existing training programs (e. g., clinical and technical) and continuing education specific to the delivery of services utilizing telecommunication technologies. -* Psychologists are encouraged to seek appropriate skilled consultation from colleagues and other resources.
  • 91. Competencies Technical Legal Ethical Clinical
  • 92. Coalition for Technology in Behavioral Science: www. ctibs. org COMMUNICATIDI-l& Practice °°'~; g;; ;g; ¢,; '°i* Science ie. g., Internet. Blogglng. Social media; Cvbemetics [e. g., Biosensingx‘ Feedbadj, Sorial networking‘: COMPUTING METHODOLOGIB le. g.. -‘urtificial Intelligence; TELE(°, ,'. w U"(m-IDLE l-latural Lang. Processing; Robotics; User Computer ~El"= '3"'°"i‘3 "-‘3”- Interfaces [e. g., Computer iologv. F. -ainot-2 "isionTracl«ing. Haptic Sensing. l'. ii-2 '" . ‘ Training lnterfaces: ;(omputer T-; «:hnologv. T hon : i.«. g. 5l'““'3‘l°"$iE«_§-rVi"U3' Llobile Pho lth. H"m; ::ii§: ::'f; n;: {‘_= r53 Llessa in -' _-onhfla g liilicrocompmersi 3DImaging_ Software [e. g.. /ideo GEITIES. F . :poi , , , '-ital . =i”. i’r1iri‘-‘i’. i 1'? ‘-, l,li‘l]I Education Public Interest HEALTH ITS: INFORMATICS (e. g., Big Data; Controlled Vocabs[e. g., ICD-10:; Decision '~‘l3H"€35Ul3P°'1lD3‘3 . OTHERTECHITOLOGIES Mining; Electronic Health and ‘. . P e rso n al H e alth R ecords; ‘ "e“ga""g; °e‘ceh': ‘;“: ';Vg" s.5L: ::. ':: tt. *;: f;; ‘:: °:; i. Information Exchange; HITEIZH; Into rmation Storage 8. Retrieval; Interoperability
  • 93. Multicultural Issues & Diversity . .. , ‘-1 ' ' v ‘T . . E. ’ .1‘. ‘l“ i i ' " i*- Vial ‘ "§ )‘. ' r P" Iii» - , ~v .1‘-re. - v'1'( . . l A M’ . 4._i. II, . 4|. . i '-V *m‘*0"" "' I-41-”. . _4_ 1’ . ..‘ _- “W r . 7 --~ . ..n_~ / ‘ , ~___ _. r I , ~ -. I I ‘-. .
  • 94. GUIDELINES FOR THE PRACTICE OF TELEPSYCHOLOGY Multicultural Issues Assessment Process Research-based Work Professional Standards Informed Consent Emergencies
  • 95. Multicultural / Multlingual Issues Issue How to measure? * Global nature of the ° Search online for various Internet— worldwide instruments that might be audiences valid for your population * Multicultural issues are * Look for English proficiency quite visible in the tests document, but English as a — Free second language issue are — Easyto take 9 not m€ntlO| 'ied - Get to know the norms * Spoken English is different from written English Rarely mentioned anywhere
  • 96. GUIDELINES FOR THE PRACTICE OF TELEPSYCHOLOGY Standards of Care in the Delivery of Telepsychology Services Guideline 2: Psychologists make every effort to ensure that ethical and professional standards of care are met at the outset and throughout the duration of the telepsychology services they provide.
  • 97. |n—Person Contact APA Telepsychology Guidelines: t In addition, psychologists may consider some initial in-person contact with the client/ patient to facilitate an active discussion on these issues and/ or conduct the initial assessment. p11
  • 98. Belrax/ I()m| Telelrerrltlr Best Prm, ti<, es tf| rec, |’| Ist l: "‘ll“”‘lll“lllil“l Ale ‘‘lll‘l*llll'‘ _‘ l’ l‘. l‘illn’i- ‘. ‘r‘. '-rl-rill £‘;1‘: ir ri -': i : l-. tti Flil Thisbest practices and docum entation checklist is derived from a Tel eMenta| Health Institute review of2 013 Am erican Psychological Association and Am ericanTelem edicine Association's Guidelines. ’ 2013 APA & ATAGuideIine Similarities Both documents do not purport toestablish binding legal standards and deferto clinical judgment inany sircific circumstance Both documents recommend: 0 Adherence to| oca| _. staterflicensing lawsinterjurisdictional practice mandatory reportingjr. federal laws r’e. -g. HlPI‘<. .»‘5. and HlTECHjr. &ethica| codes of profession Competency of practitioner (adequate professional and technical knowledge and skills. etc. - Competency of clientfpatient u'e. g. appropriateness for telepractice services. technical competencies cooperation) Informed consent Carefuland ongoing assessment Emergency planning Privacy. security and confidentiality and risk management Documentation 2013 APA 8: ATA Guideline Differences APA Written for Psychologists ATA Written for All Telemenm/ Hea/ thProvIders Global persi: -ectrve Specific | :-ers| :ve~: ti~. 'e HZ-I>nfElé'l1Cl|1(| via per so nal computer s In in. In S ’ in email, telephone s-: -cral new. ‘-Jrkrnq and vrc| -:~: - Sc-: -|: ve is real-time ' —. .. »i nn. xl-. |I. ;. Ag. nf. ;.r. ;.n. -inn u . ~.wnr«. _—. —n. un«
  • 99. Client/ Patient Training Email / Texting/ Telephone/ Video Social networking—- social media policy File exchange Computer repair Clinical records Insurance Reports Lateness/ Missed sessions Non—compliance/ Avoidance
  • 100. Safety Issues when Delivering Service to the Home David Luxton, Ph. D.
  • 101. GUIDELINES FOR THE PRACTICE OF TELEPSYCHOLOGY interjurisdictional Practice Guideline 8: Psychologists are encouraged to be familiar with and comply with all relevant laws and regulations when providing telepsychology services to clients/ patients across jurisdictional and international borders.
  • 102. Licensure Portability Fred Milan, Ph. D.
  • 103. GUIDELINES FOR THE PRACTICE OF TELEPSYCHOLOGY Informed Consent Guideline 3: Psychologists make reasonable effort to obtain and document written informed consent that specifically addresses the unique concerns related to the telepsychology services they provide. When doing so, psychologists are cognizant of the applicable laws and regulations, as well as organizational requirements that govern informed consent in this area.
  • 104. GUIDELINES FOR THE PRACTICE OF TELEPSYCHOLOGY Confidentiality of Data and Information Guideline 4: Psychologists who provide telepsychology services make reasonable effort to protect and maintain the confidentiality of the data and information relating to their clients/ patients and inform them of the potentially increased risks to loss of confidentiality inherent in the use of the telecommunication technologies, if any.
  • 105. GUIDELINES FOR THE PRACTICE OF TELEPSYCHOLOGY Security and Transmission of Data and Information Guideline 5: Psychologists who provide telepsychology services take reasonable steps to ensure that security measures are in place to protect data and information related to their clients/ patients from unintended access or disclosure.
  • 106. l Licensure Portability I I I I I . u. . . tum . , . L_“Vii«i. vwl. . in Ii A . Www l Mrwwuu . Joe McMenamin, JD, MD
  • 107. GUIDELINES FOR THE PRACTICE OF TELEPSYCHOLOGY Disposal of Data and Information and Technologies Guideline 6: Psychologists who provide telepsychology services make reasonable efforts to dispose of data and information and the technologies used in a manner that facilitates protection from unauthorized access and accounts for safe and appropriate disposal.
  • 108. GUIDELINES FOR THE PRACTICE OF TELEPSYCHOLOGY Testing and Assessment Guideline 7: Psychologists are encouraged to consider the unique issues that may arise with test instruments and assessment approaches designedfor in-person implementation when providing telepsychology services.
  • 109. Assessment Sherry Benton, Ph. D.
  • 110. Coalition for Technology in Behavioral Science APA Divisions I8 Er 22 American Counseling Association American Psychiatric ssociation American Bar Association American Telemedicine Association Competencies Task Force is exploring ways to validate competency in various technologies related to Behavioral Health practice (telehealth, mHea| th etc). HL7 & Psychotherapy Note Task Force is working to help standardize interoperability between Electronic Health Records. An additional focus is the defining of the Psychotherapy Progress Note for EHRs. JournaITask Force is forming an exciting new journal devoted to research and articles related to technology in the behavioral sciences. It is now forming an Editorial Board. If interested in participating in any initiatives, please apply by visiting website: www. ctibs. org[
  • 111. 6 Learning Objectives Explain at least three important features of health care reform and how it will impact the future of telepsychology in the next 2-5 years Name at least three essential elements covered by the APA’s 2013 Telepsychology Guidelines Explain how multi-cultural issues are relevant to telepractice. Name three factors of relevance to telepsychology when practicing over state or international borders. Describe at least one best practice when using assessment tools online. Discuss at least one best practice for successful reimbursement when delivering telepsychological services.
  • 112. ' ‘P Questions. ,. J@M I Marlene M. Maheu, Ph. D. TeleMental Health Institute, Inc. Phone: 619-255-2788 Email: mmaheu@te| ehea| th. ORG