Telepsychiatry in Washington

Why is telepsychiatry a good solution for improving Washington’s behavioral health services?

Washington, like many other states across the country, suffers from a shortage of psychiatric prescribers. US News reports only 1 psychiatrist for every 8,300 Washington residents1.

Telepsychiatry is an effective medium of care that increases access to Washington-licensed providers and specialists who may live in other parts of the country as well as to providers who are spread out throughout the state. Telepsychiatry is also a way to better leverage the time of existing Washington-based psychiatric prescribers who could seamlessly transition between appointments at different sites without having to physically travel.

Where could telepsychiatry be used in Washington?

An especially serious issue for Washington is psychiatric boarding, when a mentally ill resident is detained while waiting for psychiatric treatment.

Untreated patients pose increased risk to themselves and the facilities that house them while they wait for care. Recently, there has been a decrease of psychiatric beds in Washington with the number dropping from 1,759 beds statewide to only 1,507 in five years1.  A national study of 300 Emergency Department directors found that 41% of patients wait 2 days or more for psychiatric care.

In hospitals, telepsychiatry can be an important way of reducing ED crowding and boarding, which according to the ACEP is a major concern. Currently, Washington only has 8.3 psychiatric beds per every 100,000 people2. Using telepsychiatry would reduce inappropriate admissions, reduce risks, save costs and improve ED throughput.

Telepsychiatry is especially useful in rural areas. With telepsychiatry, facilities that offer behavioral health services can provide onsite psychiatric care to consumers in need using remote providers. Routine telepsychiatry reduces travel times, reduces costs and increases the care capacity of facilities.

What other settings could benefit from telepsychiatry in Washington?

Telepychiatry can be used to augment the care capacity of most facilities that offer behavioral health services including:

-Outpatient clinics

-CMHCs

-FQHCs

-Universities

-Correctional Facilities

-Hospital EDs

-Inpatient Units

-Residential Programs

-Mobile Crisis Units

-Primary Care Facilities

-ACOs

What are obstacles to telepsychiatry in Washington?

Private insurance companies are not required to cover telepsychiatry or any other telehealth service in Washington.

However, Washington legislators know that telemedicine is an important issue on the table. A telemedicine parity law is now on its third circuit through the House after being passed and redirected there twice already by the state Senate.

If passed in its third iteration, HB 1448 would set regulations and guidelines for the implementation of telemedicine programs throughout the state.

In the mean time however, Washington residents are suffering from the lack of psychiatric care available to them.

Providers who practice telepsychiatry in Washington must be licensed to practice by the state. However, physicians who prescribe medication based solely on electronic communication do not meet the standards of medical practice by the State of Washington Medical Quality Assurance Commission3. This restriction limits the usability of telepsychiatry for all models where the remote provider is not able to collaborate with an in-person provider.

For information on the most up-to-date reimbursement guidelines for private payers and Medicaid visit the Center for Telehealth and e-Health Law (CTeL). Medicare will reimburse for telepsychiatry services when a community is considered rural.

Am I Rural? Use the Rural Assistance Center’s “Am I Rural?” tool to determine the status of your community.

What types of providers are available through telepsychiatry?

-Psychiatric Nurse Practitioners

-Adult psychiatrists

-Child and Adolescent Psychiatrists

-Substance Use Specialists

-Integrative Psychiatry Specialists

-Clinical Psychologists

-LCSWs

-LPCs

Sources:

1) US News Health

2) ACEP

3) Seattle Times: Department of Health and Human services at Washington State Institute for Public Policy, Legislation Evaluation and Accountability Program Committee

3) Center for Telehealth and E-Law