Tuesday, May 12, 2020

Psychiatrists Urge Field to Plan Now for Post–COVID-19 Psychiatry

The lifting of federal and state regulatory barriers to telemedicine in response to COVID-19 has led to an unprecedented revolution in telehealth. Psychiatrists, patients, and health systems have shown in recent months that they can quickly adapt to telepsychiatry, but numerous questions remain: “What happens next?” and “What happens when the COVID-19 pandemic ends?” Such questions are the subject of an article appearing in JAMA Psychiatry by psychiatrists Jay H. Shore, M.D., M.P.H., and Christopher D. Schneck, M.D., of the University of Colorado School of Medicine and Matthew C. Mishkind, Ph.D., of the Steven A. Cohen Military Family Clinic at the University of Colorado.

“When the pandemic eventually ends, psychiatry and telepsychiatry will be transformed. What the psychiatric care environment will look like is currently unpredictable,” they wrote. “The longer the pandemic and associated quarantines continue, the more likely current changes become solidified and routinized into the practice of psychiatry. Less certain are what changes will remain in effect when the pandemic is controlled, as well as what changes that will occur if the pandemic becomes episodic, resulting in a series of sporadic and regional quarantines. Will the current regulatory and structural changes stay in place, or will they also change in a parallel, sporadic, and episodic manner?”

Now is the time for psychiatric organizations and clinicians to plan for these different scenarios, they wrote, including “how, when, and to what extent they would transition back to more in-person care” and what the financial implications of such changes may be. “It is not clear how the current billing environment will affect the long-term resources and sustainability of psychiatric organizations and clinicians. To the extent that information is available, financial forecasting and planning with assumptions of both current and traditional billing environments is warranted.”

This time also presents an opportunity for the field to learn more about the interactions with patients that can and should take place in person versus those that can be done through telepsychiatry or other technologies, they continued. “How much virtual care is too much? Is there a virtual saturation point, at which the benefits of a virtual relationship decrease or patients request more in-person interactions? What data need to be captured now to better understand this and identify current lessons learned?”

They concluded, “The regulatory and system changes wrought by the COVID-19 crisis present the opportunity for the field to gather lessons learned to strategically shape the post–COVID-19 world of psychiatry and telepsychiatry. This work could usher in a golden era for technology in psychiatry in which we are able to harmonize the benefits of telepsychiatry and virtual care while maintaining the core of our treatment: that of human connectedness.”

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