High-Tech Treatments (Part 2)
Reimbursement for Services
Treatment providers interested in adding new technologies
to their practices also need to determine how they will
be paid for these new services. As an example, a representative
from the Centers for Medicare & Medicaid Services
(CMS), addressing the conference through a video-teleconferencing
hookup from Baltimore, MD, focused on Medicare reimbursements.
Medicare requires interactive telecommunications technology
as a condition of payment for tele-health services along
with certain facility and geographic criteria.
Medicare covers a range of mental health services as
tele-health services. Those services include individual
psychotherapy, pharmacologic management, and psychiatric
diagnostic interview examinations. However, services
must be furnished by physicians, clinical psychologists,
clinical social workers, or clinical nurse specialists.
Services by certified addiction counselors are not covered.
Medicare requires an interactive audio and video telecommunications
system that permits two-way interaction between the physician
or practitioner at the distant site and the beneficiary
at the originating site (the location of the patient
at the time the tele-health service occurs). This service
must be rendered in real time with both the patient and
the practitioner present and able to see and hear one
However, as long as the service requirements meet the
regulations for the patient and for the interactive audio
and video telecommunications, Medicare imposes no limitations
on the type of technology that practitioners may use.
For example, wireless or Internet hookups would each
Furthermore, the originating site must be located either
in a county outside a metropolitan statistical area or
in a rural health-professional shortage area.
Finally, the originating site facility must be either
a physician's or practitioner's office, hospital, critical
access hospital, rural health clinic, or federally qualified
health center. Facilities such as a practitioner's office
or a rural health clinic must be equipped for video teleconferencing.
Medicare will not reimburse tele-mental health services
delivered to patients' homes.
According to CMS, current Medicare reimbursement requirements
are legal mandates that only the U.S. Congress can change.
Medicaid, however, may cover a wider range of technology-assisted
services, and coverage may vary among individual states.
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As presentations revealed, the range of professional
services now offered as well as the technology issues
to be addressed are well beyond what's widely used. Mental
health and substance abuse professionals across the Nation
are adapting effective treatment methods to the capabilities
of various technologies and the needs of varied consumers.
Dozens of hospitals, clinics, and state and local agencies
already deliver mental health services through video
teleconferencing. Technology-based substance abuse programs
range from primary prevention for children to aftercare
for adult addicts in recovery. These programs use e-mail,
chat rooms, live over-the-Internet groups, and interactive
Technology-based interventions using an equally wide
range of equipment address issues including smoking cessation,
weight loss, eating disorders, and depression among breast
Consumers receive services in schools, workplaces,
their own homes, and over mobile devices, wherever they
are throughout the day. Still, these technological approaches
face widespread skepticism or even opposition among some
treatment professionals. But compared to the needs of
underserved groups such as rural residents, these objections
are minor. More than 80 percent of master's-level social
workers and 90 percent of psychologists and psychiatrists
practice in metropolitan areas. More than 60 percent
of rural Americans reside in federally designated shortage
areas for mental health services, stated Dennis Mohatt,
Director of the Western Interstate Commission for Higher
Education's Mental Health Program.
The promise of e-therapy and tele-mental health also
comes laden with many unanswered legal, ethical, and
clinical questions. "Most state laws make no mention
of these new services," said Anthony Ragusea, a
predoctoral intern in psychology at Washington State
University. He added that there is "no actual case
law on this yet . . . still, most professional organizations
in mental health have approved the practice of online
Because of state control of licensure, however, electronic
services that cross state lines or even national borders
are a "crucial legal issue" that has yet to
be resolved, said Jeffrey Barnett, Psy.D., a licensed
psychologist in private practice.
Service providers using electronic technologies face
other serious challenges:
Difficulty in diagnosing or evaluating patients
without actually seeing or hearing them in person
Requirement to ascertain true identities and
obtain valid consent in the anonymity of cyberspace
Importance of protecting confidentiality and
privacy (Who else may have access to a client's computer
or e-mail account?)
Possibility of having to deal with emergencies
or make service provider referrals in distant places.
In addition, practitioners must find ways to maintain
a professional tone in electronic interactions and to
make up for the nuances of facial expression, tone of
voice, and body language that some technologies do not
Numerous professional associations are currently grappling
with the ethics of new technologies, but a general consensus
on these issues has yet to emerge, Mr. Ragusea said.
To date, research on technology-assisted services finds
the outcome to be favorable and comparable to traditional
methods in general, reported Aaron Rochlen, Ph.D., an
assistant professor of counseling psychology at the University
of Texas. Only a small number of studies have been conducted.
"The importance of research cannot be overstated,"
Dr. Rochlen said, especially of "big-number studies"
with control groups to evaluate outcomes.
"It is time for new strategies to deliver much
needed care," said Dr. Clark as the conference concluded.
« See Part 1: Conference Explores High-Tech Treatments
See AlsoRelated Content:
From the Administrator: High-Tech Options Expand Horizons »
E-Glossary and Resources »
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