More and more, we are using technology to communicate and connect with others. Even medicine is entering the domain of telecommunications to serve people who cannot come to the doctor’s office for consultation or treatment. Technology is breaking down the barriers to effective and efficient healthcare for those who are too remote from a clinic or counseling practice or due to other limitations cannot drive to a doctor’s office when necessary. There is a burgeoning industry that is designed to help people gain more access to mental health services.
Telehealth uses technology (cell phones, computers, internet, etc.) to provide access to healthcare professionals. While it offers much for the consumer of mental health services, it also has a few draw backs. For a start, it is doubtful as to whether a practitioner can fully leave the "hands-on" experience behind. Although it is predicted that telehealth will replace many consultations and other health interactions, it cannot yet fully replace a physical examination, this is particularly so in diagnostics, rehabilitation or mental health.
Telehealth enables timely and flexible care to clients wherever they may be; although this is a benefit, it also poses threats to privacy, safety, medical licensing and reimbursement. The location of the client/patient currently determines which state laws apply to the service. As an LPC clinician licensed only in the State of Texas, I may not be able offer clinical services to someone whose primary residence is in another state. These rules will probably change as more states view the benefits of telehealth.
The risk to privacy is another limitation that bears discussion. With all health practitioners, confidentiality is of utmost concern. In my office, I have better control over the exchange of confidential information. However, if the client is participates in a session where the client is in a public place using their cell phone or computer, that confidentiality may be severely compromised.
Another limitation is where Medicare will reimburse for telehealth services only when a patient is living in an area where specialists are in shortage, such as in rural counties. The area is defined by whether it is a medical facility as opposed to a patient's' home. The site that the practitioner is in, however, is unrestricted. Medicare will only reimburse live video (synchronous) type services, not voice only sessions (such as a land-line telephone). Some insurers currently will reimburse telehealth, but not all. So providers and clients must look at financial consequences if the client’s insurer will not offer telehealth as a mental health benefit. While things are changing in these areas, it is best for the client verify their benefits for telehealth counseling.
I have been monitoring how Medicare, insurance companies, and state laws/regulations around telehealth and am now more comfortable in offering this service. So I am excited to begin offering it to clients whose distance and health limits their ability to seek mental health treatment. Balancing quality of care with the values of integrity of the relationship and the limitations imposed by the profession remain primary goals in my practice.