Is telehealth here to stay?
Accessibility for patients is benefit
Now that mask mandates and social distancing are a thing of the past, most medical care has gone back to being primarily in-person. This is not the case, however, for mental health care.
Telehealth usage has dropped from its peak in 2020 at the height of the pandemic, but remains well above pre-COVID levels. Telehealth appointments made up about one percent of all visits in the last three quarters of 2019, according to data from Epic Research.
By March of 2020, mental health and substance use disorder care providers saw telehealth usage increase to nearly 60 percent of all visits. Today, more than a third of mental health care is delivered by video or phone.
While the transition to a telehealth model was difficult for many psychologists, the resounding opinion is that it has provided significant benefits for their practices. The most frequently cited one being accessibility.
Psychologist and president of the Minnesota Psychological Association, Matthew Syzdek, Ph.D. pointed out that since the boon of telehealth people have a wider variety of options when it comes to their mental health care. This alternative allows people to work with a therapist who best fits their needs, and allows therapists to offer their services to a greater number of patients.
“I work with busy professionals and I work with high schoolers,” he said. “I don’t know who is busier, and so something that before was maybe a three-hour commitment each week with travel time is now only 45 minutes.”
Syzdek also noted that the convenience of telehealth can alleviate a sense of commitment that would often lead to patients prematurely stopping treatment.
“I think telehealth is a huge piece of that because before they might have eventually said, ‘oh, you know, I’m a little bit better and I don’t want to keep spending all this time so I’m just going to stop therapy.’ And maybe they don’t get to a place of long term symptom remission or greater functioning, but they stop prematurely because of the time commitment.”
Demand for mental health care services has never been higher and some psychologists believe this is, in part, a result of telehealth diminishing barriers of entry. Behavioral health psychologist Kevin Burchby, Ph.D. of Lexington, Mass. believes there are clients who certainly would not be in any consistent therapy if it was not by a video option.
“Clients with depression symptoms impacting their motivation or energy levels are more able to log into a video session than to travel during those times,” he said. “And clients with social or general anxiety are usually more comfortable meeting from an environment they are familiar with.”
While feelings about remote therapy are generally positive among psychologists, telehealth is not without its disadvantages.
Roberta Caplan, Ph.D., a Massachusetts licensed psychologist of 30 years, was pleasantly surprised by how beneficial telehealth turned out to be for her patients and her practice. However, she believes that the physical presence of another person may matter more for patients with trauma histories or severe mood deregulation.
Several psychologists have noted that certain types of therapy benefit greatly from being done in-person. Burchby cited certain trauma approaches such as sensorimotor processing and biofeedback that he feels are not well-suited to video therapy. There also seems to be some agreement among psychologists that in-person therapy is ideal for actively suicidal patients.
Before COVID happened, it was considerably more difficult to get reimbursement for remote therapy. The declaration of a public health emergency by the federal government led to a wave of reforms and waivers to Medicaid and Medicare.
Most psychologists feel that as long as health insurance companies continue to reimburse patients for telehealth sessions, there is no reason remote therapy will not be an integral part of mental health care for the foreseeable future.
Danielle Barry, Ph.D.
“Telehealth proved to be so popular with clients during the pandemic that insurance companies have retained equivalent coverage for telehealth and in person visits, at least for behavioral health,” said Danielle Barry, Ph.D., also Massachusetts-based. “(That) makes sense if the goal is to make psychotherapy accessible to more people.”
By all accounts, telehealth therapy is as financially viable as traditional in-person therapy—if not more. “My practice is almost fully based on insurance claims which have currently remained at parity with in-person sessions,” said Burchby. “And working from a home office reduces the overhead cost for running my practice significantly.”
However, the telehealth flexibilities adopted during the pandemic are not guaranteed in the future. On December 29, 2022 the federal government passed a law that allowed greater flexibility with telehealth for Medicare beneficiaries. But those regulations expire at the end of 2024.
On the state level, rules differ from state to state, especially when it comes to private payer insurance. Connecticut, for example, passed a law instituting flexible telehealth policies that expires at the end of June of this year.
Currently, all New England states have telehealth parity laws that require insurers to provide coverage and reimbursement for telehealth care on the same basis that they would for care services provided in person.
That Maine and New Hampshire only passed their parity laws in the last year suggests that New England states whose parity laws are close to expiration will likely renew their current telehealth-related regulations.
Barry said that insurance companies even appear to be promoting telehealth to manage the demand. “Currently, the demand for psychotherapy is very high and the supply of providers is too low to meet the demand. If/when supply outweighs demand again, then I could see coverage of telehealth becoming more restricted.”
She also pointed to the infancy of telehealth practice as a factor, noting that if future research was to find telehealth inferior to in-person visits in terms of symptom reduction or other measurable outcomes, coverage could decline.