Association of Characteristics of Psychiatrists With Use of Telemental Health Visits in the Medicare Population

Choi, Suyoung; Wilcock, Andrew; Busch, Alisa B.; Huskamp, Haiden A.; Uscher‐Pines, Lori; Shi, Zhuo; Mehrotra, Ateev

doi:10.1001/jamapsychiatry.2019.0052

Cited by 20 publications

(18 citation statements)

References 6 publications

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“…The percentage of psychiatrists seeing more than three-quarters of their patient caseload via telehealth reached an unprecedented magnitude during the pandemic (85%) compared to before the pandemic (2.1%) [5]. This accelerated uptake contrasts starkly with the slow rate of engagement noted since the inception of telepsychiatry in 1956 [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Factors Influencing Patients’ Initial Decisions Regarding Telepsychiatry Participation During the COVID-19 Pandemic: Telephone-Based Survey

Severe¹,

Tang²,

Horbatch³

et al. 2020

JMIR Form Res

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Background Telepsychiatry enables patients to establish or maintain psychiatric care during the COVID-19 pandemic. Little is known about the factors influencing patients’ initial decisions to participate in telepsychiatry in the midst of a public health crisis. Objective This paper seeks to examine factors influencing patients’ initial decisions to accept or decline telepsychiatry immediately after the stay-at-home order in Michigan, their initial choice of virtual care modality (video or telephone), and their anticipated participation in telepsychiatry once clinics reopen for in-person visits. Methods Between June and August 2020, we conducted a telephone-based survey using a questionnaire comprising 14 quantitative and two qualitative items as part of a quality improvement initiative. We targeted patients who had an in-person appointment date that fell in the first few weeks following the Michigan governor’s stay-at-home order, necessitating conversion to virtual visits or deferment of in-person care. We used descriptive statistics to report individual survey responses and assess the association between chosen visit type and patient characteristics and future participation in telepsychiatry using multivariable logistic regression. Results A total of 244 patients whose original in-person appointments were scheduled within the first 3 weeks of the stay-at-home order in Michigan completed the telephone survey. The majority of the 244 respondents (n=202, 82.8%) initially chose to receive psychiatric care through video visits, while 13.5% (n=33) chose telephone visits and 1.2% (n=3) decided to postpone care until in-person visit availability. Patient age correlated with chosen visit type (P<.001; 95% CI 0.02-0.06). Patients aged ≥44 years were more likely than patients aged 0-44 years to opt for telephone visits (relative risk reduction [RRR] 1.2; 95% CI 1.06-1.35). Patient sex (P=.99), race (P=.06), type of insurance (P=.08), and number of previous visits to the clinic (P=.63) were not statistically relevant. Half of the respondents (132/244, 54.1%) stated theywere likely to continue with telepsychiatry even after in-person visits were made available. Telephone visit users were less likely than video visit users to anticipate future participation in telepsychiatry (RRR 1.08; 95% CI 0.97-1.2). Overall, virtual visits met or exceeded expectations for the majority of users. Conclusions In this cohort, patient age correlates with the choice of virtual visit type, with older adults more likely to choose telephone visits over video visits. Understanding challenges to patient-facing technologies can help advance health equity and guide best practices for engaging patients and families through telehealth.

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Section: Introductionmentioning

confidence: 99%

Factors Influencing Patients’ Initial Decisions Regarding Telepsychiatry Participation During the COVID-19 Pandemic: Telephone-Based Survey

Severe¹,

Tang²,

Horbatch³

et al. 2020

JMIR Form Res

View full text Add to dashboard Cite

show abstract

“…In a review of Medicare fee-for-service claims between 2014 and 2016, psychiatrist telemental health providers were more likely to be early in their careers, employed in large practices, and serving rural regions as compared with psychiatrists who did not use telemental health services [ 19 ]. Despite this knowledge, little is known about the characteristics of community telemental health providers, including their use of telemedicine and the factors that motivate them to use the technology [ 20 , 21 , 22 ].…”

Section: Introductionmentioning

confidence: 99%

Acceptability of Telemedicine Features to Promote Its Uptake in Practice: A Survey of Community Telemental Health Providers

Bunnell

Barrera

Paige³

et al. 2020

IJERPH

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Understanding what motivates mental health providers to use telemedicine (i.e., telemental health) is critical for optimizing its uptake, especially during unprecedented times (e.g., the COVID-19 pandemic). Drawing from the Technology Acceptance Model (TAM), this report examined the characteristics of telemental health providers and how the acceptability of telemedicine features contributes to their intention to use the technology more often in practice. Telemental health providers (N = 177) completed an online survey between March and May 2019. Most providers (75%) spent less than 25% of their work-week using telemedicine, but 70% reported an intention to use telemedicine more in the future. The belief that telemedicine affords greater access to patients, work-life balance, flexibility in providing care, and the opportunity to be at the forefront of innovative care were significant predictors of intentions to use the technology more in the future. Other significant predictors included needing assistance to coordinate insurance reimbursements, manage a successful telemedicine practice, and integrate the telemedicine program with other health IT software. Findings have important implications for increasing the frequency of telemedicine use among telemental health providers. Future research and practice should leverage providers’ positive beliefs about telemedicine acceptability and consider their needs to enhance its uptake.

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“…In prior work, rural psychiatrists were much more likely to provide telemental health. 4 The visit frequencies in the sample population were multiplied by 5 to reflect the estimated numbers that would be in the 100% 2017 Medicare files. Column percentages were limited to the 84 organizations that could be identified.…”

Section: Discussionmentioning

confidence: 99%

“…Although it is recognized that telemental health use is rapidly increasing, [1][2][3] relatively little is known about the providers and organizations that are providing this care. Prior work has described the psychiatrists who provide telemental health 4 ; however, it remains unclear which types of organizations (e.g., private telemedicine companies, academic medical centers, and community health centers) are most likely to offer this care. To fill this knowledge gap, we characterized the organizations that provide and bill for any telemedicine visit for mental health and substance use disorder (SUD) in the Medicare population.…”

Section: Introductionmentioning

confidence: 99%

Characteristics of Organizations That Provide Telemental Health

Shi

Huskamp

Souza

et al. 2019

Healthcare Transformation

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Telemental health use is rapidly increasing in the United States. It remains unclear what type of organizations are providing this care. Using deidentified claims from a 20% random sample of 2017 Medicare beneficiaries, we identified the 100 tax identification numbers billing the highest volume of telemental visits and categorized them into 84 unique organizations who provided 66.9% of all telemental health visits. Among the organizations categorized, five private telemedicine companies provided 48.3% of the visits with the remaining visits largely provided by private health clinics (24.3%) and community health centers (14.5%). A large majority of telemental visits (87.2%) were provided by organizations that focused solely on mental health or substance abuse services.

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Association of Characteristics of Psychiatrists With Use of Telemental Health Visits in the Medicare Population

Cited by 20 publications

References 6 publications

Factors Influencing Patients’ Initial Decisions Regarding Telepsychiatry Participation During the COVID-19 Pandemic: Telephone-Based Survey

Factors Influencing Patients’ Initial Decisions Regarding Telepsychiatry Participation During the COVID-19 Pandemic: Telephone-Based Survey

Acceptability of Telemedicine Features to Promote Its Uptake in Practice: A Survey of Community Telemental Health Providers

Characteristics of Organizations That Provide Telemental Health

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