APA Members Urge Congress To Protect Telehealth Access

In May, Shabana Khan, M.D., arrived in Washington, D.C., for a congressional briefing on telehealth. She already had appointments with patients scheduled, but she did not have to cancel them. Instead, she conducted the appointments via telehealth.

The ability to utilize telehealth meant Khan was able to speak with congressional staff members about an incredibly important issue, she said, while ensuring her patients weren’t put through the hassle of rescheduling, potentially delaying needed treatment. Yet if the flexibilities that Congress implemented for Medicare patients ends, she worries that some of her patients will no longer be able to access mental health care and that other payers may follow Medicare’s lead.

Khan is chair of APA’s Committee on Telepsychiatry and director of child and adolescent telepsychiatry at NYU Langone Health.

Jimmy Potash, M.D., M.P.H., panel moderator and a member of APA’s Council on Healthcare Systems and Financing, began the briefing by thanking Congress for swiftly introducing telehealth flexibilities when the COVID-19 pandemic started.

“These flexibilities have been a lifesaving tool for patients across the country, especially those seeking mental health services,” said Potash, who also serves as the Henry Phipps Professor of Psychiatry and Behavioral Sciences, director of psychiatry, and psychiatrist in chief at Johns Hopkins Medicine.

However, at the end of the year, Medicare patients will face a new requirement: They must have an in-person visit within six months of a telehealth appointment. (Patients receiving substance use disorder treatment are exempt from this rule.) During the briefing, the panel urged Congress to pass the Telemental Health Care Access Act (HR 3432/S 3651), which would permanently remove the in-person requirement for Medicare patients.

The bipartisan bill is sponsored by Reps. Doris Matsui (D-Calif.) and Troy Balderson (R-Ohio), as well as Sens. Bill Cassidy (R-La.), Tina Smith (D-Minn.), Ben Cardin (D-Md.), and John Thune (R-S.D.).

The panelists explained that the in-person requirement would apply to patients who have already been utilizing telehealth for years, risking ending care entirely for those patients who cannot make in-person visits.

Khan described previous work for a clinic that was the sole provider of psychiatric care to Medicare residents across five counties, making the requirement for patients to be seen in person especially burdensome for them. The decision about whether to select in-person or virtual care should be left to the clinician and patient, she emphasized. When necessary, psychiatrists can collaborate with their patients’ primary care providers or nurses at local clinics to ensure proper assessment, diagnosis, and treatment of patients who are too far away to receive in-person psychiatric care.

“I certainly support in-person treatment for patients, but not if it’s going to impact their ability to obtain mental health care,” Khan said. Just over half of U.S. counties do not have even one practicing psychiatrist, making telepsychiatry even more important for these patients.

Yet even urban patients can have trouble accessing in-person care. “Even in New York City, if I have a patient who is in the Bronx, it could require them to take three buses to reach me downtown,” she said. “If you have elderly patients or someone with mobility or transportation issues and they can’t afford an $80 Uber, now care is unaffordable for them.”

Panelists also outlined the numerous benefits of telehealth beyond easing transportation burdens. The number of no-shows have dramatically declined, and patients are able to keep their appointments even when they have to travel or their schedules change unexpectedly.

In addition, Potash described the benefits of getting a glimpse into a patient’s home. “I’ve had experiences with patients who are in some ways quite isolated who have pets that they’re very close to,” he said. “That closeness becomes very vivid when you see the cat walk across the desk or the dog come up to them while they’re on camera. You get a real sense of their emotional life.”

Potash shared another example of a patient whom he saw in person until the patient’s symptoms improved, and he was able to get a job. “Once he got his job, the logistics of continuing to see me were vastly easier for him if he was seen via telehealth, because he didn’t have to tell his boss that he had to take several hours off at a time,” he said. “I think all of us would agree that telemental health has obviously expanded access to care for patients who need mental health services.”

APA hosted the briefing along with the American Psychological Association, the Association of Behavioral Health and Wellness, and the American Foundation for Suicide Prevention. Khan was joined on the panel by Kate Romanow, J.D., vice president of external affairs at UnitedHealth Group, and Jim Broyles, Ph.D., a clinical psychologist and director of professional affairs for the Ohio Psychological Association. ■