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A number of key studies in both behavioral health and medical practice have emerged to help independent practitioners better plan for their future with telehealth. One study that looked at both groups is CIGNA, which just reported that 2/3 of behavioral health visits are still being conducted virtually. Examining both primary care and behavioral services as the largest specialties utilizing telehealth in 2020, greater than one-fifth of primary care and almost two-thirds of behavioral care was delivered digitally. More specifically, in their study the percentage of these specialties delivering services via telehealth were: counseling: 51%, psychiatry: 52%, family medicine 20%, internal medicine: 27%, social work 54%, and speech therapy 49%.
The CIGNA study also showed that telehealth is not being used to replace all in-person healthcare services. For instance, pediatric care often was performed in-person with only 13% being delivered virtually. They also stated that, “more than half of Americans reported that they are comfortable with virtual consultations replacing in-person visits. Indeed, 58 percent agree with this sentiment, especially if it means they can do the visit while remaining at work or home, if the visit costs less and allows for free virtual follow-ups, and if it allows for long-distance care if the patient is out of the area.”
The Future of Telehealth for Behavioral Practitioners
Zhu and colleagues reported similar findings for telemental health within a variety of behavioral professionals.1 They disseminated and tallied results of a 15minute online survey, which was completed by 175 practicing and licensed telemental health providers. In addition to personal and professional demographic items, the survey included items about the frequency of telemedicine use, the proportion of caseload served by telehealth, the comfort level using telehealth before and during the COVID-19 pandemic, and expectations to use telemedicine after the pandemic ends. They summarized by stating that mental health counselors, providers who practiced in rural regions, and providers who served patients through out-of-pocket payments expressed the most interest in providing elemental health services after the pandemic.
Similar in findings, Pierce and colleagues also conducted a corroborating national study of pandemic-based changes in US mental health care delivery.2 They recruited 2,619 licensed psychologists located in the United States to examine their telepsychology use before the COVID-19, during the pandemic, and anticipated use after the pandemic. They also looked at the demographic, training, policy, and clinical practice predictors that might also account for their findings.
Up from an average of 7.07% of their clinical work being conducted through telehealth prior to COVID, it increased 12-fold to 85.53% during the pandemic. According to their survey, 67.32% of psychologists are still conducting all of their clinical work using telehealth. Psychologists in the Pierce study estimated that they would perform 34.96% of their clinical work via telehealth post-pandemic. Interestingly, a larger increase in the percentage of telehealth use occurred in women. They also provided details of subgroups and concluded that both individual and practice characteristics affected psychologists’ ability to adopt telehealth overall.
In another study of uptake and future expectations, Reilly and colleagues found that approximately 78% of psychologists, social workers, and neuropsychologists have delivered telehealth services since early April 2020.3 The majority of the 903 mental health practitioners surveyed rapidly adjusted their practices, predominantly by shifting to telehealth. As can be expected, independent practice providers reported less difficulty implementing telehealth than providers in other settings. Overall, 59.62% were interested in continuing to provide telehealth health services moving forward.
Future of Telemedicine
Looking at the more medical side of independent practice, a Kareo study of medical practitioner examined attitudes about their future and telehealth. Independent physician practitioners feel more optimistic about their future owing to telehealth strategies. Due to telehealth’s success in helping them survive during the pandemic, independent practices are more optimistic about their future and downplay the possibility of hybrid healthcare.
According to the Founder and CEO of Kareo, independent consulting practices ended the year on a positive note contrary to expectations. The report states that telehealth adoption has increased from 22% in 2019 to 41% in 2020 to 80% at the end of 2020. For this report, Kareo surveyed 1300 practices from over 50 specialties. Nearly 35% of the practices were staffed by a single physician, while 38% employed two to five providers, and 27% employed six or more providers. A renewed commitment to the needs of patients and an integrated approach to technology solutions have been allowing practices to reinforce relationships with their patients. Telehealth adoption was found to be the most significant technology for independent medical practitioners.
A troubling trend that had some predicting the end of the small doctor’s office or clinic has seen some 27% of doctors seeking a merger with another practice or hospital. But today, more than 86% of practices surveyed do not intend to merge or enter into a partnership. This proves that independent practices have a promising future, and we, as a society, must support them so that they can thrive.
One more factor contributing to telehealth adoption is the combination of telehealth with in-person care, termed hybrid healthcare. Read Telehealth.org’s article entitled, Hybrid Healthcare System: Establishing a Post-Pandemic Telehealth for more information. As the country recovers from the pandemic and in-person treatment resumes, practices must blend the best of both worlds, delivering in-person care when necessary or requested, while also allowing virtual health care to be offered as an alternative option.
Advantages of Independent Practices
The best thing about independently-owned practices is they are more responsive to client and patient needs and provide a greater level of personalization. Moreover, they tend to have lower average costs per client/patient and lower hospital readmission rates than do hospitals or larger practices. As the report suggests, many independent health care providers found that telehealth adoption has played a key role in improving care delivery models. These providers developed better interactions with their patients and eliminated bottlenecks, delays, and other inefficiencies.
A priority this year is insurance reimbursements. 58% listed it as a priority this year, compared to 45% in 2019. The end of the emergency state, federal health care measures and the reemergence of old telehealth rules highlight the challenges faced by independent practices. Many states have passed laws to support telehealth coverage and access during the pandemic. However, states and the federal government are under pressure to establish and enact long-term comprehensive telehealth policies that help practices keep the momentum they have achieved during the pandemic. While a corollary study is not available for behavioral health, similar results are expected.
Journal Article References
- 1 Pierce, B. S., Perrin, P. B., Tyler, C. M., McKee, G. B., & Watson, J. D. (2021). The COVID-19 telepsychology revolution: A national study of pandemic-based changes in U.S. mental health care delivery. American Psychologist, 76(1), 14–25. https://doi.org/10.1037/amp0000722
- 2 Reilly, SE, Zane, KL, McCuddy, WT, et al. Mental health practitioners’ immediate practical response during the COVID-19 pandemic: observational questionnaire study. JMIR Ment Health 2020; 7: e21237. doi:10.2196/21237
- 3 Zhu, D., Paige, S. R., Slone, H., Gutierrez, A., Lutzky, C., Hedriana, H., … & Bunnell, B. E. (2021). Exploring telemental health practice before, during, and after the COVID-19 pandemic. Journal of Telemedicine and Telecare, 1357633X211025943.
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