Telepsychiatry Leader Explains How Missouri’s Outdated Medicaid Policy is Limiting Patient-Care
Missouri, and the nation as a whole, suffers from a shortage of physicians. In particular, there is an especially inadequate number of psychiatrists. According to US Health News, there is 1 psychiatrist for every 7,352 people in Missouri and 96 percent of counties in the US have a shortage of psychiatric prescribers overall. Missouri’s shortage is exacerbated by an archaic Medicaid policy that mandates that all care must come from physicians located within Missouri or a bordering state in order to receive Medicaid coverage.
While this policy may seem logical, and perhaps was at the time it was created, in today’s age of telemedicine- it is limiting and unnecessary.
Telemedicine, or the delivery of certain applications of medical care through technology allows for medical professionals, regardless of the provider’s physical location, to treat patients using tools like real-time videoconferencing. For example, for the past 15 years I have worked as a child and adolescent telepsychiatrist. Though I live in New Jersey, through telemedicine I currently see patients in the 20 different states where I am licensed.
This means I can seamlessly transition from an appointment with a child in rural New Mexico to a session with a parent in inner-city Chicago with no time in between. It means people can access me as a psychiatrist without having to be in the same room or even the same state. By efficiently leveraging the time of the nation’s current pool of physicians, those of us who practice telebehaiovral health, are able to address the physician shortage and help patients access needed care. Because, however, I happen to live in New Jersey instead of Missouri’s neighbor Illinois, I am, by Missouri Medicaid standards, unqualified to treat Missouri patients.
I write this not because I am a physician desperate for work in Missouri, but because I am an advocate for providing patients with the best care available, and I recognize that with telemedicine, that care may exist beyond the arbitrary lines of Missouri and its bordering states. In order to best leverage the breadth of telemedicine’s potential, it is a paramount that Missouri drop the “bordering states” policy and draw from a pool of all Missouri-licensed physicians.
In looking specifically at psychiatry, there is ample clinical-based evidence that telepsychiatrists can develop sustained and meaningful relationships with patients. As a seasoned telepsychiatrist myself, I have successfully served patients who struggle with a huge variety of concerns in nearly every setting. Understanding the bio-pscyho-social aspects of a patient is not determined by the location of the provider nor the medium used to talk and interact. Technology is merely a means for establishing the connection. A trained telepsychiatrist can adapt his normal in-person approach to be effective via videoconferencing.
Telepsychiatrists can successfully familiarize themselves to a patient population and community remotely. By using empathic listening, spending time with a patient, and communicating with family members and other caregivers, a telepsychiatrist can effectively serve a patient. The development of a relationship is based on the skills and empathy of the physician paired with the patient’s desire to connect. In-person interaction does is not the foundation of good clinical care; the knowledge and skill of the physician is what matters.
In addition to having a level of clinical competency, telepsychiatrists, just like in-person providers, must learn about the community and site where they are serving. The necessity of solid orientation and continuous training is not a feature unique to out-of-state remote providers. Though some of this training, orientation, and continued collaboration may need to be conducted through a different medium, the core content remains constant. Once a telepsychiatrist is oriented and begins to serve patients, he or she should regularly collaborate with the onsite team to ensure that no patient is seen in a vacuum. Again, this is not a notion unique to care delivered via telemedicine.
In conclusion, restricting physicians to just those within Missouri or bordering states means that potentially excellent candidates are being prevented from entering the pool of physicians available to serve Missouri citizens. By widening the pool and vetting candidates for culture and personality fit, physicians who serve via telemedicine can be just as effective, loyal, and reliable as in-person physicians.
If there were enough physicians in Missouri and its bordering states to serve the need, the effort to convince policymakers to adapt their licensing laws to allow for care across state lines would be moot, but unfortunately, this is not the case.
Restricting the use of telepsychiatry is a disservice to Missourians who deserve timely, quality care. I urge Missouri Medicaid to update its policy so that Missourians have a greater opportunity to receive care.
James Varrell, MD
Jim Varrell, M.D. is American Board certified in Psychiatry and Neurology, and certified in American Academy of Child and Adolescent Psychiatry with a specialty in autism. Dr. Varrell has been at the forefront of telepsychiatry across the nation and continues to educate the medical community regarding the benefits of telepsychiatry through various presentations and forums where he has served as a panelist and presenter. Dr. Varrell preformed the nation’s first involuntary psychiatric commitment via a televideo unit in 1999. Today, Dr. Varrell still regularly performs telepsychiatry evaluations and manages a staff of telepsychiatrists who see and treat consumers in 16 states.