TY - JOUR
T1 - Geriatric Telepsychiatry
T2 - Systematic Review and Policy Considerations
AU - Gentry, Melanie T.
AU - Lapid, Maria I.
AU - Rummans, Teresa A.
N1 - Funding Information:
Overall, TMH is a promising new avenue for the delivery of high quality, high value care to older adults. Unfortunately, fulfilling the promise of TMH for older adults has been limited by several barriers. In the United States, research studies in TMH have often been funded by external funding sources such as state and federal grants. Self-sustaining clinical programs in TMH have been limited at least in part, by insufficient funding and state/federal regulations. The limitation of funding of TMH services under Medicare is particularly relevant to geriatric psychiatrists seeking to improve access for older adults. Currently under Medicare, TMH services are limited to individuals seen in rural clinics. These restrictions have significant impact on the ability to develop and sustain long-term TMH practices for the treatment of older adults. Several policy areas need to be addressed in order to improve access to telemedicine services for older adults. Most crucial is to broaden the populations eligible for telemedicine services under Medicare by removing restrictions on the originating site. Although rural older adults experience particular challenges to receiving care due to distance, elders in urban or suburban areas may still greatly benefit from access to telemedicine services in overcoming physical challenges, financial barriers, and poor access to transportation. With the extreme shortage of qualified geriatric psychiatrists across the United States, living in a larger metropolitan area does not necessarily ensure close physical proximity to a trained geriatric provider. In addition, the requirement that patients been seen within a physician office or clinic should be removed to allow for seniors to receive care in their homes. As previously described, the significant physical challenges and medical comorbidities of older adults make in-home TMH an ideal option. Although not unique to Medicare or older patients, requirements related to state licensure continue to be a barrier to the comprehensive implementation of telemedicine programs. Policy changes are needed at both the state and federal level to address this burden on providers. Although reasonable concerns have been raised regarding possible increased utilization and costs associated with telemedicine visits, over the past two decades costs associated with telemedicine usage under Medicare have fallen far below projections. Additional research regarding the cost effectiveness of telemedicine for older adults is crucial in providing support for broad policy change. The VA system is a good example of the potential for TMH services to expand access, connecting patients with physicians across multiple settings and locations. Although promising legislation, such as the Medicare Telehealth Parity Act of 2017, has been introduced in Congress to expand coverage for TMH, continued public and professional advocacy will be needed in order for these bills to move forward. In a world of technological advances that can increase access, improve quality and reduce costs, older adults under Medicare are at risk of being left behind.
Publisher Copyright:
© 2018
PY - 2019/2
Y1 - 2019/2
N2 - Telemental health (TMH) for older patients has the potential to increase access to geriatric specialists, reduce travel times for patients and providers, and reduce ever growing healthcare costs. This systematic review article examines the literature regarding psychiatric assessment and treatment via telemedicine for geriatric patients. English language literature was searched using Ovid Medline, PubMed, and PsycINFO with search terms including telemedicine, telemental health, aging, and dementia. Abstracts were reviewed for relevance based on inclusion criteria. Multiple study types were reviewed, including open label, qualitative and randomized controlled trial study designs. Data was compiled regarding participants, study intervention, and outcomes. 76 articles were included. TMH was shown to be feasible and well accepted in the areas of inpatient and nursing home consultation, cognitive testing, dementia diagnosis and treatment, depression in integrated and collaborative care models, and psychotherapy. There is limited data on cost-effectiveness of TMH in the elderly. This article will discuss the current barriers to broader implementation of telemedicine for geriatric patients including reimbursement from the Medicare program. Medicare reimbursement for telemedicine is limited to rural areas, which does not allow for the widespread development of telemedicine programs. All Medicare beneficiaries would benefit from increased access to telemedicine services, not only those living in rural areas. As many elderly and disabled individuals have mobility problems, home-based telemedicine services should also be made available. There are efforts in Congress to expand the coverage of these services under Medicare, but strong advocacy will be needed to ensure these efforts are successful.
AB - Telemental health (TMH) for older patients has the potential to increase access to geriatric specialists, reduce travel times for patients and providers, and reduce ever growing healthcare costs. This systematic review article examines the literature regarding psychiatric assessment and treatment via telemedicine for geriatric patients. English language literature was searched using Ovid Medline, PubMed, and PsycINFO with search terms including telemedicine, telemental health, aging, and dementia. Abstracts were reviewed for relevance based on inclusion criteria. Multiple study types were reviewed, including open label, qualitative and randomized controlled trial study designs. Data was compiled regarding participants, study intervention, and outcomes. 76 articles were included. TMH was shown to be feasible and well accepted in the areas of inpatient and nursing home consultation, cognitive testing, dementia diagnosis and treatment, depression in integrated and collaborative care models, and psychotherapy. There is limited data on cost-effectiveness of TMH in the elderly. This article will discuss the current barriers to broader implementation of telemedicine for geriatric patients including reimbursement from the Medicare program. Medicare reimbursement for telemedicine is limited to rural areas, which does not allow for the widespread development of telemedicine programs. All Medicare beneficiaries would benefit from increased access to telemedicine services, not only those living in rural areas. As many elderly and disabled individuals have mobility problems, home-based telemedicine services should also be made available. There are efforts in Congress to expand the coverage of these services under Medicare, but strong advocacy will be needed to ensure these efforts are successful.
KW - Medicare
KW - Telemedicine
KW - geriatrics
KW - mental health
KW - reimbursement
UR - http://www.scopus.com/inward/record.url?scp=85056225259&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85056225259&partnerID=8YFLogxK
U2 - 10.1016/j.jagp.2018.10.009
DO - 10.1016/j.jagp.2018.10.009
M3 - Article
C2 - 30416025
AN - SCOPUS:85056225259
SN - 1064-7481
VL - 27
SP - 109
EP - 127
JO - American Journal of Geriatric Psychiatry
JF - American Journal of Geriatric Psychiatry
IS - 2
ER -