Behavioral health providers in North Dakota and Minnesota overcame challenges in making the rapid change to providing services through telehealth, and, while some providers say telehealth is here to stay, they want to see legal changes made to allow it to flourish.
The coronavirus pandemic that erupted in mid-March closed the doors of behavioral health providers in the region, necessitating the switch to telehealth. After a period of struggle, providers made the change and were aided by state-level executive orders which loosened restrictions on the provision of those services. When those orders expire, the gains made in expanding access to mental health services could be undone.
“Telemedicine is the way to give access to people who would never walk in our door,” said Shauna Reitmeier, CEO of Northwestern Mental Health Center, in Crookston. “Continuing these waivers and ensuring that laws change for the long haul is important.”
In particular, a Minnesota executive order signed on April 6, allows out-of-state practitioners to provide telehealth services until the state’s peacetime emergency is terminated, which could be as early as July 13.
Across the river, North Dakota Medicaid issued a temporary COVID-19 telehealth policy on March 25, that allows providers to make use of such platforms as the recently popular, Zoom and Google Hangouts. That policy is set to expire when the national emergency is declared over.
Additionally, an executive order signed on March 20 by Gov. Doug Burgum, requires insurance companies to cover online visits in the same manner as in-person visits. The order doesn’t mandate the same rate of reimbursement to providers, however. Some insurers have lowered what they will pay for a telehealth session by as much as 30%.
“Telehealth is a new service, and the laws have not yet changed as fast as the times and the technology,” wrote Heidi Jensen, co-owner of behavioral service provider Agassiz Associates, in an email to the Herald.
A national movement
At the federal level, there is some momentum in seeing the expanded access to telehealth, brought about by provisions in the Coronavirus Aid, Relief and Economic Security Act, made permanent. The number of Medicare beneficiaries using telehealth services has skyrocketed by 11,718%, over the course of the pandemic. Portions of the CARES Act waived requirements for certain providers, including rural health clinics, to bill Medicare for primary and hospice care. A bipartisan group of 30 senators, including Sen. Kevin Cramer, R-N.D., have signed a letter to Senate Majority Leader Mitch McConnell and Minority Leader Charles Schumer, advocating for the future of telehealth.
"Americans have benefited significantly from this expansion of telehealth and have come to rely on its availability," the senators wrote in a June 15 letter. "Congress should expand access to telehealth services on a permanent basis so that telehealth remains an option for all Medicare beneficiaries both now and after the pandemic."
A rapid transition
Jensen told the Herald her office purchased a HIPPA-compliant version of Zoom, when it closed its door to in-person services in mid-March. Jensen said it took about two weeks to transition all of Agassiz’s services to telehealth, including psychological, psychiatric and substance abuse evaluations, among others.
It wasn’t easy. Agassiz hired an information technology specialist to help clients transition to the new format. In some cases, clients don’t have access to WiFi, or a device to hook one up to.
The same goes in Crookston, where Northwestern Mental Health made the switch in four days. Reitmeier told the Herald her office worked to provide devices to clients who either didn’t have one, or used up their entire cellphone data plan, during a Zoom consultation. The facility was at a 3% utilization rate for telehealth before the pandemic, now it’s at 61%.
Other challenges included helping clients adjust to seeing a provider on a screen, rather than in person. Some treatments require the use of devices, such as a heart monitor -- something that can’t be done through telehealth. Initially, providers saw their number of clients decrease, but many of those people have come back, as the pandemic wears on. According to both Jensesn and Reitmeier, the need for treatment is great.
“The number of individuals needing services due to the stressful impact of COVID-19 over time is definitely on the rise,” Jensen said.
On the whole, clients have adapted well to telehealth, especially those who are more comfortable using technology. Some people feel more comfortable talking in their own home, office or even car. People living in rural areas don’t need to travel to see a provider -- a benefit which goes both ways, as providers don’t need to travel to rural hospitals when conducting emergency hospital assessments.
“I think (telehealth) really is going to be dependent on the individual and the treatment that's being provided, but, overall, yes, it is as effective as in the office,” Reitmeier said, and added that the expanded access to mental health services is threatened by the temporary nature of the executive orders that brought it about.