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Law360 (July 10, 2020, 6:07 PM EDT )
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| Sarah Churchill Llamas |
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| Bhavesh Modi |
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| Michael Smith |
As the health care community valiantly responds and adjusts to the myriad challenges associated with the novel coronavirus, individual patients have also been forced to rearrange in the midst of the public health crisis. For health care providers and patients, COVID-19 has upended many aspects of life that not long ago seemed rather stable and relatively predictable, such as education, travel, employment, entertainment, shopping, finances and social gatherings.
A disruption of this magnitude has spurred innovation in the delivery of medical care. At the same time, providers should be mindful of recent studies indicating 45%, or nearly half, of adult Americans report having their mental health negatively impacted due to COVID-19,[1] demonstrating an increase in the need for behavioral and mental health treatment and services during the public health crisis.
As a result of the global pandemic and stay-at-home orders, many health care providers have turned to telemedicine and telehealth as a means to safely, and remotely, continue offering care to their patients. A recent Merritt Hawkins & Associates LLC report found that 48% of physicians are using telemedicine to treat patients through the COVID-19 pandemic, up from 18% in 2018.[2] In fact, reporting from New York University Langone Health, which added over 1300 providers[3] to its telemedicine platform in March, demonstrates just how swiftly providers are adopting telehealth.
While most physician practices and health care facilities have policies and protocols in place for responding to behavioral or mental health warning signs when treating a patient in the clinic or facility setting, these same providers may not have similar policies and protocols for their telehealth practices — especially if the provider is new to providing care remotely. Consequently, telehealth presents novel issues providers may not be adequately prepared to handle — especially for providers forced to employ telehealth in response to COVID-19.
While telehealth enhances practitioners' ability to reach patients — particularly amid social distancing directives — virtual care also requires the provider to assess a patient's condition without several tools and factors present in the clinical setting. Regardless of location or specialty, when assessing a patient's condition, practitioners must be prepared to identify possible behavioral or mental health warning signs.
This may prove difficult in some telehealth encounters, as practitioners may have difficulty assessing a patient's environment, social support or physical cues remotely, which is especially critical amid unusual and extreme stressors associated with a global pandemic. Accordingly, practices and facilities should not assume that in-office policies and protocols would seamlessly transfer to telehealth visits.
This resource has basic information for practitioners to consider in reviewing or preparing policies and protocols regarding behavioral and/or mental health indications when treating patients remotely.
Plan Ahead: Obtain Information Early and Have It Available
Practices should have policies and protocols in place before treating patients remotely. Staff should be educated as to the policies, protocols and their respective responsibilities related to the same. Doing so will empower practices to adequately respond to crisis situations, as well as reduce the response times to said crisis.
When developing these policies and protocols, practitioners should look to obtain critical information and methods to assess the patient prior to a telehealth visit. For example, by including questions and screening tools (e.g., PHQ-2 or PHQ-9) concerning the patient and his or her environment in patient-intake forms, practitioners can be better prepared prior to each telehealth visit and have a designated repository of information to turn to in crisis situations, should they arise.
As practitioners move to treating more and more patients remotely, they should always remain knowledgeable as to where the patient is located (i.e., Are they at home or in another location), and even go a step further by obtaining the location's specific address in each telehealth encounter. Additionally, practitioners should be aware of a patient's living situation (i.e., Do they live alone? With family? Roommates?), as this information may be critical in identifying crucial support and contact persons.
Prior to or at the onset of each telehealth encounter, practitioners should request, verify or confirm alternate contact information (e.g., cell phone number, landline, email address) and identify a method to reestablish contact in case of service disruptions (e.g., If video drops, then reestablish contact via phone).
Practitioners should also request and verify the name and contact information of an emergency contact or other support person who can be contacted by the practice or other emergency personnel. If possible, this emergency contact or other support person should physically be able to check up on the patient. As always, practitioners must be sure to obtain patient consent to contact this person(s) directly.
Prior to each remote telehealth encounter, practitioners should identify and verify local emergency services contact information and crisis numbers for the region or county where the patient is located.
It is imperative that the practitioner have all the contact information described above available and in front of the provider during the remote visit. Doing so will allow the practitioner to update any information as-needed and respond quickly and appropriately to emergency situations, should they arise.
Be Prepared: Appropriate Response
Practitioners should be aware of their practice's capacity to address or treat mental or behavioral health concerns. This includes identifying and remaining realistic about the Practice's ability to treat certain conditions in-house, as well as identifying local providers specializing in mental or behavioral health and other potential referral sources.
During telehealth visits with patients exhibiting mental or behavioral health warning signs, practitioners should always determine whether there is a danger or imminent risk to the patient or others. If there is not an imminent risk of harm, practitioners should have resources, websites and local organizations available that may be helpful for the patient to explore. Practitioners may also consider additional steps the practice can take to support and/or monitor a patient's status.
Be Ready to Act: Develop Emergency Protocols
If a patient does pose a danger or imminent risk to themselves or others, coordination with local emergency services and other resources might be necessary. A patient's emergency contact or support person might also need to be contacted to help coordinate emergency services or periodically check in and monitor the patient.
If immediate attention is necessary, the primary practitioner might need to remain connected to and engaged with the patient until someone arrives at the patient's location. Practitioners should identify and work with practice staff members who are trained to help with contacting third parties in emergency situations.
Sarah Churchill Llamas is a shareholder, Bhavesh Modi is a staff attorney and Michael Smith is of counsel at Winstead PC.
The opinions expressed are those of the author(s) and do not necessarily reflect the views of the firm, its clients, or Portfolio Media Inc., or any of its or their respective affiliates. This article is for general information purposes and is not intended to be and should not be taken as legal advice.
[1] https://www.kff.org/health-reform/report/kff-health-tracking-poll-early-april-2020/.
[2] https://www.merritthawkins.com/uploadedFiles/Corona_Physician_Survey_Merritt_Hawkins_Report.pdf.
[3] https://www.beckershospitalreview.com/telehealth/nyu-langone-health-adds-1-300-providers-to-telemedicine-platform.html.
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