Getting reimbursements for video devices vary depending on your work setting. Look to your workplace's patient support services, local and state government funding programs, and federally-supported services. Federal government agencies — such as the Veterans Health Administration (Veterans Affairs, or VA) — have instituted a ["Digital Divide" consult](https://mobile.va.gov/sites/default/files/vamobile-discussion-series-202009-slides.pdf) that will contact patients, discuss their needs, and send them telehealth equipment such as Apple iPads with wireless services. Comcast offers [Internet Essentials](https://internetessentials.com), with affordable high-speed Internet wifi, a discounted laptop or desktop computer, for those who qualify for their low-income program. The federal government has [Lifeline](https://www.fcc.gov/lifeline-consumers), a "discount on monthly telephone service, broadband Internet service, or bundled voice-broadband packages purchased from participating wireline or wireless providers." Service providers like [SafeLink Wireless](https://www.safelinkwireless.com), [Assurance Wireless](https://www.assurancewireless.com), [TruConnect](https://www.truconnect.com) provide wireless devices, hotspots, and accounts. States such as California implement Lifeline as [Your Call Wireless](https://yourcallwireless.com/lifeline/), providing phone services and cell phones. Finally, large commercial organizations such as [T-mobile](https://www.t-mobile.com/offers/lifeline-program), [Verizon](https://www.verizon.com/solutions-and-services/lifeline/), and [AT&T](https://www.att.com/home-phone/lifeline/) offer Lifeline services.

Getting reimbursements for video devices vary depending on your work setting. Look to your workplace's patient support services, local and state government funding programs, and federally-supported services. Federal government agencies — such as the Veterans Health Administration (Veterans Affairs, or VA) — have instituted a ["Digital Divide" consult](https://mobile.va.gov/sites/default/files/vamobile-discussion-series-202009-slides.pdf) that will contact patients, discuss their needs, and send them telehealth equipment such as Apple iPads with wireless services. Comcast offers [Internet Essentials](https://internetessentials.com), with affordable high-speed Internet wifi, a discounted laptop or desktop computer, for those who qualify for their low-income program. The federal government has [Lifeline](https://www.fcc.gov/lifeline-consumers), a "discount on monthly telephone service, broadband Internet service, or bundled voice-broadband packages purchased from participating wireline or wireless providers." Service providers like [SafeLink Wireless](https://www.safelinkwireless.com), [Assurance Wireless](https://www.assurancewireless.com), [TruConnect](https://www.truconnect.com) provide wireless devices, hotspots, and accounts. States such as California implement Lifeline as [Your Call Wireless](https://yourcallwireless.com/lifeline/), providing phone services and cell phones. Finally, large commercial organizations such as [T-mobile](https://www.t-mobile.com/offers/lifeline-program), [Verizon](https://www.verizon.com/solutions-and-services/lifeline/), and [AT&T](https://www.att.com/home-phone/lifeline/) offer Lifeline services.

Prescribing long-acting injectables (LAI) is similar to that of prescribing any medication — determine the dose, frequency, and applicable dispensing location. Many clinics and work settings allow you to arrange for the long-acting injectable to be provided at another clinic site or nursing site. For instance, the [Veterans Affairs' telehealth system](https://telehealth.va.gov) allows a prescriber to order the medication, and request nursing support at a specific clinic, through their electronic health record. According to the [Pharmacy Times](https://www.pharmacytimes.com/publications/specialty-pharmacy-times/2019/2019-Asembia-Recap/New-Frontiers-for-Pharmacists-Administration-of-Long-Acting-Injectable-Antipsychotics), as of 2019, pharmacists can provide vaccinations in all 50 U.S. states and the District of Columbia. Only 44 states allow pharmacists to give long-acting injectable medications. Calling your pharmacy for options can help clarify what services are available. And, according to the [National Community Pharmacists Association](https://ncpa.org/administration-long-acting-anti-psychotic-injectable), industry programs from pharmaceutical manufacturers of long-acting injectable atypical antipsychotic medications — such as Invega Sustenna — can help determine which locations can administer such medications. Recognized "Injection Centers" are networks of pharmacies and healthcare facilities that help provide these injections.

Prescribing long-acting injectables (LAI) is similar to that of prescribing any medication — determine the dose, frequency, and applicable dispensing location. Many clinics and work settings allow you to arrange for the long-acting injectable to be provided at another clinic site or nursing site. For instance, the [Veterans Affairs' telehealth system](https://telehealth.va.gov) allows a prescriber to order the medication, and request nursing support at a specific clinic, through their electronic health record. According to the [Pharmacy Times](https://www.pharmacytimes.com/publications/specialty-pharmacy-times/2019/2019-Asembia-Recap/New-Frontiers-for-Pharmacists-Administration-of-Long-Acting-Injectable-Antipsychotics), as of 2019, pharmacists can provide vaccinations in all 50 U.S. states and the District of Columbia. Only 44 states allow pharmacists to give long-acting injectable medications. Calling your pharmacy for options can help clarify what services are available. And, according to the [National Community Pharmacists Association](https://ncpa.org/administration-long-acting-anti-psychotic-injectable), industry programs from pharmaceutical manufacturers of long-acting injectable atypical antipsychotic medications — such as Invega Sustenna — can help determine which locations can administer such medications. Recognized "Injection Centers" are networks of pharmacies and healthcare facilities that help provide these injections.

Working for the federal government does not necessarily allow you to see patients via telepsychiatry, wherever you are. While there are no absolute contraindications to patients being assessed or treated using telemental health, you have to check with your supervisor — and any applicable administrative rules and trainings — for these rules. Ask your supervisor about federal telework agreements, contingency plans for persons who appear in-person or who are unable to connect by video, and whether support staff are available to guide your patient in case of an outage. Furthermore, telemedicine requires you to know which state a patient is located. You would need to follow that state's licensing laws and regulations. Usually, this means you must have a license to practice in that patient's state, have malpractice cover your practice in that state. Some states allow for a single state license to cover multiple states — the Interstate Licensure Compact, for instance — but not all states participate in this. Resources, such as the [American Medical Association Telehealth quick guide](https://www.ama-assn.org/practice-management/digital/ama-telehealth-quick-guide), can help you determine which laws apply.

Working for the federal government does not necessarily allow you to see patients via telepsychiatry, wherever you are. While there are no absolute contraindications to patients being assessed or treated using telemental health, you have to check with your supervisor — and any applicable administrative rules and trainings — for these rules. Ask your supervisor about federal telework agreements, contingency plans for persons who appear in-person or who are unable to connect by video, and whether support staff are available to guide your patient in case of an outage. Furthermore, telemedicine requires you to know which state a patient is located. You would need to follow that state's licensing laws and regulations. Usually, this means you must have a license to practice in that patient's state, have malpractice cover your practice in that state. Some states allow for a single state license to cover multiple states — the Interstate Licensure Compact, for instance — but not all states participate in this. Resources, such as the [American Medical Association Telehealth quick guide](https://www.ama-assn.org/practice-management/digital/ama-telehealth-quick-guide), can help you determine which laws apply.

There is no absolute contraindication for telepsychiatry and virtually any mental health condition can be treated via telepsychiatry. Generally, the concerns about psychotic patients becoming more paranoid or distrustful with telepsychiatry are overblown. However, in rare cases, a patient may not be appropriate for telepsychiatry if they are truly fearful about a delusion that involves the camera or videoconferencing equipment. Does this mean that telepsychiatry is inappropriate or impossible to effectively treat such as patient? Not necessarily... It is important to remember that psychotic patients can incorporate anything from their environment into their delusional beliefs. For example, a patient may be delusional that they are being held captive in a secret Nazi prison camp. This does not mean that they should be discharged from the unit out to the street. Likewise, a patient who has delusions about telepsychiatry does not necessarily fail to benefit from telepsychiatry. Nevertheless, it is theoretically possible for a patient to be so paranoid about telepsychiatry that they become mute or refuse to participate in the telepsychiatry session. If that same patient is willing to converse with a psychiatrist in the facility, then perhaps onsite psychiatry may be a more effective option. This would be a clinical decision based on the case factors. Ultimately, if the treatment team feels that the patient fundamentally cannot benefit from telepsychiatry due to their delusional beliefs about that modality of care, then other arrangements should be made to provide care onsite. In summary, there are certain clinical situations where a patient's mental status or condition may require that arrangements are made for onsite psychiatric care. However, this happens very rarely. Overall, telepsychiatry is an effective option in the vast majority of mental health cases.

There is no absolute contraindication for telepsychiatry and virtually any mental health condition can be treated via telepsychiatry. Generally, the concerns about psychotic patients becoming more paranoid or distrustful with telepsychiatry are overblown. However, in rare cases, a patient may not be appropriate for telepsychiatry if they are truly fearful about a delusion that involves the camera or videoconferencing equipment. Does this mean that telepsychiatry is inappropriate or impossible to effectively treat such as patient? Not necessarily... It is important to remember that psychotic patients can incorporate anything from their environment into their delusional beliefs. For example, a patient may be delusional that they are being held captive in a secret Nazi prison camp. This does not mean that they should be discharged from the unit out to the street. Likewise, a patient who has delusions about telepsychiatry does not necessarily fail to benefit from telepsychiatry. Nevertheless, it is theoretically possible for a patient to be so paranoid about telepsychiatry that they become mute or refuse to participate in the telepsychiatry session. If that same patient is willing to converse with a psychiatrist in the facility, then perhaps onsite psychiatry may be a more effective option. This would be a clinical decision based on the case factors. Ultimately, if the treatment team feels that the patient fundamentally cannot benefit from telepsychiatry due to their delusional beliefs about that modality of care, then other arrangements should be made to provide care onsite. In summary, there are certain clinical situations where a patient's mental status or condition may require that arrangements are made for onsite psychiatric care. However, this happens very rarely. Overall, telepsychiatry is an effective option in the vast majority of mental health cases.

Telepsychiatry has been utilized in a variety of inpatient units with success and is an acceptable mode of delivering care in these settings. Both government and corporate health care organizations have embraced telepsychiatry for this purpose. In the early days of telepsychiatry, some administrators and providers were hesitant or skeptical about using telepsychiatry for inpatient units. Reasons given were mostly a subjective and vague concern about the ability of providers to appropriately care for severely ill patients without being on site, in person. However, in recent years, as telepsychiatry has become more widely adopted, those concerns have diminished. Those who have experience with inpatient telepsychiatry have come to understand that providing care in this way is not substantially different that how it would be provided in-person. In fact, there are several advantages of telepsychiatry over onsite psychiatry in the inpatient unit: * Telepsychiatry allows inpatient units in underserved and rural areas to be adequately staff * Telepsychiatry allows the provider to work from the comfort of his home, rather than being forced to sit for long hours under fluorescent lights within a noisy, musty and uncomfortable inpatient unit. * Telepsychiatry gives providers opportunities to create any variety of schedule that works best for their lifestyle, including working during odd hours, weekdays, nights, part time, or full time. With telepsychiatry, shifts can more easily be modified and swapped to fit the needs of the providers. * Telepsychiatry allows the inpatient unit to supplement staff easily and efficiently. This is especially useful when facilities are running short on staff due to illness, surges in patient volume, or any other factors. * Telepsychiatry allows for 24/7 coverage of inpatient units, which is often hard to do when relying solely on in-person onsite coverage. **The Importance of Effective Communication:** Effective communication is important in virtually any healthcare setting, and inpatient telepsychiatry is no different. Communication between the telepsychiatrist and members of the inpatient treatment team allows optimal coordination of patient care. This includes: * Reviewing the treatment plan * Reviewing progress of the patient toward discharge goals * Addressing urgent and emergent patient issues * Relaying factors on the unit which may affect patient experience. For example, excess noise from other patients, physical plant issues (like plumbing or electrical issues in the unit), overcrowding on the unit, or hostile patients that are disrupting the environment for other patients. * Oftentimes, the way a patient presents to the psychiatrist may be different than how they behave on the unit. It is helpful for the psychiatrist to know how the patient is doing both on and off camera. Efforts should also be made to establish adequate communication between the telepsychiatrist and the patient. Although communication with a severely mentally ill person can often be challenging, the telepsychiatrist should try to involve the patient in the treatment goals and plans as well as answer any patient questions and concerns. **What about paranoid and psychotic inpatients? Are they appropriate for telepsychiatry? ** There is no absolute contraindication for telepsychiatry and virtually any mental health condition can be treated via telepsychiatry. However, there are certain clinical situations where a patient's mental status or condition may require that arrangements are made for onsite psychiatric care. For more information, please see the article ["Are psychotic patients appropriate for telepsychiatry?"](https://ask.orbithealth.com/faqs/are-psychotic-patients-appropriate-for-telepsychiatry) In summary, telepsychiatry is an appropriate and effective way to provide care to inpatient facilities, especially when there is good communication.

Telepsychiatry has been utilized in a variety of inpatient units with success and is an acceptable mode of delivering care in these settings. Both government and corporate health care organizations have embraced telepsychiatry for this purpose. In the early days of telepsychiatry, some administrators and providers were hesitant or skeptical about using telepsychiatry for inpatient units. Reasons given were mostly a subjective and vague concern about the ability of providers to appropriately care for severely ill patients without being on site, in person. However, in recent years, as telepsychiatry has become more widely adopted, those concerns have diminished. Those who have experience with inpatient telepsychiatry have come to understand that providing care in this way is not substantially different that how it would be provided in-person. In fact, there are several advantages of telepsychiatry over onsite psychiatry in the inpatient unit: * Telepsychiatry allows inpatient units in underserved and rural areas to be adequately staff * Telepsychiatry allows the provider to work from the comfort of his home, rather than being forced to sit for long hours under fluorescent lights within a noisy, musty and uncomfortable inpatient unit. * Telepsychiatry gives providers opportunities to create any variety of schedule that works best for their lifestyle, including working during odd hours, weekdays, nights, part time, or full time. With telepsychiatry, shifts can more easily be modified and swapped to fit the needs of the providers. * Telepsychiatry allows the inpatient unit to supplement staff easily and efficiently. This is especially useful when facilities are running short on staff due to illness, surges in patient volume, or any other factors. * Telepsychiatry allows for 24/7 coverage of inpatient units, which is often hard to do when relying solely on in-person onsite coverage. **The Importance of Effective Communication:** Effective communication is important in virtually any healthcare setting, and inpatient telepsychiatry is no different. Communication between the telepsychiatrist and members of the inpatient treatment team allows optimal coordination of patient care. This includes: * Reviewing the treatment plan * Reviewing progress of the patient toward discharge goals * Addressing urgent and emergent patient issues * Relaying factors on the unit which may affect patient experience. For example, excess noise from other patients, physical plant issues (like plumbing or electrical issues in the unit), overcrowding on the unit, or hostile patients that are disrupting the environment for other patients. * Oftentimes, the way a patient presents to the psychiatrist may be different than how they behave on the unit. It is helpful for the psychiatrist to know how the patient is doing both on and off camera. Efforts should also be made to establish adequate communication between the telepsychiatrist and the patient. Although communication with a severely mentally ill person can often be challenging, the telepsychiatrist should try to involve the patient in the treatment goals and plans as well as answer any patient questions and concerns. **What about paranoid and psychotic inpatients? Are they appropriate for telepsychiatry? ** There is no absolute contraindication for telepsychiatry and virtually any mental health condition can be treated via telepsychiatry. However, there are certain clinical situations where a patient's mental status or condition may require that arrangements are made for onsite psychiatric care. For more information, please see the article ["Are psychotic patients appropriate for telepsychiatry?"](https://ask.orbithealth.com/faqs/are-psychotic-patients-appropriate-for-telepsychiatry) In summary, telepsychiatry is an appropriate and effective way to provide care to inpatient facilities, especially when there is good communication.

Internet Speed: Anyone can test the bandwidth by going to websites like speedtest.net. Upload speeds of over 3mps are generally effective if there are not a whole lot of other programs running on the computer. However, it’s probably best to shoot for higher speeds and your internet service provider can give you options. If you can afford it, its best to have the highest speeds the company can offer. Also, ask for “dedicated bandwidth” which some companies offer that prevents your neighbors internet usage to bring down your own bandwidth. Also, keep in mind that other devices running in the same household can hog up bandwidth and reduce the quality of the telehealth connection. Computer: Most computers these days have enough power for videoconferencing. However, computers that have a minimum of 8 gigs of RAM and I7 processors provide a more reliable videoconferencing experience (you might be able to get away with using an I3 or I5 processor, but this sometimes results in a slow computer response). Video: Most (but not all) computers these days have cameras that are adequate for videoconferencing. If your computer does not have a good camera, webcams can be purchased cheaply ($50-100). While 720p video mode (“HD ready”) may be adequate, it is helpful to have a 1080p resolution (High Definition). While video is important, appointments are more often impacted by poor audio. Oftentimes, people run audio through their computers which is hit or miss. For a better quality of audio, you can purchase a microphone/speaker combination device which can be plugged into the USB port of your computer. This will make audio clearer and filter out background noise. It is a good idea to do a test run with the patient, clinic, or hospital, prior to the appointment to determine what equipment is being used and to experience the quality of the videoconferencing appointment. Look to make sure there is no pixilation, freezing, graininess, or blurry video. Make sure the video and audio are in sync--- in other words, the audio is not lagging behind the video. Make sure that the audio is clear and that you can easily understand what the other person is saying. Both parties (patient and doctor) should be able to talk at the same time and still hear each other if the audio is working correctly. Paying attention to and optimizing the quality of video and audio will improve the telehealth experience for everyone.

Internet Speed: Anyone can test the bandwidth by going to websites like speedtest.net. Upload speeds of over 3mps are generally effective if there are not a whole lot of other programs running on the computer. However, it’s probably best to shoot for higher speeds and your internet service provider can give you options. If you can afford it, its best to have the highest speeds the company can offer. Also, ask for “dedicated bandwidth” which some companies offer that prevents your neighbors internet usage to bring down your own bandwidth. Also, keep in mind that other devices running in the same household can hog up bandwidth and reduce the quality of the telehealth connection. Computer: Most computers these days have enough power for videoconferencing. However, computers that have a minimum of 8 gigs of RAM and I7 processors provide a more reliable videoconferencing experience (you might be able to get away with using an I3 or I5 processor, but this sometimes results in a slow computer response). Video: Most (but not all) computers these days have cameras that are adequate for videoconferencing. If your computer does not have a good camera, webcams can be purchased cheaply ($50-100). While 720p video mode (“HD ready”) may be adequate, it is helpful to have a 1080p resolution (High Definition). While video is important, appointments are more often impacted by poor audio. Oftentimes, people run audio through their computers which is hit or miss. For a better quality of audio, you can purchase a microphone/speaker combination device which can be plugged into the USB port of your computer. This will make audio clearer and filter out background noise. It is a good idea to do a test run with the patient, clinic, or hospital, prior to the appointment to determine what equipment is being used and to experience the quality of the videoconferencing appointment. Look to make sure there is no pixilation, freezing, graininess, or blurry video. Make sure the video and audio are in sync--- in other words, the audio is not lagging behind the video. Make sure that the audio is clear and that you can easily understand what the other person is saying. Both parties (patient and doctor) should be able to talk at the same time and still hear each other if the audio is working correctly. Paying attention to and optimizing the quality of video and audio will improve the telehealth experience for everyone.

Home - Ultimate Guide to Telepsychiatry by Orbit Health

Can you get reimbursements for video devices for patients who don't have a computer or smartphone?

Getting reimbursements for video devices vary depending on your work setting. Look to your workplace's patient support services, local and state government funding programs, and federally-supported services.

federal government

Learn more →

How do you prescribe long-acting injectables via telepsychiatry?

Prescribing long-acting injectables (LAI) is similar to that of prescribing any medication — determine the dose, frequency, and applicable dispensing location. We cover Injection Center networks, pharmacy capabilities, and examples of health systems that offer long-acting injectables.

Learn more →

Does working for the federal government allow you to see patients via telepsychiatry, wherever you are?

While there are no absolute contraindications to patients being assessed or treated using telemental health, you have to check with your supervisor — and any applicable administrative rules and trainings — for these rules.

federal government

Learn more →

The Ultimate Guide to Telepsychiatry

Can you get reimbursements for video devices for patients who don't have a computer or smartphone?

How do you prescribe long-acting injectables via telepsychiatry?

Does working for the federal government allow you to see patients via telepsychiatry, wherever you are?

Are psychotic patients appropriate for telepsychiatry?

Is telepsychiatry appropriate for inpatient settings?

How do you optimize internet speeds, audio and video?

Can you get reimbursements for video devices for patients who don't have a computer or smartphone?

How do you prescribe long-acting injectables via telepsychiatry?

Does working for the federal government allow you to see patients via telepsychiatry, wherever you are?

Are psychotic patients appropriate for telepsychiatry?

Is telepsychiatry appropriate for inpatient settings?

How do you optimize internet speeds, audio and video?

Need telepsychiatry for your organization?

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