To Congresswoman Claudia Tenney, US Representative serving the 22^ndDistrict of New York

From: Kailin Cheng

Date: January 19, 2018

Re: Access to Telepsychiatry for Rural areas in Herkimer County, NY

Statement of Issue: Herkimer County has a population of about 62,613 with a population density of 45 per square mile, 98% Caucasians, 0.50% African American, 0.41% Asian, 0.22% Native American, and 0.87% from other ethnicities. More than 10% of their residents are veterans. The recent statistics reveal suicide death rate has worsened for the population of Herkimer County. There is only one health care center with mental health (Herkimer County Mental Health: 301 N Washington St Ste 2470, Herkimer, NY 13350) with three psychiatrists and three social workers. It clearly shows a severe shortage of psychiatrist, mental health therapists, the population of Herkimer does not have access to enough mental health providers to meet the demand of people who need the services, most of them live in remote rural area of Herkimer County.

• With limited number of public transportation, and only one mental health center, visits to a mental health provider can take a whole day
• The only mental health center is not open on weekends: people usually work on weekdays, which decrease access for most people, the latest hour of operation is 7:00PM on Mondays only.
• The high number of suicide is alarming, there should be a sectional study to find the population in need of mental health services.
• Around 16% of its population reported binge drinking in the past month in 2013, there was no significant changes since last report in 2009. Alcohol abuse by those with depression is a particular problem, since alcohol is a strong depressant.

Policy Options:

Incorporate telehealth services into the rural areas of Herkimer County New York. For enhancing the delivering quality care in rural communities. Allow hospitals from neighboring counties or from anywhere in New York state who participate in telehealth to provide their services in mental health to the population of Herkimer County living in rural regions. The telehealth appointments can be done once a week according to patient needs and clinician or social worker’s judgement. Medication can be mail to the patient’s home address.

• Advantages: Patients do not have to move away from their homes, they only need a mobile phone with internet connection or a computer with camera and internet connection. The state of New York accepts telehealth as another form of health care services and the payment/reimbursement are same as in person appointments. Medicaid, Medicare, and some private insurances cover for telehealth mental care appointments. It would save waiting time and transportation time for patients. Telehealth for mental health or telepsychiatry can be very useful for those patients in severe depression who do not leave their homes.
• Disadvantages: Not everyone would may have or know how to use mobile phones or computers with camera and internet connection, in this case patients should have a in person visit first to teach them how to use the technology. At the beginning of the telehealth initiative, large funds would be needed to buy equipment for the installation in hospitals.

Allow telehealth services to reach civilians (not active duty or veterans) who live in rural areas of Herkimer County. To increase the number of access to mental health services telehealth could play a vital role in the community. The telehealth appointments can be done once a week according to patient needs and clinician or social worker’s judgement. Medication can be mail to the patient’s home address.

• Advantages: More patients would have access to mental care from qualifying mental health providers of other parts of New York state that use the telehealth system. Evidence-based costs and time effectiveness and may have positive impact on overall health outcomes. Patients can use their cell phones or computers with internet access
• Disadvantages: The laws of reimbursements are still not clear about allowing civilians to use telehealth. Not everyone would may have or know how to use mobile phones or computers with camera and internet connection. There will be initial cost for installing health stations for those who do not have alternate ways to access telehealth.

Policy Recommendation: Telehealth is a type of health care delivery where the health professional does not see the patient physically but on a communication device, which has two-way video messaging on real time. The New York state is the 22^nd state to pass reimbursement law requiring that telehealth appointments to be paid at the same rate as in-person ones, signed by New York Governor Andrew Cuomo, which went into effect Jan. 1, 2016. With the rapid growth of digital era, telecommunication technology is proven to be very helpful on reducing waiting time, increasing access to specialty professionals, cost effective, and having the ability to care for rural populations. Private insurances, Medicaid program, and Medicare Part B provides reimbursement for services deliver via telehealth. As of this date telehealth is incorporated into 11 rural county regions of New York as they are medically underserving (Clinton, Essex, Franklin, Fulton, Hamilton, Jefferson, Lewis, Saratoga, St. Lawrence, Warren, and Washington). However, telehealth option is not incorporated into Herkimer County of New York. One of the most promising approaches for the use of telehealth in mental health and can help with the shortage of mental health providers in Herkimer County. Even if it passes the policy for telepsychiatry for veterans and active duty officers, it counts for more than 10% of Herkimer County and it is still a good start to provide more access.

Sources:

Poropatich R, Lappan C, Gilbert G. Telehealth in the Department of Defense. In: Rheuban K, Krupinski EA. eds. Understanding Telehealth New York, NY: McGraw-Hill; . http://accessmedicine.mhmedical.com/content.aspx?bookid=2217§ionid=171282621. Accessed January 05, 2018.

http://www.cchpca.org/telehealth-policy

http://www.cchpca.org/national-telehealth-policy

https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes.html

http://www.apa.org/monitor/2011/06/telehealth.aspx

https://www.medicare.gov/coverage/telehealth.html

https://mhealthintelligence.com/news/new-york-eases-telehealth-rules-for-mental-health-providers

http://www.ahihealth.org/what-we-do/telemedicine/

https://www.nyconnects.ny.gov/services/herkimer-county-mental-health-services-omh-pr-700706960100