A shortage of mental health providers, coupled with rising demand for services, is pushing many Kansans to turn to telemedicine for treatment.
The tools are being used for everything from medication management to talk therapy and crisis intervention, and new legislation going into effect this year could expand services to Kansans.
Outgoing Gov. Jeff Colyer signed the Kansas Telemedicine Act, providing parity for telemedicine, defining what telemedicine is, who can provide it and prohibiting insurance providers from excluding telemedicine services.
"It'll be interesting to see what kind of effect it has," said Kari Bruffett, vice president for policy at the Kansas Health Institute. "It certainly opens up telemedicine to more payer reimbursement."
Telemedicine enables patients to get mental health services quickly and allows providers to reach those in rural areas. It also lowers the costs of delivering services, said Walter Hill, executive director of High Plains Mental Health Center, which has been reaching out to patients via teleconferencing for about 15 years and continues to expand its use of technology.
He said the Kansas Telemedicine Act won't bring any huge changes to High Plains.
"We're just hoping that will set the stage that more payers will be willing to reimburse for services," he said.
Based in Hays, with branch offices in Goodland, Colby, Norton, Phillipsburg and Osborne, High Plains Mental Health Center covers 20 counties in northwest Kansas, providing services to about 5,500 patients each year, with about 2,200 patients receiving services via telemedicine.
High Plains currently has about 50 telemedicine units at county jails, hospital emergency departments, doctors' offices and clinics throughout the region. The organization also has a fleet of cars that travel about 750,000 miles a year to serve clients, Hill said. Without telemedicine, the organization's fleet would have needed to travel 1.25 million miles to provide the services it did in 2017.
High Plains recently started doing almost all of its consultations and emergency work with Hays Medical Center via telemedicine.
"It increases how quickly we can get people seen," Hill said. "They can roll the cart into the emergency room or up onto the medical floor."
High Plains also is turning to telemedicine to deal with staffing shortages, with plans to contract with a nationwide telepsychiatry network called innovaTel to hire a part-time psychiatrist to treat patients via telemedicine, Hill said. The psychiatrist must have a Kansas license but may be located in Texas or Florida.
Hill said hiring contract mental health providers living and working remotely is a fairly recent development in telemedicine, which is continually evolving.
While telemedicine has been around for years, the new legislation may help tear down barriers some providers have faced in adopting the technology more widely.
CKF Addiction Treatment serves patients in 65 counties in Kansas, and many of those patients are in small, rural communities with limited access to services. The organization currently uses telemedicine for assessments and for support groups paid for by a federal grant to treat substance use disorder, CEO Shane Hudson said. The organization hasn't developed programs for counselor-led treatment via telemedicine.
Hudson said he was excited to see the Kansas Telemedicine Act pass, but he said the legislation still leaves some questions to be resolved.
Hudson is concerned about limitations to originating sites, where patients are located when receiving services. The law doesn't specify whether patients can access services from home. KanCare requires patients to log on from an approved site, such as a hospital or clinic.
"You're really cutting the legs off of something that could really be great," he said. "You're not really doing telehealth if people can't get on and access the services."
Many providers wanted the law to include payment parity requiring insurance providers to reimburse telemedicine services at the same rate as in-person services.
Shawna Wright, associate director of the KU Center for Telemedicine and Telehealth, said keeping the law open and broad is a good thing.
"Sometimes if you're too specific in your law, then you limit yourself for how telemedicine grows," she said.
Wright founded a telepsychology practice, Wright Psychological Services, and began working with patients at skilled nursing facilities in southeast Kansas in 2012. She said she was surprised at how accepting patients were of the technology and how quickly her client load grew.
She learned to adjust her approach, asking patients more questions to assess their needs and requesting assistance from workers on site at the nursing facilities when necessary.
"I had to grow as a professional to really evaluate what the patient needs and adapt to that," she said. "There are limitations, but most of them can be overcome if you can become comfortable with asking questions or even requesting assistance."
Now working for the KU Center for Telemedicine and Telehealth, Wright has gone from learning and studying about telemedicine to doing quite a bit of training on the subject.
"It's booming now," Wright said of telemedicine. "Technology has taken off, so it's a lot more convenient, a lot more specific and a lot more affordable than it has been before. But it's not new."
In addition to direct-to-patient services, telehealth also connects providers to education and mentoring. The University of Kansas Medical Center's Project ECHO (Extension for Community Healthcare Outcomes), connects provides across the state through video conferencing, building specialty teams to address topics ranging from pediatric psychiatry to pain management and the opioid crisis.
"Everybody learns from it," Wright said.
Project ECHO gives primary care providers in rural communities access to mentoring from specialists that allows them to better manage complex cases locally.
"Having the ability to use technology to not just have an office visit but also really connect a system of health providers in the state so that where you live doesn't have to determine your outcome I think is a real huge promise for telehealth," said the Kansas Health Institute's Bruffett.
Jonna Lorenz is a freelance writer. She can be reached at firstname.lastname@example.org.