title: Telepsychiatry reduces geographic physician disparity in rural settings, but is it financially feasible because of reimbursement?
abstract: Telemedicine has been shown to improve rural patient outcomes in two randomized controlled trials, to increase access to many patients, to serve underserved minorities, and to train primary care providers. Yet, programs are dwindling even after successful grants due to inadequate reimbursement. Studies have been thoroughly done to gauge the payor status of potential rural telemedicine patients, as the "floodgates" are not generally open to all-including those who cannot pay-in typical grants. Or the population of one community may not be representative of others. This study is part of a grant that explored the use of telemedicine for rural service delivery, attempted to get a clear snapshot of whom would be served if all were invited (paying or not), and to understand issues with the reimbursement systems. This article (1) examines the receipts of reimbursement and insurance coverage during the 1-year grant period by determining actual versus projected reimbursements, (2) identifies what payor(s) typical patients use, and (3) identifies problems and barriers for future study. Other administrative issues pertinent to telemedicine and costs are briefly discussed (eg, no-show rates, staffing, scheduling).
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of California, Davis, 2230 Stockton Boulevard, Sacramento, CA 95817, USA. dmhilty@ucdavis.edu
authors.forename: Donald M
authors.initials: DM
authors.lastname: Hilty
authors.forename: Hattie C
authors.initials: HC
authors.lastname: Cobb
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Neufeld
authors.forename: James A
authors.initials: JA
authors.lastname: Bourgeois
authors.forename: Peter M
authors.initials: PM
authors.lastname: Yellowlees
mesh_terms: D002140:California; D003362:Cost-Benefit Analysis; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D019458:Insurance Coverage / Q000191:economics; D007349:Insurance, Health, Reimbursement / Q000191:economics*; D007358:Insurance, Psychiatric / Q000191:economics*; D008484:Medicaid / Q000191:economics; D008507:Medically Underserved Area; D006278:Medicare / Q000191:economics; D016032:Randomized Controlled Trials as Topic; D019114:Remote Consultation / Q000191:economics*; D012423:Rural Health; D016896:Treatment Outcome; D014481:United States