It’s that time of year again – the time when we take stock and reflect upon where we have been and where we are headed. Physically, you may have traveled far less in the last 21 months than ever before, but you have, nonetheless, been on quite a journey!

Many of you have likely made changes to the way you practice. You may have decided to give up the expense and hassle of working in an office in favor of practicing telemedicine from your home. You may have elected to cut back on your hours or to close your practice entirely and join a group. You may have realized that there are particular conditions you have a special interest in treating or types of patients and situations you want to avoid going forward.  Even if you haven’t made dramatic changes yourself, you’ve no doubt been reminded of the unpredictability of life and practice.

As you look forward to 2022, here are a few New Year's Resolutions from PRMS® Risk Management to consider:

  1. Get control of your charts. Those who have temporarily given up office space or relocated completely may have been forced to make hasty arrangements for their charts. If you’ve left part of them behind as you work out of a temporary space, or have boxes stuck in your basement, now is the time to get a handle on them. Make sure you know where all charts are located, determine whether older charts may be destroyed, and ensure everything you keep is securely stored.  For additional information see “Retaining and Discarding Psychiatric Records” and “Medical Record Storage Company Agreements.” 
  2. Determine who your active patients are. Since the onset of the pandemic, a number of your patients have likely fallen out of treatment due to relocation or changes to their financial situations or health insurance plans. You’ve likely also have had a few patients who saw you remotely for a visit or two but didn’t follow through with treatment. In order to ensure that there is a clear understanding between yourself and the patient as to the status of your relationship, consider sending them a letter to either confirm their decision to end treatment or make them aware that their chart will be closed if you do not hear from them within a given timeframe.  Sample letters may be found in “Termination of the Physician-Patient Relationship.” 
  3. Get your remote practice set up for the long haul if you haven’t already done so. Find space set off from your main family areas to protect patient privacy. Ensure that you have a place with good lighting and minimal background noise. During the PHE, HHS has waived the requirement that telemedicine platforms be HIPAA-compliant. It is expected, however, that this requirement will be re-instated once the PHE has expired. If you have not already done so and you anticipate continuing to treat via telemedicine, invest in a system that meets HIPAA requirements. (Note, no matter what the vendor tells you, if they do not offer a Business Associate Agreement, they are not HIPAA-compliant.)  Consider what other equipment may be useful such as headphones, a webcam, printer/scanner, a separate monitor to view records during sessions, etc. For more information see “Converting From an Office to a Home-Based Telepsychiatry Practice.” 
  4. If you are unable to see patients in person at your current practice location, make arrangements to borrow space from a colleague in the event a face-to-face visit is needed at some point in the future. During the PHE, the DEA has waived the Ryan Haight Act's requirement for an in-person visit prior to prescribing a controlled substance; however, it is anticipated that this requirement will be reinstated once the PHE has expired. Many states follow this rule as well, but others may have a state requirement in effect for an in-person visit.  Beyond the need to satisfy prescribing requirements, there may also be other patients for whom you believe an occasional face-to-face appointment would be beneficial. If you do not have a colleague with extra space, consider seeing if your local hospital can accommodate you. 
  5. Make sure your practice forms are up-to-date and include a consent for telemedicine.
  6. Make sure you have what is legally required to treat patients in other states via telemedicine. Depending upon the state, this may mean a full medical license or a telemedicine certificate, or there may be statutory provisions that allow the limited practice of telemedicine without a license or certificate. Although most states had some type of licensure waiver during the height of the PHE, the majority of these waivers have either ended or are ending soon. To determine what is required, contact the licensing board in each state in which you will be treating patients outside of your home state.
  7. Along these same lines, make sure you know the laws and regulations governing the practice of medicine in each state in which you will be seeing patients, including laws pertaining to prescribing controlled substances, reporting requirements, and CME requirements. Individual state licensing boards typically have this information on their website. What laws you are subject to will likely be tied to licensure status. For example, someone with a full license will typically need to meet CME requirements while someone practicing under a statutory exception will not.
  8. Make sure you are compliant with DEA regulations regarding the prescribing of controlled substances in those additional states. During the PHE, the DEA has waived the Ryan Haight Act's requirement that there be one in-person visit prior to prescribing controlled substances, but it is likely that this rule will be re-instated post-PHE. It is also likely that the requirement for separate DEA registrations in each state where patients are located will be re-instated post-PHE.
  9. Develop a contingency plan to allow someone to either take over your practice during your unexpected absence or shut it down completely in the event you are not able to return. For more information see “Initiating My Contingency Plan.” 

Thank you for choosing PRMS® for your psychiatric professional liability insurance needs. We look forward to working with you and other partners in the behavioral healthcare community in 2022!

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