Five tips for transitioning your practice to telehealth

When COVID-19 forced Boston private practitioner Luana Bessa, PhD, to take her practice Bela Luz Health online in March, she was worried about whether she could still have deep, meaningful connections with patients through a screen.

To her surprise, Bessa’s intimacy with patients increased instead of diminished. While she is still mindful of maintaining the therapeutic “frame,” it can be easier for everyday life to intrude on that frame while working virtually. But that’s OK, says Bessa. “I’ve had clients tell me, ‘It makes you more human when I see your cat jump on your lap,’” she laughs. “It has really enriched my relationships with some clients.”

Bessa and others recommend several ways to ensure that the transition to telehealth is a positive experience for both you and your patients.

Make sure your practice will be viable so that you continue serving patients over the long haul. If you have an office sitting idle, for example, see if your landlord will renegotiate or suspend lease payments, suggests Kimberly Y. Campbell, PhD, of Campbell Psychological Services, LLC, in Silver Spring, Maryland. Also renegotiate agreements with other vendors, such as parking lot owners, cleaning services, and the like.

And since patients can’t just hand you or your receptionist a credit card, you’ll need to set up an alternate payment system. Campbell turned to a credit card processing company called Clover. Other practitioners use the payment system that’s part of their electronic health record system. Natasha Holmes, PsyD, uses SimplePractice to handle payment for her Boston practice And Still We Rise, LLC. Although there’s a fee for processing payments, an integrated program makes payment as easy as clicking a button after a patient’s session and watching the payment show up at your bank the next day.

Remember that you’ll need a business associate agreement for a payment system that does anything beyond processing payments, such as invoicing or conducting financial analyses, says Deborah Baker, JD, director of legal and regulatory policy at APA. As for other options, don’t be tempted by apps. “Be aware of platforms that do automatic receipts to patients’ email or text messaging,” she says. “It’s not a good idea because it’s dealing with identifiable patient information and sending it in an unsecure way.” The social media aspect of apps like Venmo or Square makes them even more problematic, says Baker.

Even if you’ve been doing teletherapy for a while now, consider asking a colleague, friend, or family member to help make sure you’re optimizing the experience for your patients. How you position your screen is key, says Holmes. “I think we’ve all been in Zoom meetings where the computer angle is such that you’re seeing right up someone’s nose,” she says. “The DSM-5 [the Diagnostic and Statistical Manual of Mental Health Disorders] is the perfect platform to use to prop your computer up on.”

You may also have to experiment with where you look, adds Bessa. “If I look at the little camera hole on the phone or laptop, I’m not actually looking at the client,” she says. “I prefer to look at the client and see what they’re doing instead of looking at the camera hole to make it look like I’m looking at them.” Using a smartphone rather than a larger screen, making the client’s image full-screen and being consistent with where you look can help, she says, adding that she is upfront with patients about the issue.

Choose a private spot in your home as your new office and be mindful of eliminating distractions, whether that means using a white noise machine to block out noise or locking your door to keep family members from interrupting. Instead of putting your desk against a wall, which may give patients a view of your entire home, put your back against the wall, suggests Holmes. And once you’ve chosen an area of your home as your new office, avoid changing locations, she says, explaining that consistency is helpful in these trying times. (She also suggests bringing a plant or artwork from your old office to reinforce that sense of continuity.)

And even though you’re working from home, you probably don’t want to use your home address in your business communications, Holmes adds. Before the pandemic, Holmes rented an office from the international firm Regus. Once the pandemic struck, the company allowed her to downgrade her rental agreement from a brick-and-mortar office to a virtual one. In addition to protecting her privacy by maintaining a business address, the revised rental agreement also allows access to a printer, conference room, and other amenities as needed.

Both the government and private insurers have relaxed many regulations pertaining to telehealth. “Medicare, Medicaid, and private insurers have opened up access in significant ways that didn’t exist before COVID,” says Baker. And the government is allowing practitioners to use many platforms that don’t comply with the Health Insurance Portability and Accountability Act (HIPAA). But those changes won’t last forever, and practitioners should be ready. “Be really vigilant,” says Baker, citing as one example the need to identify a HIPAA-compliant platform you can use when the government resumes enforcement again.

Screen fatigue is real, says private practitioner Charmain Jackman, PhD, of InnoPsych, Inc., in Boston. “At the end of the day, I’ve been drained in a different way than I have ever been drained by work,” she says. The solution?  Short breaks between sessions and a full hour for lunch. “I never did that before,” says Jackman, who used to spend lunch hours doing paperwork or making calls. “Now I go upstairs and have lunch or go out in the backyard with my kids.”

Teletherapy can also be isolating, says Holmes, who seeks community via Facebook groups focused on online therapy and a consultation group of three other private practitioners who come together virtually every week to talk about teletherapy, enjoy game nights, or just chat. Your state psychological association is another potential resource, says Campbell, president of the Maryland Psychological Association, which offers webinars on teletherapy plus a listserv members can use for instant consultation.

For more tips on teletherapy, see “How to launch a practice that is 100% online.”