Potential for independent telehealth practice as Psych NP?

Psychcns · Feb 29, 2016

Seems doable in Oregon. They address it on their FAQ page. People are doing it there from out of state. Other places are doing it too. Prescribing controlled substances across state boarders can be tricky. From what I have read you need a license where the pt resides.

PG2018 · Feb 29, 2016

I work for a company. Each NP has a region, if you will. Rather than driving around the region we have remote offices and use a state-sponsored telehealth system to see patients. I say we. I don't. My region is rather metropolitan so they generally drive to me. Having said that, we have NPs living out of state that see patients here.

What you want is legal, ethical, billable, and doable. You're going to have to deal with some costs. It's something more complicated than Skype - much more secure as well. I recommend exploring options through the National Health Service Corps. They may have funding for you.

You cannot log in to someone at their home webcam and treat them. You're going to need remote clinics and administrative staff. If you want autonomy, I'd really recommend you rent a small space somewhere and grow your practice. As a newb going into this you're looking at too large of a hole to climb back out of.

Unless you have a cash only practice, you're going to need an EHR system, and who knows you may still need one anyway. (I wonder if you could hire someone to make you something via MS Access.) You could shave the overhead by doing housecalls. I'd love to have a concierge practice. It's rather lurative if you have the clientele. The affluent probably want a MD, but when we have people come in paying cash for our service it's a $400 evaluation rather than the paultry 120 Medicaid pays. I think our med checks are 150 versus like 29 and 56 from Medicaid. I don't have Medicare or any other insurers memorized.

akcompton1 · Feb 29, 2016

Thanks for the reply, all the details are MUCH appreciated... I guess I started wondering about it when you see these companies advertising "talk to a therapist right now" on the internet. I need to find details on the type of system these people are using...

The unicorn I am chasing is a situation in which I could theoretically work from a laptop, regardless of physical location, so that I can travel with my spouse.

Cash only appeals to me even if I don't make much more than what Medicaid would pay, just to simplify the process.

To make things even more challenging, I'm big time "in the hole" for my masters degree already, so startup costs might be out of reach for me. The VA would pay for me to complete the DNP but I'd be committed for an additional three years, during which time I probably wouldn't make significantly more than what I'm already making as an RN.....Argh the stress is getting to me already!

akcompton1 · Feb 29, 2016

Hmm...so maybe obtain a license in a few states and create my own "region"? Thanks for the input!

PG2018 · Mar 1, 2016

Thanks for the reply, all the details are MUCH appreciated... I guess I started wondering about it when you see these companies advertising "talk to a therapist right now" on the internet. I need to find details on the type of system these people are using...
The unicorn I am chasing is a situation in which I could theoretically work from a laptop, regardless of physical location, so that I can travel with my spouse.
Cash only appeals to me even if I don't make much more than what Medicaid would pay, just to simplify the process.
To make things even more challenging, I'm big time "in the hole" for my masters degree already, so startup costs might be out of reach for me. The VA would pay for me to complete the DNP but I'd be committed for an additional three years, during which time I probably wouldn't make significantly more than what I'm already making as an RN.....Argh the stress is getting to me already!

Read The 4 Hour Work Week by Timothy Ferriss. You'll see similarity.

sixty3dayswithSarah, BSN, CNA, RN · Mar 1, 2016

I just got excepted for that (FPMHARNP) an MSN.... Do you find it's worth it financially ?

TheOldGuy · Mar 5, 2016

I've been doing telepsych independently for a little over a year. I do it on top of my day job for a little extra cash. There are a number of companies that have put together secure software, EHR, etc. They handle lining up the patients and billing. And yes, I CAN see pts while they are sitting at home on their laptops. My plan is to continue to see pts this way and in a few years retire to someplace nice with a sandy beach and work part-time.....

Kauaidreamer · Mar 5, 2016

I've been doing telepsych independently for a little over a year. I do it on top of my day job for a little extra cash. There are a number of companies that have put together secure software, EHR, etc. They handle lining up the patients and billing. And yes, I CAN see pts while they are sitting at home on their laptops. My plan is to continue to see pts this way and in a few years retire to someplace nice with a sandy beach and work part-time.....

I'm still fuzzy on the process for being able to prescribe in different states. Our situation is that my significant other will graduate with her Psych NP degree in July, but I still have another three years (more if I decide to add the FNP option). We live in Florida, so I'm fairly certain we would have to move to a state where we could at least obtain a DEA number (since Florida has the most restrictive practice in the nation NP's cannot write for controlled substances even with physician oversight). Ultimately, I want a job which will facilitate my (preferably our) living in Hawaii (essentially the primary reason I became a nurse in the first place) and now nine years later I'm 47 still working in the ICU (which I abhor especially now that we do trauma and have residents) not feeling any closer to the aloha state. I make about 80k now with no benefits, but would be willing to make 65 or 70 K without benefits if it meant being able to live in Kauai (from my perspective a tent with wifi would be okay, but my significant other would want at least a small apartment or condo, frankly she doesn't share my desire to move so ultimately it may be a solo routine).

akcompton1 · Mar 5, 2016

That is exactly the setup I want...I would think that this would continue to expand with the provider shortage we are experiencing. Thanks for giving me hope that this is possible for me!!!!

Kauaidreamer · Mar 5, 2016

I don't care about working independently (as in on my own) so much as being able to work geographically where I want (read Kauai). One option I've considered is becoming licensed in five to ten states with significant demand and then getting set up to work with one or more telemedicine companies.

Mistacleanup4101 · Jan 26, 2017

I know that this comment is almost a year old, just so that future people will know. As far as seeing patients at home this can be done thru a secure system called jabber. You can schedule the patient yourself or you can open up slots and the patient can schedule themselves and they can only contact you between the parameters you set. It is made by Cisco. Most all telehealth equipment is made by Cisco. as far as prescribing look into the Ryan Heights act. You have to see the patients at least once face to face before you can prescribe to them via telehealth.