Roy can’t prognosticate without coffee.

While news outlets have been calling 2015 a rough year, it was a pretty quiet one on the HIPAA front. 2013 saw the Omnibus Rule shake things up big time, 2014 was a lot of scrambling to keep up, and in 2015 we struggled with the aftermath.

As much as that struggle was hard in some places, it didn’t see a lot of concrete changes in regulation or ethics outside of Medicare. However, I have quite a few things to report as we go into 2016, which promises to hold a lot more surprises for the mental health community!

The State of Private Practice

Solo or Group?

Private practice is being impacted in many states due to the Affordable Care Act. Every state does it differently, but the ACA and Medicare have created an across-the-board incentive to group up. A huge part of the awkwardly-named Federal Strategic Plan for Health Information Technology is getting different health care professions integrating care much more. And it wants us using electronic records to keep that integration flowing smoothly (well, that’s the plan, at least. It hasn’t been going as smoothly as hoped.)

For those who work with managed care and Medicare, paperwork and red tape in general increased in 2015. More red tape = more incentive to group up and share the bureaucratic load.

Ain’t no party like a therapist party!

Luckily, my experience is that this doesn’t seem to have negatively impacted the flourishing of private practice. I’ve seen a lot of group practices form to manage the load together, especially in Minnesota where the state is putting regulatory pressure on health care pros to integrate more with other providers.

The big change, in my view, is that solo practice is becoming something where you either need to be on top of managing bureaucracy and running a business or simply stay away from managed care (in which case you still need to run your business, of course, but it’s simpler.) The latter strategy is one I think we’ll see more and more of in 2016 across the whole health care industry — not just in mental health.

Internet Marketing

Surprise, surprise, but the Web is still a popular place to find a therapist. I’m not really sure that’s the best for clients, but it is the way it is.

In 2015, we saw a massive rise in the use of smartphones to surf the Web. Our industry was hugely impacted by that. If you’ve ever looked at the records of who is visiting your website, you may see a whopping 50% or so of your website visitors are using a mobile phone.

As a result, the mighty Google did decree that they shall penalize websites that are not specifically designed to work well with mobile phones. That is an important 2015 event to take note of if you use your website to help attract clients.

We have discussed this trend during the weekly Office Hours sessions that are part of Person-Centered Tech Support. Our friend Joe Bavonese has also been studying the subject and has a lot of good ideas for how to leverage the shift for private practitioners’ benefit. We will be hosting a free presentation with Joe on February 12th to discuss what he’s learned. Joe will also follow up with a visit to Office Hours some time after the February 12th event.

→ Click here to register for the free event with Joe Bavonese.

In the meantime, ask your web designer or web hosting company if your site is “mobile responsive” — that’s the jargon term. If the answer is “no,” find out if it’s possible to revise it so that it is.

Mobile responsive websites will usually change their appearance when you “squish” the screen. You can try it on the Person-Centered Tech website: make your browser window narrower and narrower (so that it’s very tall and narrow) and you’ll see the website change to fit the smaller window. That’s an example of “mobile responsive.”

Electronic Health Records

Our cohort (professional Counselors, Marriage and Family Therapists, Clinical Social Workers, Psychologists, and our ilk) are still not part of the Federal incentive program that requires us to use Electronic Health Records. The Meaningful Use program (that’s the name of the EHR incentive program) saw setbacks in 2015 and is behind schedule. There is little will or momentum to add non-prescribing mental health pros to the roster of “EPs” (“Eligible Professionals” who are part of the program.) For more background, read our article on EHR in mental health.

However, working with managed care — especially Medicare — is becoming increasingly difficult without a proper certified Electronic Health Record (EHR) system. There are many reasons, but a large one is that EHR makes it easier to submit Physician Quality Reporting System (PQRS) reports, which are required of any health care group that includes within it physicians and other pros who are in that “Eligible Professional” set.

That means that those who work in managed care have increased pressure to act as if they are part of the Meaningful Use program and, thusly, increased pressure to make friends with the HIPAA Security Rule.

I think it’s likely that in 2016, we will all need to befriend electronic records or decide to stay on the outskirts of health care. The outskirts ain’t so bad, though. We’re pretty relaxed out here.

Online Therapy/Telemental Health

In my opinion, distance psychotherapy hasn’t taken off the way we thought it would in 2012. That said, though, more and more of us are making use of it at some level. 2015 saw yet more expansion of telemental health programs in Medicare and other areas of government, and more popularization of the idea as available to clients.

What Software To Use?

The growth of the tech industry around telemental health has been staggering, and yet I can tell you that we’re still far from the peak of it. As recently as 2012, many (including myself) argued that Skype was a perfectly suitable way to go for online therapy. The 2013 HIPAA Omnibus Rule put the kibosh on that. However, competitors like VSee popped up as good alternatives.

It is with mixed feelings that I report that the era of using free software to perform online therapy is coming to a close. In 2015, the Feds made it very clear that they expect all clinicians to be very rigorous about getting HIPAA Business Associate Agreements from the companies they work with for online therapy, storing information, and just about everything else.

So, for those of us who are HIPAA covered entities, we recommend that you only do online therapy using software providers that give you a HIPAA Business Associate Agreement. Don’t panic, though, if you aren’t doing that right now. Read on for our recommendations. (Not sure what a Business Associate Agreement is? Read our article on it here.)

This is a major note for many who have been following Person-Centered Tech over the years, as I have often recommended VSee as a good, free option for online therapy. This is significant because the free version of VSee, while very secure, does not include a HIPAA Business Associate Agreement (“BAA”.) The folks at VSee have stated that they are willing to offer a lower rate to small mental health practices for their Pro software, which offers a BAA. I have put in a request for details, and will be updating our article on VSee as I get more information. In the meantime, you can inquire directly with them at https://vsee.com/contactsales.

If you need to transition to new software, let me strongly urge you to take it slow. Don’t run out and immediately buy or download something new. The process of risk management is often a slow one, and you will do yourself and your clients a much greater service if you take the time to investigate new options and make the transition at a reasonable pace. If your current setup didn’t bring about a disaster yesterday, there is no change in the odds that it will do so tomorrow.

For researching new options, we highly recommend the Telemental Health Comparisons website.

The trend in online therapy software for small practices seems to be going in the direction of using online practice management systems that include video software within them. My hope, however, is that we’ll see standalone video companies like VSee and Zoom bring their healthcare plan prices into the below-$40/month range in 2016. Person-Centered Tech will certainly be advocating for them to do so.

The Bottom Line: Getting Paid

2015 also saw the credit card industry introduce and aggressively push the use of EMV credit cards, or “chip cards.” If you accept credit cards, you’ll need a special card reader to take advantage of the chip’s features.

In November, we wrote about the shift to EMV cards and for private practitioners our general recommendation is that you should get the new EMV card reader, but you have little reason to rush into getting a new reader. This is despite the credit card companies’ applying negative incentives for you to do so. We, ourselves, will be getting our new reader sometime soon here. Y’know, once we have a spare moment somewhere…

I predict that 2016 will see not only chip cards, but also a huge rise in cardless payments using smartphones (and maybe other kinds of mobile gizmos!) When you’re looking into getting your new EMV chip card reader, think about getting the reader that can also do wireless payments. You may be happy you did down the line.

As for HIPAA and credit cards? The scene hasn’t really changed. And that’s no surprise. If you’re not up on that scene, start with our article on Banks and HIPAA to get you oriented.

Person-Centered Tech in 2016

We are still working hard on our goal of completing the HIPAA Security Workbook so as to bridge the gap between small mental health practice and HIPAA Security. We expect you’ll be seeing a lot of movement from us there by the end of January.

We also plan to keep expanding on Person-Centered Tech Support (we might even give it a new name!) We are finding that the need to get periodic help with tech, ethics and HIPAA is deep in our community, and Person-Centered Tech Support is part of our effort to meet that need affordably and effectively.

We hope 2016 is happy and prosperous for all of you!