Telehealth Member Advocacy Survey

4. What setting(s) do you work in?
Select all that apply:

• Community Mental Health Center
• Federal/Military Setting
• Fully Retired
• Group Office Practice, Traditional
• Inpatient Unit-Private Psych Hospital
• Inpatient Unit- Public Psych Hospital
• Nursing Home
• Outpatient Clinical- Public Hospital or Freestand Facility
• Solo Office Practice
• Correctional or Forensic Facility
• Federal/Veteran's Administration
• Group Model HMO Clinic
• Inpatient Unit-Private General Hospital
• Inpatient Unit: Public General Hospital
• Medical School, University
• Outpatient Clinic- Private or Freestand Facility
• Residential Treatment Center
• Student/College Mental Health
• Other: Please enter an 'other' value for this selection.

5. I accept the following insurance:
Select all that apply:

• Medicare
• Medicaid
• In-network payments with commercial plans
• Tricare
• I don't take insurance

6. What is the primary reason your patient population seeks treatment?
Select all that apply and include corresponding percentage:

• Mental Health: Please enter an 'other' value for this selection.
• Substance Use Disorder: Please enter an 'other' value for this selection.
• Comorbid Mental Health/Substance Use Disorder: Please enter an 'other' value for this selection.

7. What types of communication technology are you primarily using to treat patients via telehealth during the public health emergency? 
Select all that apply:

• Telephone
• Live video-audio combined
• Text messaging or via a patient EHR portal
• Non-live video-audio combined (reviewed while patient is not participating in real time)
• I have stopped seeing patients
• Additional Comments: Please enter an 'other' value for this selection.

8. What percentage of your total patient population were you seeing via telehealth before your state declared a state of emergency?

• 0%
• 1-25%
• 26-50%
• 51-75%
• 76-100%

9. What percentage of your total patient population are you seeing via telehealth since your state declared a state of emergency?

• 0%
• 1-25%
• 26-50%
• 51-75%
• 76-100%

10. Approximately what was your patient no-show percentage when seeing patients in person prior to your state declaring an emergency?

• 0%
• 1-25%
• 26-50%
• 51-75%
• 76-100%

11. Approximately what is your no-show rate when seeing patients via telehealth since your state declared a state of emergency?

• 0%
• 1-25%
• 26-50%
• 51-75%
• 76-100%

13. In general, for patients being seen via telehealth for the first time, how satisfied are your patients with the transition to telehealth?

• Dissatisfied
• Somewhat dissatisfied
• Neither satisfied or dissatisfied
• Somewhat satisfied
• Satisfied
• Additional Comments: Please enter an 'other' value for this selection.

14. What percentage of your patients cannot do audio and video telehealth and can only do telephone (audio only) telehealth visits?

• 0%
• 1-25%
• 26-50%
• 51-75%
• 76-100%

16. Are you getting reimbursed appropriately for telehealth?

• Yes
• No
• Additional Comments: Please enter an 'other' value for this selection.