telepsychiatry for illinois health systems trilok shah, m.d
TRANSCRIPT
TELEPSYCHIATRY FOR ILLINOIS
HEALTH SYSTEMS
Trilok Shah, M.D.
GOALS
Background
Discuss benefits of a telepsychiatry program
Discuss steps to developing a telepsych program
Discuss answers to commonly asked questions
BACKGROUND Graduated Medical School University of Illinois COM
Psychiatry Residency from Advocate Lutheran General
Board Certified by American Board of Psychiatry and Neurology
Started In Touch Physicians telepsychiatry group to reach patients in underserved areas
Implemented new telepsychiatry programs across a variety of settings
Work with patients admitted to acute inpatient psychiatry units and with outpatient psychiatry clinic patients
WHAT IS IT?Psychiatry services carried out using audio-visual medium
Focus on the service not the technologyHas been around for long time
WHERE IS IT BEING DONE?Hospitals - ERs, Consults, Inpatient
Clinics - Private practice, CMHC, FQHCs, RHCs
Schools
Correctional facilities
Nursing/residential homes
Locum tenens coverage
EMERGENCY ROOMS Community Hospital of San Bernardino, Dignity Health
System Program for their emergency rooms Connected the emergency rooms at several different
sites with one centralized psychiatry service Improved ER throughput, sped up bed turnover time,
helped ER physicians with disposition
Midwest Medical Center in Galena and FHN in Freeport, IL Telepsychiatry demonstration project for their ERs Connected ERs in rural hospitals with 24/7 psychiatry
service. They had NO psychiatry services before the program.
PSYCHIATRY UNITSSwedish American Hospital in Rockford, IL
Program for inpatient psychiatry unitSupports onsite psychiatrists who are
overburdened Provides much needed weekend psychiatry
coverageOffers the providers, the patients, and the
managers more choiceContinuity of care for patients, as opposed to
locums docs turnover, and at a reduced cost
OUTPATIENT CLINICSGibson Area Hospital in Gibson City, IL
Program for their behavioral health clinicHuge influx of new patients for the hospital from
all over the map
Rosecrance in Rockford, ILProgram for outpatient clinics and residential care
patientsReduces the logjam that many clinics have in
getting patients seen by a psychiatristEases burden on PCPs who are stuck dealing with
complex psych issues on their own
OTHERSSCHOOLS
California State University at San BernardinoProgram for their student health center
CORRECTIONAL FACILITIES
California Department of CorrectionsProgram for their correctional system
WHY IS IT BEING DONE?Increased Access to Providers
Improved Quality of Care
Cost Benefits and Improved Workflow
Value Beyond Fee for Service
Increased Access to Providers
A Congressional report earlier this year said 55% of the nation’s counties have NO practicing psychiatrists, psychologists or SWs
According to HHS, Illinois has a deficit of 169 Psychiatrists
In rural AND urban areas
Improved Quality of CarePCPs recognize and diagnose less than half of
mental disorders Pirl, W.F.; Beck, B.J.; Safren, S. A.; Kim, H. (2001). "A descriptive study of psychiatric
consultations in a community primary care center". Primary Care Companion Journal of Clinical Psychiatry, 3 (5): 190–194. doi:10.4088/PCC.v03n0501
PCPs prescribe 50% of psychotropic meds- often out of necessity
DEVELOPING YOUR PROGRAMConvene Your Telemedicine Team
Assess the need & the current resources
Develop your financial plan
Select provider
Select technology
Develop protocols & do practice runs
Set launch date & market
Launch program
Convene Your Team
Project Manager
IT Representative
Financial Officer
Quality Improvement Representative
Provider (?)
Develop Your Financial Plan
What will be the associated costsProviderSupport staffEquipment and setup – a much smaller cost now
Reimbursement
ReimbursementMedicare & IL Medicaid
GeographyRural for Medicare- Telehealth Payment Eligibility AnalyzerHPSA for Medicaid
Facility- office, hospital, RHC, FQHC, SNF, CMHCProvider- must have completed a psychiatry
residency program CPT codes- most evaluation and follow up codesReimbursement to the health professional is the
same as in-person amounts. Originating (patient) site is reimbursed an additional $25 per telemedicine encounter
Select Your ProviderFits your needs
AvailabilityExperienceSubspecialty
Willingness to work with the whole teamLong term relationship with your facility and
patients
Our Providers Are… Illinois licensed, Board certified psychiatristsLocal and interested in serving the patients hereAdult and child specialistsExperienced in implementing programs in different
settingsAre thoroughly vetted, and have clean practice recordsGo through extensive training processAble to help with credentialing, billing, technology, staff
training, developing protocols, and with data collection for continuing program evaluation
English proficient, and not requiring any visa sponsorshipBacked by $1mil/$3mil liability coverage
Models We OfferDirect patient care
Popular for CMHCs, RHCs, FQHCsA remote provider supplements onsite carePre-scheduled appointments Provider can do what onsite provider would do:
Med management Initial evaluationFollow-up careTreatment team meetings
Models We OfferCrisis Telepsychiatry
Popular model for ERsRapid, on‐demand access to a psychiatric
professionalOffer psychiatric assessment, admission and
commitment decisions24/7/365 availabilityResponse time: Less than 1 hour
Models We OfferConsultation Model
Consultation for onsite providers who are caring for patients with psychiatric issues
Provider may participate in treatment teams taking part onsite
Provide educational seminars on commonly encountered psychiatric issues- depression, substance abuse, suicide prevention, controlled medication prescribing
Model We Will OfferOnline Provider Platform
Providers sign up on our secure site to provide psychiatry and therapy services
Patients select a provider based on the provider’s profile and reviews
Patients schedule appointment onlinePatient and provider have brief call prior to
initial appointment to ensure good fitAppointment takes place on secure
platform
Select the TechnologyWork with your provider to ensure compatibility
Engage your IT team, but do not let them be the sole decision makers
Security is not just about the technology- it is also about how it is used
Think about long term needsNeed mobile unit?
Technology costs are no longer prohibitive
Develop Protocols & Practice Runs
Scheduling
Medical records
Prescribing - Controlled medications
Orders - Ordering and receiving results
Consents
Loss of signal or loss of power
Emergency situations
Keys to SustainabilityExpect to encounter some resistanceTrainExpect to make adjustmentsInform everyone earlyKeep the onsite team engaged
Challenge team to focus on the positivesAddress fears about being replacedSupport, not replace
Keep the provider engagedInclude them in your e-mail listsFamiliarize them with the community’s resourcesInform them of major changes in the organization
COMMON QUESTIONSWill patients like it?
Does it work?
Will Patients Like It?A number of patients prefer this:
AccessConvenienceCost savingsDistance is perceived as protective by some
patients Neutral place So many patients already use similar
technology to socialize/keep in touch with others
Do Our Patients (and Sites) Like It?
Timeliness of ServiceAverage time for our providers to respond to ER consult
is less than 30 minutesPatient seen and documentation completed on average
within 60 minutesWait time for our outpatient clinic patients once they
are checked in is less than 10 minutes
Patients SatisfactionPatient satisfaction with psychiatrist 89%Patient satisfaction with telepsychiatry experience 91%80% of patients reporting their telepsychiatry
experience being equivalent to an in-person encounter, and 10% reporting that it was very close to being equivalent
Does It Work?
MORE COMMON QUESTIONSHow does a typical telepsychiatry encounter go?
Can the In Touch providers prescribe medications?
How do In Touch providers document?
Can the In Touch providers integrate with the healthcare team at my organization?
Can we supplement the In Touch telepsychiatry services with our own psychiatrists?
RESOURCES In Touch Physicians Resource Center
http://www.intouchphysicians.com/resource-center.html
Practice Guidelines for Tele-Mental Health Services http://www.intouchphysicians.com/uploads/3/4/2/8/342
8956/ata_telemedicine_core_guidelines.pdf
Practice Guidelines for Telemedicine Services http://www.intouchphysicians.com/uploads/3/4/2/8/342
8956/ata_practice-guidelines_videoconferencing.pdf
American Telemedicine Association http://www.americantelemed.org
Telepsychiatry in the 21st Century http://www.intouchphysicians.com/uploads/3/4/2/8/342
8956/telepsychiatry_in_the_21st_century.pdf
DISCUSSION
Trilok Shah, MDPresident, CMO773-916-7595tshah@intouchphysicians.comwww.intouchphysicians.com