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The Psychiatrist Will See You Now…Please Activate Your Webcam

As health care moves from a fee-for-service model to population health management, organizations across the nation are developing behavioral health service lines to more effectively treat behavioral health patients, including those with comorbid medical conditions. Unfortunately, program expansion is often challenged by a shortage of behavioral health providers—a hurdle that is compounded by the low percentage of psychiatrists who are willing to accept private insurance or Medicare.

Telepsychiatry Is Poised for Growth as Reimbursement and Physician Acceptance Improve
One strategy for leveraging a limited pool of psychiatrists, licensed clinical social workers and other behavioral health providers is the use of virtual visits. Sg2 forecasts that by 2019, there will be 12.8 million virtual E&M visits for psychiatry, accounting for 9% of all psychiatry E&M visits. While reimbursement has historically presented challenges for providers using telemedicine, CMS reimburses certain physician-provided virtual mental health services, and states are beginning to propose legislation mandating Medicaid and private payer coverage of telepsychiatry services.

With recent research demonstrating the feasibility and efficacy of telepsychiatry (with mental health assessments and interventions proving to be comparable to face-to-face services), the market momentum will continue to shift toward its use, as organizations realize its long-term value and implement telepsychiatry services across care settings.

ED and OP Consults Are Prime Candidates for Telepsychiatry
Telepsychiatry can be successfully implemented in a variety of care settings. When launching a new program, the emergency department and outpatient specialist consults are two key considerations.

Emergency Department
Too often, individuals seeking treatment for psychiatric conditions will use the ED as their entry point—and if the only crisis management offerings are in inpatient care, a costly inpatient stay may be the next step. By implementing telepsychiatry consults in the ED, providers can confer with remote specialists who are trained in behavioral health screening and triage. Organizations considering implementing telepsychiatry consults in the ED should:

  • Collaborate with behavioral health professionals and ED teams to identify which technologies and consult protocols from established telestroke programs can be duplicated for a telepsychiatry ED consult program.
  • Partner ED directors with behavioral health service line directors to build internal support for the program and to educate staff and patients on the virtual consult process.
  • Track metrics, such as wait time, number of consults per month and number of patients leaving the ED before being seen, to demonstrate the program’s success and identify areas for improvement.
  • Consider extending virtual consults to the acute care setting for patients with both acute and mental health needs (eg, heart attack patient experiencing depression; drug overdose patient in the intensive care unit).
  • Educate in-house providers to promote the program and to ensure clinically appropriate utilization.

Outpatient Specialist Consults
For patients living far from tertiary care centers, timely access to specialist care for psychiatric conditions is limited. Telepsychiatry can eliminate the need for patients and/or providers to travel long distances for specialist care. These services have been particularly successful in pediatric and adolescent populations. For example, the Marcus Autism Center, part of Children’s Healthcare of Atlanta, teamed up with the Georgia Partnership for TeleHealth to provide pediatric access to specialty care across rural Georgia. Since its inception in 2009, the partnership has facilitated more than 1,900 virtual encounters at school-based health clinics, walk-in clinics, hospitals and physician offices.

Success of outpatient telepsychiatry consults is based upon several considerations:

  • Apply for funding through private, state or federal grant programs to help cover up-front technology and equipment costs.
  • Centralize scheduling and marketing efforts to streamline administrative processes and avoid duplicative work.
  • Ensure rural facilities have access to required equipment (eg, camera, video display monitor, audio components, user interface), supporting system design (eg, HIPAA encryption) and network connection (eg, broadband access).
  • Consider combining outpatient consults with online psychotherapy services.

As virtual care becomes increasingly mainstream, Sg2 expects a growing number of organizations to utilize telepsychiatry to channel patients to proper access points, simultaneously treat both medical and mental conditions, and lower the cost of care for this patient population. We will continue to track telepsychiatry trends and are available to provide guidance on implementing telepsychiatry consults and integrating these initiatives into enterprise-wide virtual health strategies.

Note: Sg2 Consultant Allison Hebron contributed to this post.

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As of February 11, 2016, Vizient, Inc. has completed its purchase of MedAssets Sg2 and spend and clinical resource management segments from Pamplona Capital Management, LLC. MedAssets revenue cycle business will continue to operate as a wholly-owned subsidiary of Pamplona Capital Management LLP.

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