TELEPSYCHIATRY FOR ILLINOIS HEALTH SYSTEMS Trilok Shah, M.D

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