improving access to quality medical care webinar series · hospital telepsychiatry scenarios •...
TRANSCRIPT
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© 2017 UA Board of Regents
Improving Access to Quality Medical Care Webinar Series
Presented by
Southwest Telehealth Resource Center and the Arizona Telemedicine Program
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WelcomeSWTRC region - AZ, UT, CO, NM & NV Fellow HRSA Telehealth Resource CentersAll other participants from the US & abroad
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The Arizona Telemedicine Program, the Southwest Telehealth Resource Center & Insight welcomes you to this free webinar on the implementation & practice of telemedicine. The practice & delivery of healthcare is changing, with an emphasis on improving quality, safety, efficiency, & access to care.
Telemedicine can help you achieve these goals!
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Webinar Tips & Notes
• Mute your phone &/or computer microphone• Time is reserved at the end for Q&A, please use the
Chat function to ask questions• Please fill out the post-webinar survey• Webinar is being recorded• Recordings will be posted on the SWTRC website
http://www.southwesttrc.org
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“Behavioral Health Across the Continuum: The Power of
Telepsychiatry in Increasing Access to Care”
Randy McCloudInSight Telepsychiatry
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Agenda
• Overview of Telepsychiatry• Behavioral Health Workforce• Where is Telepsychiatry Used?• Building a Connected Community
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Think About It…• If you had unlimited resources, how would you improve your
organization?• How is your community affected by a lack of behavioral health
access?• Where does your organization’s psychiatric capacity fall short?• Does the structure of current behavioral health workforce make
sense for the ever changing landscape of behavioral health?
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The Impact of One Behavioral Health Consumer
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Behavioral Health Workforce
• There are 37,296 psychiatrists in the United States1
• About 4,000 areas nationwide where patient to psychiatrist ratio is 30,000 to 12
• 59% are 55 or older (entering zone of retirement)3
• United States needs around 45,000 more psychiatrists4
1. https://members.aamc.org/eweb/upload/Physician%20Specialty%20Databook%202014.pdf2. https://www.rt.com/usa/314777-us-shortage-psychiatrists-demand-grows/3. https://www.usnews.com/opinion/blogs/policy-dose/2015/09/15/the-us-needs-more-psychiatrists-to-meet-mental-health-demands4. http://www.psychiatrictimes.com/articles/45000-more-psychiatrists-anyone-0
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How can existing psychiatrists be used to meet the increasing demand?
Behavioral Health Workforce
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TelepsychiatryA medium for delivering psychiatric care through
videoconferencing technology
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Telepsychiatry is Different
Telepsychiatry
Focus on conversation and collateral collection
Long-term physician-patient relationship
Typically 8-12 appointments
Multiple types of appointments
Other Branches of Telehealth
Focus on physical observation
Short-term encounters
Single consultation
Urgent care
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BenefitsCo
nsum
er
• Reduces time in hospital
• Provides access to specialists
• Flexible hours for scheduling appointments
• Facilitates continuity of care
• Reduces wait times• High consumer and
family satisfactionTe
lem
enta
l Hea
lth
Prov
ider
• Increases time and efficiency
• Decreases transportation costs
• Increases number of visits
• Improves communication and collaboration
• Ability to see a diverse consumer population
• Flexibility to work from home
Com
mun
ity
• Increases access to specialists
• Reduces inappropriate admissions
• Connects siloed health care organizations
• Improves population health
• Reduces risks and liabilities
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Challenges
Consumer
Adapting to new method of care
Using new technology
May feel alone
Provider
Licensure in multiple states
Must make time to interact with onsite
staff
Potential to feel isolated
Program
Complying with multiple state and federal regulations
Getting buy in from a new program
Designing efficient workflows
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Where is Telepsychiatry Used?
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Scheduled Services ModelRemote providers can be used to complete most tasks
that an onsite provider would
Initial Assessments and
Testing
Treatment Team Meetings
Medication Management
Therapy and Counseling
Group Sessions
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On-Demand ModelRapid, on-demand access to a psychiatric professional
Psychiatric Assessments
Admission and Commitment
Decisions
Consults and Orders
Rounding Referrals
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Direct-to-Consumer Model• Convenient value-add for consumers• Flexible hours for providers in private practice• Great for night and weekend appointments • Expand care almost anywhere (home, dorm room, hub site, etc.)
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Connected Services Model• What is it?
– Programs that blend several telepsychiatry models together in order connect new settings on the care continuum
• What are some examples?– Telehealth consulting and community assessment projects– Programs with ACOs and health systems– Inpatient programs– Programs for skilled nursing facilities– Programs for schools or universities
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Individual goes to ED and is assessed by telepsychiatrist
Needs to be admitted to inpatient unit and
telepsychiatry does overnight rounding
Individual leaves hospital and lives far away, hospital
required to set them up with care
Hospital Telepsychiatry Scenarios
• Follow-up referral options– Telepsychiatrist in a step-down program or partial hospitalization– Telepsychiatrist available or serving in Community Mental Health Center in
individual's location– In-home care with a telepsychiatry provider
• With all these options, there is a continuity of care for the individual
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Skilled Nursing Facility Telepsychiatry Scenario
1• Individual is “sundowning” and nobody knows how to treat them
2• SNF calls telepsychiatrist and they are able to keep the individual
where they are comfortable and out of the ED
3• Telepsychiatrist able to review individual’s current medications
and make appropriate decisions
4• Telepsychiatrist able to follow-up with individual over time
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In-home Telepsychiatry Scenario
Individual with history of panic disorder and agoraphobia
Individual cannot leave their home due to severity of panic attacks
Primary care provider suggests telepsychiatry as an option
Individual is able to have appointments privately at home, perhaps at night or on the weekends
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Increase access to care, including specialists
Expand psychiatric workforce
More convenient options for care
Utilize same network of providers in settings across the care continuum
Benefits
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Building a Connected Community:
How to Implement a Telepsychiatry Program
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Consider Regulatory and Legal Environment
Cultivate Stakeholder Buy-In
Select Technology
Design Workflows
Provider Credentialing
Program Planning
Training
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Know State-Specific Regulation and Rules• Licensure
• State Medical Board• Reimbursement
• Medicaid• Private Payers
• Physician-Patient Relationship & prescribing• Telemedicine specific legislation or regulation
• Permitted services, professionals, sites, etc.
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Interstate Medical Licensure CompactWhat is it?
In Brief: Expedited licensure pathway– State Collaboration
Goal of the Compact: To increase access to health care for individuals in underserved or rural areas and allow patients to more easily consult medical experts
Bonus: The Compact increases the opportunity to utilize telemedicine technologies
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Cultivate Stakeholder Buy-ins
Providers Executives IT
Medical Affairs Community Payers
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Select Your Providers
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Medical Affairs• Plan ahead! Provider credentialing is the largest roadblock to
launching new programs• Are your bylaws conducive to telepsychiatry?• Will you accept credentialing by proxy?
• Licensing • Credentialing• Paneling• Payer Enrollment• Maintenance of Certification,
Reappointments, CMEs
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Pick the Right
Equipment
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Design Clinical Flow
Consult Request by Onsite Staff
Initial Referral Info Collected Provider Assigned
Review CollateralClinical Interview
Orders & Documentation in
EMR
Communication back to Onsite Staff
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Put Telepsychiatry in its Place
• Make sure all parties know why and how telepsychiatry will be used
• Support in-person care, not replace• Demystify the technology
• Technology shouldn’t be the focus• Conduct your orientation and training via televideo to get each
side used to it • Problems are generally just user error
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Train Providers
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Telepsychiatry Practices to Avoid
• Insecure/unprotected video and documentation platform
• Slow internet connection• Provider is not licensed to practice
in the consumer’s state• Distracting visuals in the
background • Distracting sounds
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Appropriate Telepsychiatry Practices
• Have a technology back-up plan• Have emergency contact number and emergency
numbers of the consumer’s area• Review consumer’s information prior to the first
session• Have a white noise machine or ambient sound• Check video presentation beforehand• Refer to another telebehavioral health provider or in-
person provider if necessary• Provider is trained to practice telebehavioral health
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Practice GuidelinesThe American Telemedicine Association and the
American Psychiatric Association both have guidelines for the practice of telepsychiatry and
are excellent resources.
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Future of Telepsychiatry
Moving toward in-home care
Trends in “consumerism”
Care across the continuum
Ubiquitous reimbursement
Outcome data for
telepsychiatry
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Questions?
Randy McCloudLead Account ExecutiveInSight Telepsychiatry Randy.McCloud@in-sight.net302.353.6663www.InSightTelepsychiatry.com
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Improving Access to Quality Medical Care Webinar Series
Please check our website for upcoming webinars and events
http://www.telemedicine.arizona
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© 2017 UA Board of Regents
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This webinar series is made possible through funding provided by health Resources and Services Administration, Office for the Advancement of Telehealth and the Office of Rural Health Policy, Rural Hospital Flexibility Program.