As is the case nationally, psychiatry is in limited supply in the area of River Valley Health and Dental Center in Williamsport, Pennsylvania.
It just was not realistic to attempt to recruit and retain both an adult and pediatric psychiatrist to join River Valley’s medical staff. That said, as a large primary care office offering integrated behavioral health, it was important to expand mental health services to include specialty care for patients.
Further, as a federally qualified health center, River Valley is charged with providing comprehensive, whole-person care. No question existed in the minds of staff about the value of adding psychiatry to their continuum of care.
“Also as is the case nationally, the COVID-19 pandemic provided a monumental challenge for us in terms of continuity of care,” said Susan King, behavioral health coordinator at River Valley Health and Dental Center. “In an instant, our patients were afraid to come to the office to see us, and soon thereafter, authorities in Pennsylvania instructed us to remain home in order to flatten the curve.”
"Given the shortage of psychiatry providers nationwide and specifically in our rural area, hiring our own psychiatrist was not possible."
Susan King, River Valley Health and Dental Center
River Valley recognized the need to protect medical and office staff as well as the community it serves. It understood that prolonged stress associated with a global pandemic would take a toll on all patients, but particularly patients with existing mental health conditions. River Valley needed to quickly implement expanded services in order to continue to care for the mental and physical health needs of each of its nearly 17,000 patients.
So River Valley decided to move to telemedicine via InSight + Regroup, a tele-psychiatry technology and services vendor.
“The goal of our telemedicine program for psychiatry was simple: Provide our patients access to specialty psychiatric care while also affording them the privilege of shared access to their physical and mental health records by medical and psychiatric providers,” King explained. “Given the shortage of psychiatry providers nationwide and specifically in our rural area, hiring our own psychiatrist was not possible.
“When the COVID pandemic hit, we worried that patient fear about coming into the office or patients following governmental advisories to remain at home would influence access to needed care.”
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MEETING THE CHALLENGE
Using telehealth for psychiatry was an obvious solution, King stated. It gave River Valley assistance with recruiting providers and allowed the practice to contract for a couple of days a week to start until it gained a sense of what its panel size needed to be.
River Valley contracted with InSight + Regroup to provide psychiatric specialty care. River Valley had a registered medical assistant designated to work with the psychiatry providers to complete rooming, scheduling, securing consents and releases of information, and to be a conduit for communication between the psychiatrist and the patient’s medical provider in the office.
River Valley uses eClinicalWorks for its EHR and Bluejeans to connect virtually with the psychiatry provider. When the pandemic hit, the practice worked with InSight + Regroup to determine the most user-friendly option for patients to access the provider.
At the time, eClinicalWorks was brand new to staff and patients had not been activated in the eCW portal. The goal was to find the easiest pathway to care for patients as possible.
“InSight + Regroup allowed our registered medical assistant to have access to their room scheduling as we determined that secure remote access to Bluejeans was less cumbersome for our patients,” King explained. “The registered medical assistant uses the Bluejeans platform to send a text with a secure link to the visit specifically assigned to each patient visit for a clinic day.”
River Valley saw solid patient show rates during the pandemic. With the change to remote access of telehealth, a provider sees an average of 28 visits a week out of 40 slots. Patients directly attribute being able to be seen from their home or job as a reason for being able to keep their appointment.
“And as for patient satisfaction, our survey results speak volumes,” King noted. “100% of our tele-psychiatry participants agree with the following statements: ‘I am able to talk with my doctor during tele-psychiatry sessions about the same information I would talk to my doctor about in person. I can clearly see and hear the doctor during sessions.’“
Since program inception, 89.47% of patients reported zero technical concerns during the course of their visit, she added.
ADVICE FOR OTHERS
“The most important variables to consider are regulations of your state departments of health and human services and public health and the extent to which a variety of payers will cover the provided service,” King advised.
“Tele-psychiatry became allowable by the state in our part of Pennsylvania about ten years ago. At the time, only Medical Assistance would cover the service. Over time, other commercial payers became amenable to the idea of tele-service delivery. Providers will want to make sure that offering tele-psychiatry will not adversely impact their licensure and that the payers who insure their patients will pay for the service you offer.”
Once the agency establishes that providing tele-psychiatry is feasible, providers will want to assess the volume of their need and the ease with which panels are likely to grow, she added.
Because offering patients a choice was important, River Valley did not want to overextend itself and contract for a greater number of hours than needed, she said. Likewise, the practice has been vigilant in monitoring how quickly it is able to schedule new individuals for evaluation.
“Our goal is to keep our provider full and keep access quick without contracting for too many hours and resulting in too much downtime for the provider,” King concluded.
“Further, because providing pediatric services requires more care with regard to who is legally able to provide consent, we needed to be mindful of potential delays in securing legal documents needed to make those determinations. As such, growth in our pediatrics program has been slower despite that the pace is not a reflection of the need.”
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