Telepsychiatry

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Presentation by James Varrell, MD, InSight Telepsychiatry

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Telepsychiatry

  1. 1. • Began hospital based telepsychiatry in 1999 with Center for Family Guidance, PC. • Founded InSight Telepsychiatry, LLC in 2008 after providing services for over a decade as a component of Center for Family Guidance, PC. • Today, InSight performs 15,000+ telepsychiatry encounters each year. • InSight’s team has been involved in behavioral health and telemedicine advocacy and policy for the past 13 years.
  2. 2. Used In a variety of settings: Emergency Departments Med/Surg Floors Correctional Facilities Outpatient Offices Primary Care Clinics Crisis Centers Nursing Homes Schools Mobile Outreach* Home-Based*
  3. 3. – Direct Cost Elements • Round Trip Distance Equipment purchase or lease • Round Trip Travel Time Transmission lines • Fuel Costs Warranty and support • Personnel Costs (custody) Patient retention and no-shows • Physician Visit Costs Appropriate Level of Care – Indirect Cost Elements • Opportunity Cost Staff Satisfaction & Retention • Liability Exposure Provider Relationships • Safety (consumer & staff) Training & Supervision • Regulatory & contractual compliance .
  4. 4. Direct Cost Benefit Indirect Cost Benefit • Reduced inappropriate admissions • Improved ED throughput • Improved wait times • Reduced transport costs • Patient Satisfaction • Staff Satisfaction & Retention • Improved Safety • Decreased Liability BH consumers remain in ED 3.2 times longer than average Physician reimbursement for BH consumers is 40% less than average A BH consumer costs nearly $2,400 more than the average patient *Source: Academic Regional Referal Center with over 90,000 patients/year
  5. 5. Direct Cost Benefit • Reduction in offsite trips – Transport and custody • Formulary Adherence • Suicide Watch release Indirect Cost Benefit • Flight risk & public safety • Relationships with community providers • Inmate care and safety Effective Management Controls of Formulary 20% overall reduction possible *Survey of CA Dept of Corrections Pharmaceutical Expenditures (2003) Bucks County, PA Jail – Formulary Adherence Reduction of pharmacy costs by almost 2/3 per month Nearly $480,000 annually
  6. 6. Direct Cost Benefit • Officer overtime expense – 2 officers for 26 hours • ED expense Indirect Cost Benefit Arrested Individual - Telepsych Avg Weekend Wait Officer Pay / Hr Overtime / Hr ED visit Psychiatrist Bill (Hrs) $ $ $ $ 26 42 63 2,225 220 Results Pilot (months) # Uses Savings • Arrestee care and safety $ • Relationships with Savings / Use $ community • Public safety 5 15 76,000 5,067
  7. 7. Care is exponentially better than no care at all • Cost Benefits • • • • • Cost Concerns Travel expense Psychiatrist travel time Locum tenens alternatives Recruitment costs NP & MD collaboration • Training and Supervision • Regularly contact reduces inpatient treatment needs •Reimbursement •Fee for Service •Support Staff •Televideo Equipment •Transmission lines •IT support costs
  8. 8. Primary Care Telepsychiatry • Consultative or Referral Basis – Allows a primary care physician easy access to a psychiatric consult or referral – Great applicability for pediatrics • Rural Primary Care Clinics – Federally Qualified Health Centers • Benefits – Improved diagnosis and proper prescriptions – Fast access to specialists – Reduce travel and wait times
  9. 9. Growing areas of interest/need Behavioral Health Integration • InSight’s partnership with the University of Virginia Health System • Identified communities in need of behavioral health services • Connect these communities to UVA’s clinicians • First partnership was at a FQHC • Community Care of the Sandhills (NC Primary Care Health Network) • Primary Care Physicians empowered to assess and treat both the physical and mental health of their consumers - reduces no-show rates - improves access to specialty care - one stop healthcare is convenient and effective for patients - integrates physical and medical health care
  10. 10. Access to Care Employee Retention Consumer Satisfaction Regulatory Compliance Cost Effectiveness Guaranteed Quality Appropriate Level of Care Timeliness of Service Risk Reduction / Safety Training & Supervision Access to Specialists

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