Telepsychiatry for Emergency Medicine
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Telehealth Secrets Conference 2018, Day 2 by VSee Speaker: Rudolfo Zaragoza, MD & Kimberly Lopez (Vituity) More info here: vsee.com/conference
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Telepsychiatry for Emergency Medicine
- 2. Physician Partners We care for over 6.3 Million Patients DC 2200 Annually Advanced Providers 1400 Scribes 2000 Practice Locations 250+ 40+ years of experience 5600 Providers
- 4. Our California Footprint in Numbers • 1,680 Physician Partners • 925 Advanced Practice Providers • 1,420 Scribes • 215 Practice Sites • 4M Patients Annually • 2M Medi-Cal Patients Annually
- 5. TelePsychiatry TeleNeurology Tele-Skilled Nursing Tele-Critical Care Tele-Urgent Care Tele-Transitional Care
- 6. Telepsychiatry: Benefits to Hospitals and Patients Patient evaluations by emergency trained psychiatrists delivers: Improved clinical quality Reduction in boarding, allowing for efficient bed turnaround and ED throughput Decreased risk and improved safety for patients, families, and care teams Reduction in admissions, which often occur unnecessarily for behavioral health patients Care plan collaboration with in- person providers Improved rates of patient acceptance by IP psych facilities because a thorough evaluation with documentation has occurred by a psychiatrist
- 7. Telepsychiatry Growth and Outcomes 0 100 200 300 400 500 600 700 Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul 2016 2017 2018 NumberofConsults TPSY Consult Volume 29% 34% 37% Recommend admission to inpatient psychiatric care. Recommend discharge from emergency services with referral to outpatient care. Recommend observation in the emergency room with reassessment within 24 hours. Disposition Recommendations
- 8. Case Study: How we improved one site’s TAT-D Q1-2016 Q2-2016 Q3-2016 Q4-2016 Q1-2017 Q2-2017 Q3-2017 Q4-2017 Q1-2018 Q2-2018 Total Volume 296 374 423 376 331 392 402 382 415 465 TAT-D 304 316 298 337 309 265 274 302 263 260 0 50 100 150 200 250 300 350 400 0 50 100 150 200 250 300 350 400 450 500 Vituity ED/TelePsych Tele Psych Go live
- 10. Thank You. Please visit us online: www.vituity.com; email us at telehealth@vituity.com; or talk to our team wearing orange lanyards.
Editor's Notes
- Hello, I’m Rudy Zaragoza, a practicing Emergency Medicine Physician; a TeleMedicine Provider, and Vice President of Transformation for Vituity, the nations largest physician-owned partnership. And this is Kim Lopez our Program Director of Psychiatry and Neurology. It’s our distinct pleasure to be here today with all of you, to share a little about who Vituity is, and what we have been doing in regards to TeleMedicine efforts and services. We’re happy to say that we are part of the 10% of TM start-ups still standing. Something interesting about me is that I know Milton Chen, the worlds most interesting man. Who would’ve known that he’s hanging out with Navy SEALS on Mission in Afganistan.
- First, a High Level Overview of Who we are… Vituity is a physician owned and led partnership of Dynamic and Engaged providers staffing hospitals, clinics, and practices across the country Practicing for >45 years, and work in >250 practice locations. Last year we cared for more than 6.3 M patients, and this year we’re ontrack to care for @6.8M >2200 physician partners, >1400 APs, >2000 Scribes – making us the second largest scribe company in America We are supported by a world class MSO, consisting of: Nurses, Executives, Engineers and Healthcare Experts that keep our organization moving swiftly forward Vituity is a very unique physician group. As healthcare practitioners we are constantly looking for ways to innovate and improve the health of our patients and communities. We proud of the work we do, see it as a privilege and remain very passionate about our roles as Change Leaders of our healthcare environment.
- As you can see from this slide, we have a very diverse practice. Though our roots are in EM, our partners now practice across 10 specialties with a keen focus and commitment to the acute, post-acute, and urgent care patient populations.
- Now while our organization is evolving across the country, the majority of our care continues to be delivered in California. We see over 4 million patients annually in California, and are the states single largest MediCal provider.
- Part of our evolution as an organization involves growth and focus in TeleMedicine and the build of our own platform in collaboration with VSee – who built the platform to meet the needs of our patients and providers. Each practice line was able to customize their platform and EMR to be user friendly and highly efficient. The name of our TM Platform is On Duty We have multiple interfaces, co-designed by our physicians for all these use cases TelePsychiatry is our fastest growing practice line and this year was formally endorsed by the Hospital Associations of Southern, Northern and Central California as the Telepsychiatry provider of choice TeleNeurology includes the integration of Teleneurology, Telestroke , Neurodiagnostics and remote monitoring at over 35 hospitals across the country Tele-SNF allows patients to be more aggressively managed in the post-acute care space, improves the level of care at these facilities and helps to save money by decreasing unnecessary transports back to the ER as well as lowers the number of hospital readmissions from Skilled Nursing Facilities TeleCritical Care allows remote management and monitoring of some of our sickest patients in ICUs and vented settings TeleUC patients are located both in clinics as well as in their homes through an Employer based model And finally, Tele-Transitional Care allows patients to be managed outside of hospital walls through navigators and others, but now I’d like to turn the floor over to Kim, who is going to share with you specific information regarding our fastest growing program, Telepsychiatry. Each one includes a customized EMR to be prepared for changes to laws when billing comes, but also to be super efficient Take telepsych for example. Huge shortage in psychiatrists nation-wide Even bigger shortage if you’re talking about those special types of pscyhiatrist who want to see patients in hospitals in their moments of most acute crisis Telepsych helps patients be seen the moment they need it where ever they are and maybe avoid painful waits or unnecessary transfers to inpatient units which is a lose-lose-lose. But there are challenges – seeing patients in 15 different hospitals during a shift is complicated, especially when you consider the EMRs Also, most EMRs aren’t well-formatted for documenting the acute psychiatric condition. Our psychiatrists designed an EMR to be able to document exactly what you need to know to treat your patient. It’s also more efficient because it’s the same every time
- In closing, I would like to share with you how TH is becoming central to our organization and to the patient care that we provide. We have been seeking use cases and opportunities to improve care delivery through, the use of technology that will allow us to better manage our patients beyond the walls of bricks and mortor facilities. TH is now being utilized to coordinate care across the care continuum from the ER, to the patients home, from the clinic or hospital to the SNF and on and on. An example of recent innovation, is our use of Telehealth for a Next Generation APM(Alternative Payment Model), as was mentioned yesterday, by Dr Ingrid Vasiliu-Feltes of MEDNAX. Starting this month, we will be participating in a CMS BPCI-A, Bundled Payments for Clinical Improvement –Advanced. We will have our Telemedicine providers help manage care for Medicare beneficiaries over a course of 90 days post discharge from a hospital Inpatient Stay. The program aims to reduce costs by placing financial accountability on participating health care providers and (a second aim is), another aim is, care team redesign through 1. early patient engagement, 2. collaborative communications and 3. post-acute care navigation. Its been a pleasure sharing some of our Telemedicine Innovations with you. We hope you found it interesting and that some of you would consider collaborating or partnering with us on a future Telehealth initiative. Thank You