Value of integrating telepsychiatry and primary care in the Rockies
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1 Value of integrating telepsychiatry and primary care in the Rockies Presented by: University of Wyoming Center for Rural Health Research and Education and Access Psychiatry Solutions, LLC Rex Gantenbein PhD CRHRE Phil Hirsch PhD Access Psychiatry
2 UW Center for Rural Health Research and Education CRHRE (pronounced share ) established in 2000 Unit of UW College of Health Sciences Focus: using technology to support improved health care in rural areas Staff includes faculty, research scientists, education and technology specialists
3 Why integrate primary and behavioral health care in Wyoming? Wyoming has a shortage of behavioral health practitioners All 23 counties are designated as Mental Health Professional Shortage Areas by HRSA Few psychiatrists, clinical psychologists, or psychiatric nurse practitioners practice in the state
4 Why integrate primary and behavioral health care in Wyoming? Wyomingites have trouble getting care for mental health 20,000 adults and 5,000 children in the state live with serious mental health conditions [NAMI, 2010] Only 17% of the adults receive services through the public health system Wyoming has a rate of suicide almost double the national average National Alliance on Mental Illness (2010). NAMI state advocacy 2010, state statistics: Wyoming.
![health conditions [NAMI, 2010] Only 17% of the adults receive services through the public health system Wyoming has a rate of](/docs-images/45/7473697/images/page_4.jpg "suicide almost double the national average National Alliance on Mental Illness (2010).")
5 Why integrate primary and behavioral health care in Wyoming? Wyomingites have trouble getting care for behavioral health as well Heavy tobacco and alcohol use are prevalent in the state Unmet needs for treatment in these and similar areas are consistently higher in Wyoming than the national average [SAMHSA, 2008] Substance Abuse and Mental Health Services Administration (2009). States in Brief: Wyoming.
6 Behavioral health integration Screening Evidence based tx Care coordination Improving Chronic Illness Care - MacColl Institute for Healthcare Innovation with funding from the Robert Wood Johnson Foundation.
7 Screening - Risky alcohol/drug
8 EBP Problem drinking
9 Percent detected Screening - Depression Detection rates - depression 80% 70% 60% 50% 40% 30% 20% 10% 0% Traditional Primary care with screening Location of service
10 Evidence based practice Health TeamWorks
11 USPSTF Amended Recommendation The U.S. Preventive Services Task Force (USPSTF) recommends screening adults for depression in clinical practices that have systems in place to assure accurate diagnosis, effective treatment, and follow up. (italics added)
12 Referral to where?
13 Not your father s telepsychiatry
14 Evidence based E = MC2 Systematic review of studies of patient satisfaction with telemedicine. Mair F & Whitten P. BMJ June 3; 320(7248): Sample Kennedy C & Yellowlees P. The effectiveness of telepsychiatry measured using the Health of the Nation Outcome Scale and the Mental Health Inventory. Journal of Telemedicine and Telecare 9:12 16, Evidence-Based Practice for Telemental Health. American Telemedicine Association: 2009.
15 SUSTAINABLE? Payer mix Medicaid : Commercial Contracted rates Service mix Demand Originating site factors FQHC? CMHC?
16 Medicaid Provisions Synchronous audio-visual contact Usual originating sites Does not include telephone, , fax Informed Consent for Telehealth Same procedure codes and rates as for services delivered in person Procedures GT Consultations GT Consultations GT Office or other outpatient visits GT Individual psychotherapy GT Pharmacologic management GT Psychiatric diagnostic interview examination GT Neurobehavioral status exam ESRD codes Facility fee
17 Medicare Medicare will pay for [telehealth for] a limited number of Part B services. Located in a rural Health Professional Shortage Area County outside of a Metropolitan Statistical Area. The originating sites authorized by law The office of a physician or practitioner; Hospitals; Critical Access Hospitals (CAH); Rural Health Clinics (RHC); Federally Qualified Health Centers (FQHC); Hospital-based or CAH-based Renal Dialysis Centers (including satellites); Skilled Nursing Facilities (SNF); and Community Mental Health Centers (CMHC).
18 Value Improved detection/management of psych illness Improved management of coexsting chronic illness Physician time savings Realization of P4P incentives Positive net revenue Physician time savings/reallocation Morale
19 "Efforts to provide everyone a medical home will require inclusion of mental health care if they are to succeed in improving care and reducing costs."
20
21
22 Who s driving?
23 Contact info Rex Gantenbein, PhD CRHRE Univ. of Wyoming Phil Hirsch PhD Access Psychiatry Solutions
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