UPMC Telehealth Program. Leveraging Advances in Technology to Transform Healthcare Delivery through New Models of Care

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1 UPMC Telehealth Program Leveraging Advances in Technology to Transform Healthcare Delivery through New Models of Care

2 UPMC s Telehealth Expansion Pediatric Specialty Inpatient Dermatology Pre & Post Operative Visits Tele-Stroke Tele-Psych Teleconsult Centers Health Plan- Employer Onsite Care Physical Medicine & Rehabilitation 2013 UPMC AnywhereCare On-line Virtual Visits Tele-Skilled Nursing Facility Visits In-patient & Outpatient Specialty Services Expansion Tele-Maternal Fetal Medicine Surgical Oncology/Breast Visits Infectious Disease Pre & Post operative visits Transplant Behavioral & Nutrition Counseling Expanded On-line edermatology visits On-line Chronic Care Visits Remote Monitoring Teleconsult Center expansion Integrate on-demand Specialty visits through PCP practices 2

3 UPMC s Telehealth Regional Footprint 3

4 Thank you! 4 UPMC Telehealth Program- Copyright 2016 NOT FOR DISTRIBUTION

5 Legal, Regulatory and Reimbursement Issues Physician Licensure Physician Hospital Credentialing Online Medicine/Prescribing Patient Privacy and Medical Records Reimbursement MA Service Bulletin & Waver Medicare Commercial 5

6 PA Service Bulletin Telepsych may be used to deliver in-plan services when the psychiatrist or licensed psychologist is not physically available to provide an in-plan service in-person or is not available due to location (the clinic is at an unreasonable distance from available providers), after-hour emergencies (evenings, nights, weekends, or holidays), shortage of professionals, or transportation barriers for individual(s). In general, telepsych should be used for those situations where service would otherwise be prevented or delayed. Interpretive services, including sign language, may be provided as necessary in the provision of a telepysch service. 6

7 PA Service Bulletin Telepsych is not intended to replace a facility s capacity to provide in-person psychiatric and/or psychological services, and it is expected that a facility providing telepsych will commit to maintenance of effort regarding the provision of in-person services over time. In instances in which telepsych is proposed by an office or licensed facility without in-person psychiatric and/or psychological capacity, it is expected that the service provider will continue efforts to obtain the capacity for in-person service provision. 7

8 APA DEFINITION TELEPSYCHIATRY The use of video-based telepsychiatry helps meet patients needs for convenient, affordable and readily-accessible mental health services. With a robust evidence base that shows telepsychiatry leading to improved outcomes and higher patient satisfaction ratings, policy makers, payers and providers are increasingly considering ways to implement and use telepsychiatry. 8

9 APA POLICY TELEPSYCHIATRY APA s current policy on telepsychiatry, updated from its 1995 iteration with consultation from APA s Council on Quality Care (and other Components) states: Telemedicine in psychiatry, using video conferencing, is a validated and effective practice of medicine that increases access to care. The American Psychiatric Association supports the use of telemedicine as a legitimate component of a mental health delivery system to the extent that its use is in the best interest of the patient and is in compliance with the APA policies on medical ethics and confidentiality. 9

10 Tele Behavioral Health Visits 7,000 Visits 6,000 5,000 4,000 3,000 Visits 2,000 1,000 0 FY10 FY11 FY12 FY13 FY14 FY15 FY15 FY 16 10

11 Overall Satisfaction 80% Overall, how would you rate your satisfaction with this new style compared with the face-to-face consultation? 74% 70% 60% 50% 48% 40% 36% 30% 26% 20% 10% 0% 16% 0% Adequate Almost as Good As Good Session 1 Session Community Care 11 11

12 Physician Satisfaction Project Distributed 1/2014 and again March psychiatrists doing telepsychiatry at University of Pittsburgh Medical Center (UPMC). Experience Psychiatry: Residents in training 26 years Telepsychiatry: A few months 4 years 10-part, self-reported questionnaire Location of services Patient satisfaction Comparable to face to face Technology Platforms used Technical support Helpfulness of clinician in room Patient care and management Adequacy of appointment time Overall experience

13 Initial Questionnaire results Comparable to face to face I am able to manage patients, develop and implement a plan of care Strongly Agree Agree Disagree All the time most of time some of time little of time

14 Initial Questionnaire Results How helpful is it to have the clinican in the room? overall satisfaction with telepsychiatry Extremely quite a bit moderately excellent very good good

15 Follow-up qualitative interviews Semi-structured interviews with the 12 psychiatrists previously interviewed Objectives: To assess physician satisfaction with the provision of telepsychiatry services To assess factors affecting physician satisfaction with telepsychiatry across telepsychiatry sites To identify what makes a telepsychiatry clinic function smoothly Overall Satisfaction of telepsychiatrist Excellent Very Good Good poor

16 The positive feedback Almost all psychiatrists (92%) agree that they are providing quality care for their patients and increasing access to underserved communities. Bringing our expertise and commitment to quality care despite the challenges. Unequivocal response that the onsite clinician in the room is critical to good patient care. Improved patient care and improved provider satisfaction Majority of psychiatrists would recommend a career in telepsych to a colleague Would you recommend? Yes Maybe No

17 Concerns: Technology Limitations: Low visual resolution Physical exam Nonverbal cues Audio: cuts in/out and lag time The cameras do not have zoom or scan capabilities Satisfaction would be improved if technology were improved. 83% agree or strongly agree not applicable: because no technology concerns Overall satisfaction with technology Very good Good fair poor If technology improved strongly agree agree nonapplicable

18 Concerns: Lack of face to face contact There s no replacement to sitting next to the patient. the remaining senses control of the environment Comparable but not identical Psychiatrists agree they can establish rapport and provide good patient care Adequate What is lacking? The obvious lack of physical presence that contributes to normal human connectedness. comparable to face to face strongly agree agree disagree strongly disagree

19 WPIC TELEPSYCHIATRY PROGRAM Press Gainey Results (N=140) How much driving did this visit save you round trip? % response Good or Very Good 6+ Hours 14% 4-6 Hours 9% 2-4 Hours 8% 0-2 Hours 69% 19

20 Partnership with UPMC HealthPlan Other Areas of Service Current and Pending Psychooncology Pregnancy and Postpartum Depression Psychosomatic Medicine Transplant Psychiatric Consultation Liaison inpatient medical settings Digestive Disorders Geriatrics and Long Term Care ED Primary Care Consultation 20

21 AREAS OF CONCENTRATION Psychiatric Services to Patients in Rural Behavioral Health Settings Direct to Consumer Consultations to other Medical Settings/Specialties 21