Telehealth: Virtual Visits in Behavioral Health. Robin Varnado and Rebecca Wiedmeyer June 28, 2018

Transcription

1 Telehealth: Virtual Visits in Behavioral Health Robin Varnado and Rebecca Wiedmeyer June 28, 2018

2 Agenda Introduction to Erie Background of Telepsych project The Program Pilot Lessons Learned Billing Considerations Questions and Discussion 2

3 Session Objectives Provide an overview of Erie s Telepsych pilot and lessons learned. Explore the paradigm shifts in workflow and care that occur between Telehealth and traditional visits. Identify evolving compliance and billing considerations in a Telepsych program. 3

4 Introduction to Erie 4

5 About Erie Family Health Centers Erie is a community health center that provides comprehensive care to 70,000 patients every year. Erie has 13 locations in Chicago, Evanston and Waukegan, including: o 7 primary care locations - 4 with integrated dental care o 5 school-based health centers o 1 teen only health center Erie s mission is to provide high quality, affordable health care to support healthier people, families and communities. As part of this mission, Erie staffs each clinic with Behavioral Health staff and currently employs 20 BH clinicians and 3 support staff. 5

6 Who We Serve Fast Facts about Erie Patients: 73% are Hispanic 64% are female 61% have Medicaid 30% are uninsured 44% are under the age of 18 6

7 Reimbursement Statistics Medicaid: 60% Uninsured: 29% Commercial: 8% Medicare: 3% 7

8 Background of Telepsych Project 8

9 Behavioral Health at Erie Until five years ago, Erie s Behavioral Health Department operated in a solely therapeutic model. At that time, Erie consisted of 8 medical clinics and employed 8 Behavioral Health Therapists. 5 years ago Erie began to integrate behavioral health into medical visits. 4 additional therapists were hired to pilot this model at 4 Erie sites. In the subsequent years 4, additional staff have been added, and Erie now employs 20 behavioral health therapists. This number will grow to 23 in FY 19. 9

10 Behavioral Health at Erie, Continued While behavioral health therapists support each of Erie s 13 clinics, providing Psychiatry services at each site has been much harder to negotiate. Currently, Erie has on staff and/or under contract two fulltime and one part-time Psychiatric providers. We are recruiting for one additional part-time provider with the hope of securing support for our pediatric population. Given the geographic location of our clinics, securing Psychiatry services for the patients of our Waukegan clinic has been difficult. 10

11 Origin of Telepsych Pilot In an effort to support the psychiatry needs of our Lake County population, Erie s development team began to speak with funders about the possibility of funding telepsychiatry. In the Spring of 2017 a grant was secured to support the development of a Telepsychiatry program at Erie. The goals of the grant: 75% of patient show an improvement in assessment of life areas. 75% will present a meaningful reduction in their presenting problem over the course of treatment 100% will see a psychiatrist within 30 days of need for services being identified. 11

12 The Program Pilot 12

13 Telehealth Team Robin Varnado Regional Director of Operations and Behavioral Health Rebecca Wiedmeyer Project Manager of Health Initiatives Almu Ruiz Clinical Director of Behavioral Health Leyna Inberg Psychiatric Nurse Practitioner Maritza Solis Behavioral Health Consultant Mentor: Katie Bohling, Director of Telemedicine at Lurie Children s Hospital in Chicago, IL 13

14 Initial Scope 4 patients/week Thursdays from 9-1 pm. BH schedules their own patients (control over particular cases scheduled for this service) Provider (Leyna Inberg) at Division Street -> Patient/Behavioral Health Specialist (Almu/Maritza) at Waukegan Series of grant-driven questions documented in Excel for capture (identifying patients at risk for gambling addiction per Video Gaming Grant.) 14

15 Hardware 15

16 Hardware/Software for Pilot Patient/Behavioral Health Specialist: Ipad 4 Lurie Polycom solution Tablet cart from A Ethernet adaptor CAT6 cable (make sure length is appropriate) 16

17 Hardware/Software for Pilot Provider Laptop (PC) Lurie Polycom solution Dual monitor CAT6 cable (make sure length is appropriate) MDToolbox.com for EPCS 17

18 Hardware Considerations Physical Space LAN access versus WIFI Line of site (e.g. single line of vision versus dual monitors) for both provider and patient Camera (stationary/standard versus remote controlled) Provider background space/appearance 18

19 Software Considerations Must be secured and HIPAA-compliant Consider network/bandwidth in choosing solution Integration with EHR not necessarily a priority Vendor options: Specialized (Dr. Chrono, Visuwell) versus Generalized (Zoom, Skype) EPCS if Telepsych 19

20 Lessons Learned Connectivity is imperative for a successful Telemedicine experience. Considerations, such as provider background, lighting, sound quality, are very different than normal patient visits Training and practice sessions are extremely important (e.g. training provider to look at camera while typing, etc.) 20

21 Lessons Learned Telehealth provides flexibility for the patient and the provider. Laws and billing regulations surrounding Telehealth are changing DAILY, especially at the state level. 21

22 Reimbursement Medicaid Modifiers GT and GQ Medicare - Several important codes to be aware of Payors Vary, but coverage is improving rapidly *Pay attention to State laws 22

23 Parity Laws The fight to save beautiful minds can get pretty ugly, -Patrick J. Kennedy, A Common Struggle: A Personal Journey Through Past and Future Mental Illness and Addiction 23

24 Questions or Feedback? Please reach out to Robin Varnado and Rebecca Wiedmeyer with questions or comments. 24