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Tele-Behavioral Health University of New Mexico Department of Psychiatry and Behavioral Sciences Division of Community Behavioral Health
Tele-Behavioral Health
University of New Mexico Department of Psychiatry and Behavioral Sciences
Division of Community Behavioral Health
Access to Behavioral Health Care
New Mexico Facts: • 5th largest state
geographically • Highest poverty rate in the
US • Highest percentage of
children living in poverty in U.S.
• 3rd highest income disparity of all states
NM Ratio of Psychiatrists to Population
For the Urban Population the Ratio is 1 to 2,970
For the Rural Population the Ratio is 1 to 21,276
Important Mental Health Disparities in Rural Communities
• Higher rates of co-occurring mental health and substance use disorders and decreased utilization of care (Simmons & Havens, 2007)
• Increased rates of suicide (Singh, 2002; McCarthy, 2012)
• Reduced access to evidence based practices (Fortney, 2010; Rudnick, 2013)
• Dramatically fewer psychiatrists per person (Baldwin, 2006; Brems et al., 2006)
What is Tele-Health? • Telehealth is the use of electronic information and
telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration.
The Division of Community Behavioral Health in the UNM Department of Psychiatry
• UNM CBH has been doing tele-health since 1995
• Education • Outpatient Services • Case Consultation and Supervision • Recent Pilot with Emergency Psychiatry
Outpatient Tele-psychiatry Experience: • 4,500+ patient visits. • 2,878 hours of service provided. • 540,000+ miles of patient travel avoided. • $305,100+ in patient travel costs avoided. • 16,450+ hours of work and/or school NOT missed by patients.
South Carolina Statewide Emergency Tele-Psychiatry Project
NIH Funded Study Outcomes showed: • More than 80 percent of patients responded that they were satisfied with the process and services that they received • 84.1 percent of ER staff and physicians said telepsychiatry improved patient care; 90.9 percent reported that they were satisfied with the procedures, and 84.3 percent said they were satisfied with technology
Dr. Meera Narasimham, PI, Professor of Psychiatry and Director Biological Research, Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine
SC Statewide Emergency Tele-Psychiatry Outcomes continued
• Length of hospital stays were reduced
• 84.7 percent of patients followed up with treatment plan within 30 days, and 87.2 percent followed up within 90 days.
• More than 7,500 patients have been
treated since the project was implemented in March 2009. Twenty-two hospitals are participating, and the goal is to have 12 more hospitals by Dec. 31.
Partnerships and Funding• Demonstrated collaboration and capacity
building for emergency psychiatric service expansion through a Public-Private-Academic partnership.
• USC School of Medicine Grant funding • Coordinated through the SC Dept. of Mental
Health • Duke Endowment funding • South Carolina Hospital Association developed
a uniform credentialing application for tele-psychiatry
• SC Revenue and Fiscal Affairs Office technical lead to develop E.H.R
UNM Response to Community Needs: Exploration of an Emergency Tele-Psychiatry System
• Similar to the South Carolina Statewide Emergency Tele-psychiatry Project, the Division of Community Behavioral Health seeks to Collaborate with the rural hospitals, state agencies, and third party payers to expand emergency psychiatric assessments to rural hospitals in New Mexico.
• Financial contribution of rural hospitals will depend on the
scale of clinical need/demand and participation of other partners to ensure support of infrastructure.
• Anticipate the expansion of this program will result in reduced transportation costs, increased care in home communities, and reduced lengths of stay for our partner hospitals.
Projected Costs for Emergency Psychiatry Expansion In projecting costs we acknowledge the need to scale up services over period of time: Example: • Two hours a day of psychiatric coverage could serve 5 rural Emergency
Department at a total cost of approximately $350,000 per annum • Four hours a day of psychiatric coverage could serve 10 rural Emergency
Departments at a total cost of approximately $675,000 per annum • Six hours a day of psychiatric coverage could serve 15 rural Emergency
Departments at a total cost of approximately $940,000 per annum
Total operational costs estimates include:
• Recurring Costs: • Psychiatry time • Coordinator time • Tech support
• Fixed costs: • Equipment • Initial Contracting and
provider credentialing
*Model does not include connectivity costs as most Hospitals are online with necessary bandwidth to support function
Projected cost saving and revenue generation
• Reduction in costs for emergency mental health services; • Emergency psychiatric evaluations can be conducted through telehealth in
community ED : • Reduces costs of travel and transportation for patients who are referred for
psychiatric assessment and who do not need hospitalization –i.e., Patients who meet criteria for a higher level of care can be efficiently referred for psychiatric hospitalization.
• Reduces costs of hospital admissions by reducing length of stay—i.e.,
Patients who can be discharged from the hospital can remain in their own communities.
• Third party billing for services rendered through telehealth can create revenue for
the originating site.
Who can Bill, What can you Bill, Where can you Bill WHO
• Physicians
• Psychiatrists
• Nurse practitioners
• Physician assistants
• Clinical nurse specialists
• Clinical psychologists
• Clinical social workers
WHAT • E&M Codes + Q3014 modifier
WHERE • Healthcare clinics and hospitals
Six Month Pilot of Emergency Psychiatry Assessments at UNM Psychiatric emergency assessments: • 95 patients seen by telehealth
• 78% of emergency telepsychiatry consults were adequately managed
in the community ED and did not require transfer by ambulance to UNM HSC. Based on local cost projections, this prevented $650 in unnecessary emergency transfer costs per encounter, or $48,100 total
Developing a Tele-Behavioral Health Program
Operational considerations:
• Connectivity • Tablet vs. mobile cart • Dedicated telehealth
coordinator vs. shared responsibility among existing administrative and clinical staff at rural hospital
• Need for on-site tech support ?
Clinical Considerations
• Rural hospital maintains clinical responsibility for the patient.
• Local ED physicians write orders for any urgent medications needed.
• Telehealth providers will be credentialed at rural hospitals.
• All clinical notes are immediately faxed to rural hospitals for inclusion in the chart.
Resources and Information Economic Evaluation of Telemedicine: Review of the Literature and Research Guidelines for Benefit-Cost Analysis (.pdf document), María E. Dávalos, Michael T. French, Anne E. Burdick, and Scott C. Simmons. Telemedicine and e-Health. December 2009, 15(10): 933-948. doi:10.1089/tmj.2009.0067.
• Increasing Access to Behavioral Health Care Through Technology http://www.hrsa.gov/publichealth/guidelines/behavioralhealth/behavioralhealthcareaccess.pdf
• Examples of Research Outcomes: Telemedicine’s Impact on Healthcare Cost and Quality http://www.americantelemed.org/docs/default-source/policy/examples-of-research-outcomes---telemedicine's-impact-on-healthcare-cost-and-quality.pdf
Questions and Comments: • Caroline Bonham, MD, MSc
Director, Division of Community Behavioral Health Dept. of Psychiatry and Behavioral Sciences
• Jennifer S. Nanez, LMSW Senior Program Therapist Division of Community Behavioral Health
• MSC 09-5030 1 University of New Mexico Albuquerque, NM 87131-0001
