Updated on: April 18, 2019

New Guide Revealed for Tele-behavioral Health

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Original story posted on: April 16, 2019

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New guide offers the possibility of improving a hospital’s bottom line.

Last week, The National Quality Forum and the American Hospital Association Center for Health Care Innovation released their how-to guide for hospitals and health systems seeking to implement, strengthen, and sustain tele-behavioral health.

Entitled Redesigning Care, the guide outlines an excellent framework for those contemplating building their own tele-behavioral health capabilities.  But there are fundamental questions hospitals and health systems must ask themselves prior to embarking on such a significant investment in time, people and resources: is tele-behavioral health the answer to your prayers?  Will it alleviate many of your clinical, financial, or operational issues? The answer is…maybe. 

Success is largely dependent on how thoroughly you assess your current state and pinpoint the areas where tele-behavioral health can make the biggest impact on your patients and clinical operations: what measurable improvements can you reasonably expect and how will tele-behavioral health be incorporated into your clinical workflow?  And success depends entirely on execution: even the most thoughtful, detailed plan is useless barring individuals knowing how their roles contribute to the overall efficacy of a functioning tele-behavioral health program.  Otherwise stated, the devil is in the details and "one size fits all" most definitely does not work.

The Redesigning Care guide effectively articulates many of the challenges hospitals and health systems are currently facing as a result of the nationwide shortage of behavioral health professionals, especially psychiatrists.  The primary challenge, from both a provider and patient standpoint, is, of course, that patients do not have access to swift, appropriate care for their behavioral health needs.  However, this is just the proverbial tip of the iceberg as it relates to the broader set of challenges faced by hospitals and health systems.  Boarding psychiatric patients in the emergency department (ED), bloated length of stay, both in the ED and hospital-wide, stress on ED staff who does not have access to the resources required to care for these patients appropriately are daunting challenges.  Having framed the challenges, Redesigning Care goes on to suggest a possible solution - tele-behavioral health – and provide a framework that hospitals and health systems can use to build a successful tele-behavioral health program; a framework that touches on all the right considerations: leadership enfranchisement, operational and clinical workflow considerations, training and measurement among them.

Those of us in the physician advisor world, who view everything through the lens of improving clinical workflow and direct patient care, certainly believe that hospitals and health systems that afford these fundamentals their appropriate time and attention, will inherently address and alleviate the challenges outlined above, and, in doing so, will improve quality and outcomes, reduce length of stay, and eliminate psychiatric patients boarding in the ED. 

Hospitals and health systems will also, albeit indirectly, improve the bottom line.  While our focus is always the patient, another primary consideration is financial: understanding the details of the tele-medicine reimbursement model to ensure proper reimbursement for the quality care that is delivered, and more broadly recognizing how much revenue is lost when patients are boarded in the ED and inpatient units simply because there is no one available to treat them. 

Redesigning Care provides a sound framework and articulates the key work streams required to create a tele-behavioral health practice.  And while some hospitals and health systems have the resources (human and otherwise) to undertake this type of effort, others may not.  For the latter, there is hope:  hospitals and health systems can identify partners who specialize in telepsychiatry.  For some, this may be a near-term solution they employ while simultaneously laying the groundwork for their own home-grown program.  For others, the financial flexibility and ease of a “turn-key” solution may make sense indefinitely. 

Regardless of which category a hospital or health system is in, having a partner that assumes much, if not all, of the burden associated with building a program, and understanding the regulatory and reimbursement landscape, represents a way to begin delivering superior patient care, alleviating bottlenecks and ensuring that the hospital or health system is optimizing its resources and revenue potential.

 

Kathy Seward, MD, CHCQM-PHYADV

Kathy Seward, MD, CHCQM-PHYADV is a medical director of coordination of care at a five-hospital system in southeastern North Carolina.  She is also the chief medical officer and co-founder of qlēr Solutions, Inc., a telemedicine company that provides psychiatric care to patients throughout the United States. Seward is a member of the RACmonitor editorial board.

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