Telepsychiatry in Rural Communties

1. Telepsychiatry in Rural Communties Options and Opportunities

2. Kings View Telepsychiatry Program • Objectives • Define telepsychiatry • Describe telepsychiatry models • Their role in rural ommunities • Share our experience • Positives • Negatives • Opportunities for the future

3. Telepsychiatry • “the use of teleconferencing equipment to provide HIPAA compliant, community standard care” • Amply defined in law to cover live, store and forward, EMR and e-prescribing

4. Telepsychiatry Basic Model Support Technology Specialty To provide community mental health and social services to those with limited resources, and to do so in the spirit of Christ’s example of love, compassion, and respect for all persons.

5. Telepsychiatry Rural Communities • A perfect marriage: • Resource-rich areas can distribute to resource-poor • Resource matching vs economy of scale • Technology access continues to drive down costs • Can establish community standard • Low litigation risk

6. Rural Communities Telepsychiatry • A Perfect Marriage: • Can obtain multiple service levels with limited cost/commitment • Can obtain multiple providers/resources/specialties with minimal cost/commitment • Equipment costs are dropping • Reimbursable w/o discount • Costs are recouperable

7. Telepsychiatry Models • Direct Service Model • Consultation Model • Hybrid Model

8. Direct Service Model • Assumes the total care of the client • Requires extensive knowledge of the community resources including , but not limited to: • Pharmacy • Therapy • Geography and weather • Population demographics

9. Consultation Model • Confined by the capricious definition of consultation vs ongoing care • Must manage the disconnect between consultant level of expertise and PCP level of comfort • Only indirectly addresses access-to-adequate-care issues

10. Hybrid Model • Best of both • High level expertise • Team approach • Worse of both • Specialty~PCP disconnect • Who belongs in which? • Liability

11. Experience • Necessary functions • Support Services • Network and Infrastructure • Care Provider • Community Programs • Regional Centers • FQHC and RHC’s • Highly specialized care • Vulnerabilities

12. Basic Model Positives Negatives • Team approach • Involves both ends • Improves access • Myths and misconceptions • Heuristic dissent • Rurality and sophistication

13. Community Programs Positives Negatives • Predictable models • Decent evidence base • Practice latitude • Appreciation of services • Poor payor mix • Challenging consumers • Access to cutting edge • Systemic paranoia

14. FQHC’s and RHC’s Positives Negatives • Reimbursement schedules • All models can be utilized in setting • Addresses a significant need • Continuity of care • Transfer of care • Difficulty with deciphering reimbursement-based access issues

15. Cost • Not as high as anticipated • Comparator Matrix • Recruitment • Salary + Benefits • Support and vacation • Bias in practice style • Bias in intrinsic practitioner demographics • Training Day Phenomenon • Access is losing out as an excuse

16. Opportunities • Access vs excess • Geographic barriers • Cultural barriers • Mission:To provide community mental health and social services to those with limited resources, and to do so in the spirit of Christ’s example of love, compassion, and respect for all persons