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ED Telepsychiatry Cuts Admissions, Saves Money
By: M. ALEXANDER OTTO |
Vitals
Major Finding: Telepsychiatry consultations reduced hospital admissions for mental health patients from about 12% to 8% at 25 hospitals in South Carolina, and shortened emergency department stays from an average of 4 to 3 days.
Data Source: Outcomes data for more than 6,000 telepsychiatry patients and matched controls.
Disclosures: Dr. Chapman and her colleagues said they have no disclosures. The study was funded by the National Institute of Mental Health and the Duke Endowment.
Commentary
Telehealth Worth the Startup EffortHonolulu - A statewide telepsychiatry consulting service in South Carolina shortened emergency department stays and reduced hospital admissions for more than 6,000 mental health patients. Those patients also used outpatient psychiatric services more, and their care was less expensive.
Under the program, psychiatrists assess emergency department patients remotely via live video link. So far, 25 hospitals that lack readily available onsite psychiatric consulting services are participating. The South Carolina Department of Mental Health plans to enroll 15 more within a year, according to Dr. Stephanie R. Chapman, a psychiatry resident at the University of South Carolina, Columbia.
"In our state, we have so many mental health patients who are not receiving the care they need in the emergency room. A lot of facilities have no psychiatrists working in them. Someone has to drive in days later to see these patients," she said at the annual meeting of the American Psychiatric Association. "It’s a big problem. That is why this was initially implemented" in March 2009, she said.
When telepsychiatry is called for, a video cart is rolled into the patient’s room. At the other end of the feed is a psychiatrist in either Charleston, Columbia, Aiken, or Greenville, S.C.
The patient and psychiatrist are able to see one another and talk over the link. The psychiatrist does the assessment over about 30 minutes, prepped beforehand with the patient’s history, lab results, and other findings.
Afterward, the psychiatrist might recommend hospitalization or set up an outpatient appointment through the local mental health department, she said.
At present, the service is available 16 hours a day. Psychiatrists take turns manning the feed at offices in the four towns, usually in 8-hour shifts. When a shift ends in Aiken, for example, a psychiatrist in the Greenville office might pick up the feed.
To see how the program is doing, Dr. Chapman and her colleagues compared the 6,000-plus telepsychiatry patients’ outcomes with those for matched controls at hospitals not yet participating in the program.
About 8% of telepsychiatry patients were admitted vs. 12% of control patients. With telepsychiatry, "we now have a more specialized person performing the consult" and perhaps making better calls on who needs to be hospitalized, Dr. Chapman said.
ED stays averaged 3 days for telepsychiatry patients and 4 days for controls. About 85% with severe mental illnesses in the telepsychiatry group had outpatient follow-up within 30 days, compared with 22% in the control group.
The program saves money, too. Medicaid telepsychiatry patients had median charges of $2,000; median charges were $2,800 among Medicaid patients in the control group. With other payer mixes, median charges for telepsychiatry patients were $6,800 vs. $11,000 for those in the control group.
Overall, about 80% of patients said they were satisfied with the service. About 90% of physicians said they were satisfied, too, and about three-quarters said telepsychiatry increased productivity.
In short, "the patient receives a higher quality of care, and the hospitals have reduced costs," Dr. Chapman and her colleagues concluded.
Commentary
Telehealth is a burgeoning technology with early adopters demonstrating its usefulness in many venues. The clinical use of telehealth has outpaced the governmental regulators and third party payers’ reimbursement paradigms so that clinical oversight and payment systems need to play catch-up. Intensivist shortages, patient demand, and technological advances have led to rapid appreciation of the usefulness of telehealth modalities in the mitigation of unmet demand for specialist care.
E-mail, Twitter, and Facebook led to a revolution in asynchronous communication; similarly, telehealth has fostered care delivery to geographically disconnected patient and physician. Telepsychiatry as used in our local system allows for three hospitals to be served by a single group of psychiatric evaluation specialists. While many patients require onsite evaluation, many are accepting of the telehealth communication link.
Telehealth seems well worth the startup effort and has many intrinsic benefits, including less travel hospital to hospital, continuing oversight of more than one patient’s insurance vetting and bed search, and faster door to psychiatric evaluation time.
Telepsychiatry appears to have a strong role to play in reducing length of stay and the attendant expense for a significant portion of this challenging cohort of ED patients. This study is an important addition to the literature by demonstrating what many of us have observed – that telehealth saves time and money while finding considerable acceptance by the patient and their care providers.
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Dr. Alexander M. Rosenau is vice chair and attending physician in the department of emergency medicine at Lehigh Valley Hospital and Health Network and is the emergency medicine residency program director at Lehigh Valley Hospital.
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