How Providers Can Earn Competitive Wages with Telepsychiatry

How Providers Can Earn Competitive Wages with Telepsychiatry

Myth: Because telepsychaitry focuses on an underserved, under-insured and largely Medicaid populations, psychiatrists can not earn a competitive living given their skills. 

Fact: Psychiatrists can earn well-above-average pay ($150/hr, $300k/yr or more), serving the communities most in need through telepsychiatry.

Telepsychiatry can often pay at par, if not better, than other psychiatric treatment settings. By focusing on patients in underserved settings, telepsychiatry can take advantage of a few different types of reimbursement bonuses that can meaningfully increase the total potential revenue derived from telepsychiatry. 

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There's a Serious and Growing Psychiatrist Shortage in the U.S.

There's a Serious and Growing Psychiatrist Shortage in the U.S.

According to a study conducted by the Association of American Medical Colleges- 59 percent of psychiatrist are 55 or older, implicating that more that half of the psychiatrist population may soon be retiring or decreasing their working hours (1).

Aside from an aging psychiatrist population - statistics help us tell us a deeper story. According to the American Medical Association, the number of adult and child psychiatrists rose by only 12 percent from 1994 to 2013, from 43,640 to 49,079. During that span, the U.S. population increased by about 37 percent; meanwhile, millions more Americans have become eligible for mental health coverage under the Affordable Care Act (1). So, although the number of licensed psychiatrists is steadily increasing - the sheer volume of mental health need is surpassing the status quo.  

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An Ode to the 5k

An Ode to the 5k

Over the past decade, an increasing amount of scientific inquiry has focused on the anxiolytic effects of exercise. Running has been shown to have neurological effects that demonstrate its mood-related benefits. 

There is a wealth of academic literature supporting the clinical advantages of incorporating exercise into psychiatry treatments for a range of psychological disorders with particular emphasis on mood disorders, like clinical depression.

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The Future of Psychiatry is Online

The Future of Psychiatry is Online

We live in a world where technology is ubiquitous. Most industries have adapted to how tech-driven the Western consumer landscape is by offering their products or services online.

The advantages of integrating technology use into any service provider space are endless as it expands reach and increases ease of accessibility and service use. The behavioral health sector is necessarily following suit as telepsychiatry platforms are growing in number and the demand for these services is on the rise.

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1DocWay’s Holiday Stress Survival Guide

1DocWay’s Holiday Stress Survival Guide

The holiday season is upon us! While this time of year is filled with joy and cheer, it also brings financial concerns, unrealistic expectations and competing demands.

Though it’s impossible to eliminate stress completely, we’ve built this survival guide to help you manage your stress and restore your holiday spirit. ‘Tis the season to be jolly, after all!

 

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We’re getting adopted - 1DocWay acquired by Genoa, a QoL Healthcare Company

 
 

1DocWay is excited to announce we have been acquired by Genoa, a QoL Healthcare Company. As a result of this acquisition, we will expand our reach in the behavioral health community and provide a valuable solution to the shortage of providers at hundreds of more clinics in need. For our existing customers, we will continue to offer the services, infrastructure, and technology we currently provide with the high level of quality you have come to expect from us. Going forward, we will operate our enterprise services under the name Genoa Telepsychiatry, and continue our direct to consumer offerings under the 1DocWay brand. This will enable us have a clear value proposition and offering for our Clinic, Hospital, Community Health Center and other facility-based partners, while maintaining a consumer-facing presence that is distinct from anything else on the market today. Read more about Genoa here and check back regularly as we integrate the companies and update our news.

We are very excited to be a part of Genoa because in the extensive time we have spent with the senior leadership of the company, we have found a common vision and shared goals for improved outcomes in behavioral health and an emphasis on putting patients first. We believe becoming a part of Genoa will enable us to grow faster and reach many more patients which thrills us. But we know we’re also going to have a lot of fun working with a team that is truly smart, down to earth and motivated to change the face of behavioral health.

Bipolar Disorder in Primary Care

bipolar disorder in primary care

We know from conversations with many of the primary care practices we serve that the Bipolar Disorders (BP) are among the psychiatric conditions for which primary care clinicians often seek psychiatric support. The table to the right presents data from the National Institutes of Health regarding prevalence of BP in the general population. 

Drilling down a bit, research also indicates that prevalence of BP in a primary care patient panel may be somewhat higher than in the general population (somewhere between .5 - 4.3% across studies), suggesting that in a patient panel of about 2,200 unique patients, as many as 108 of them might benefit from treatment for BP (Cerimele, et al. 2014).

Also, and probably of particular note, is the finding that many patients with BP report symptoms to their primary care providers that might well lead to a different diagnosis and to (probably ineffective) treatment of a different psychiatric condition. For example, Chiu, et al., (2011) found that among patients in primary care settings who reported past or current symptoms of depression, anxiety, substance abuse or attention deficit disorder, 27.9% screened positive for BP on a standardized and validated screening measure.

Data like those suggest the considerable importance - in terms of accurate diagnosis and guideline-concordant treatment - of screening, decision support, and psychiatric involvement for patients with known or suspected BP in the primary care setting, or for patients who report symptoms of other psychiatric conditions which don't seem to quite fit your sense of the patient. For a look at a validated and widely used screen for Bipolar Disorder, click this link to the Mood Disorders Questionnaire (MDQ)

Contact us for information regarding how to bring our psychiatrists and psychologists into your organization.

An Epidemic of Patient Non-Compliance

Since the early '90's it's been thought that a majority of patients who are prescribed antidepressant medications fail to take them as directed. HEDIS data from that time suggested that only about 48% of patients prescribed medication were still taking it at six weeks, and only about 21% were still taking it at 12 weeks.

There is a widely held belief that there is better compliance with selective serotonin reuptake inhibitors (SSRIs) as compared with tricyclic antidepressants because of their faster onset of therapeutic action, greater efficacy, and better tolerance. To test that theory, researchers conducted a multi-center, randomized, parallel-group, open-label comparison of dothiepin (a Tricyclic) and fluoxetine (a SSRI) and compared compliance across the two groups.

As shown in the table below, seventy six percent of the fluoxetine patients (N=58) and 64% of dothiepin patients (N=49) were compliant with treatment at or above the 80% level over the 12-week study - a significantly greater degree of compliance for the SSRI group. These data represent a more precise estimate of compliance than do HEDIS data. They are suggestive of an overall higher level of antidepressant medication adherence than previously thought, with a compliance advantage for the SSRI's. 

However, to my eye, the more interesting aspect of this study is the finding that between one-quarter and one-third of patients who were prescribed antidepressant medication stop taking it during the first three months of treatment.

As Yogi Berra famously said, "If people are determined to stay away from the ballpark, you just can't make them." Twelve weeks or fewer is too short a time frame to treat depression effectively and prevent its recurrence.

Data such as these are particularly disappointing since it is well established that more than 80% of patients with depression can be treated effectively when there is treatment adherence.  Over 70% of prescriptions of antidepressant medications in the U.S. are written by primary care practitioners. And when treatment is consistent with best practice guidelines, that is good all the way around.

However, for the one-quarter to one-third of patients who don't comply with treatment recommendations, or for those patients who don't show a significant treatment response within six weeks, referral to a 1DocWay psychiatrist or psychologist can be essential to engaging patient compliance or modifying treatment strategy.

Contact us to learn more about how 1DocWay telepsychiatry and telepsychology can help improve patient compliance.

Top 5 Challenges in Managing Psychiatry in the ED And How to Overcome Them

Being in an emergency room is stressful for everyone involved and managing behavioral health patients in the ED poses many challenges. 1 in 4 Americans experience
mental illness each year and up to 15% of ED visits are related to psychiatric diagnoses.
Wait times for an available psychiatrist can be up to two days, leading to boarding the patient.

The top five challenges this presents are:

  1. Delayed Care
  2. Expertise Shortage
  3. Overcrowding
  4. Costly Resource Expenditures
  5. High Stress and Risks

Telepsychiatry can help ED's manage behavioral health patients in an easier, more timely, and cost-efficient way and greatly improve the experience and clinical outcomes for the patients while enhancing satisfaction for both patients and providers.

Click here to learn how you can use telepsychiatry to overcome the challenges of managing psychiatry through the ED.

How Do I Know if Telemedicine is Right For Us?

Over the past few months of talking with different organizations about the ways that 1DocWay helps hospitals, nursing facilities, and clinics, I’ve heard different variations of the same concern: is telemedicine right for us?

Some people think their facility might be too small to benefit from telemedicine, or their organization doesn’t have the technical expertise to adapt to a telemedicine system. There are concerns about managing the security and compliance needs in an organization that already has constraints on IT personnel and resources.

These are smart questions and in any business decision it’s important to assess the risks of moving forward.

In the last 24 months 1DocWay has helped over 50 facilities adopt telepsychiatry and every day more FCHQs, primary care clinics, and nursing homes are choosing telepsychiatry. When deciding whether telemedicine is right for your organization, consider some of these facts:

  • Most facilities adopting telepsychiatry have no IT department at all or up to one person managing all of IT for that facility.
  • Over 90% of the facilities that we work with are able to get telemedicine up and running with less than 5 hours of investment needed for technical set up and training.
  • Over 90% of the facilities that we work with don’t require any new purchases of hardware or software; they’re able to leverage existing technology as long as it was purchased within the last 3 years.

If you’re still not sure if telemedicine is right for your organization, reach out for a free consultation. We can talk about what the risks may be for your specific facility to move forward. Then, let’s review what the risks are of not moving forward!

Mental Health Concerns in Primary Care Settings: More Frequent than You Think

A substantial number of patients seen by a primary care physician (PCP) each day come into the office with significant psychiatric or psychological concerns - either as the primary reason for the visit or co-existing with other medical conditions.

A study conducted by the Centers for Disease Control and Prevention indicated a large proportion of PCP visits (20.4%) are directly related behavioral health. In fact, the likelihood of patients having mental health related issues escalates as patients age. Patients who are 75 or above are 25.3% more likely to present mental health related issues than patients who are under 12.

Some behavioral health conditions are relatively easier to diagnose than are others. Some can be readily addressed in primary care while others lie out of primary care physicians’ areas of expertise. Some can be solved within the time constraints of the typical PCP schedule, while others cannot.

Telepsychiatry services are provided to relieve the burden of the primary care physicians. Videoconferencing equipment brings psychiatrists and psychologists into clinics to treat patients who might have behavioral health conditions that are difficult to diagnose or treat in a timely manner.

THE TABLE ABOVE SHOWS THE PROPORTIONS OF PRIMARY CARE VISITS THAT HAVE A SIGNIFICANT BEHAVIORAL HEALTH COMPONENT ACROSS AGE GROUPS, AND REFLECTS THE PROGRESSIVE INCREASE IN THAT PROPORTION AS PATIENTS GROW OLDER. 

THE TABLE ABOVE SHOWS THE PROPORTIONS OF PRIMARY CARE VISITS THAT HAVE A SIGNIFICANT BEHAVIORAL HEALTH COMPONENT ACROSS AGE GROUPS, AND REFLECTS THE PROGRESSIVE INCREASE IN THAT PROPORTION AS PATIENTS GROW OLDER. 

If you work in a primary care setting it is important to bear in mind that anywhere from one in ten to almost one in three patients you see in your clinic on a daily basis might benefit from referral for behavioral health services. Telepsychiatry technology is an optimal way to bring that behavioral health service into your clinic, where your patients will be most comfortable receiving it, and to integrate it with your overall medical management of your patients.

Focusing on Attention Deficit Disorder

As a telepsychiatry practice we are often asked to help primary care and specialty clinics evaluate and treat patients with attention deficit disorders. ADD is a disorder that occurs frequently among children and adolescents, affecting more than 5.1 million children and teens nationwide according to the Centers for Disease Control.

A significant proportion of these children are not diagnosed or treated. Even among those who are, treatment often does not follow the best practice guidelines of the American Academy of Pediatrics.

Among those psychiatric conditions that most frequently co-occur with Attention Deficit in children are Oppositional Defiant Disorder, Depression/Dysthymia, and Generalized Anxiety. A moment's reflection suggests that these co-occurrences may be less a matter of simple correlation and more of a complex interactive syndrome in which difficulty attending and focusing behavior give rise to, and are exacerbated by other intense behavioral and emotional syndromes.

ADD is not restricted to children and teens. The social, vocational and intrapsychic effects of impaired ability to concentrate and focus can have markedly deleterious effects on the mood and emotional state of affected adults, as shown in the Table to the right.

While many adults learn to contain or cope with the symptoms and consequences of ADD - or deny them - that's not to say that the effects are not still profound.

If you are a healthcare provider, as you go through your practice week, please keep in mind that as many as one in ten of the children you see in your exam room, and one in twenty adults might have ADD, and that these conditions are often missed, or misdiagnosed as childhood anxiety, conduct disorders, or learning disabilities. If you would like assistance and decision support diagnosing and arranging proper treatment for these children and teens, we would welcome an opportunity to help.

A team consisting of primary care practitioners and behavioral health specialists is often an optimal combination for proper diagnosis and treatment and for supporting long term patient engagement, compliance and monitoring for success.

Telepsychiatry service delivery is an efficient and effective way to bring the behavioral health portion of that team into the primary care setting. As just- released research from East Carolina University reaffirms, it is also a great way to reduce patient no-show rates for mental health services from the usual 35-42% of scheduled visits in specialty BH practices to as low as 7-10% in the primary care clinic. If patients show up, they can be treated effectively.

Anxiety Disorders are Underdiagnosed and Undertreated in Primary Care

As with depression, the rate of undetected or undertreated anxiety in primary care is substantial. The twelve month prevalence of anxiety disorders in the general community is 19.3%, and is several fold greater in primary care settings (1).

In a three site investigation of university-affiliated primary care practices, researchers found that only 33% of patients diagnosed with anxiety had received any counseling for the condition, and only 25% had received counseling from a mental health professional (the remaining 8% had been counseled by the primary care team only).

Further, only about 10% of these patients received counseling that included multiple elements of cognitive behavioral therapy, the recommended best counseling practice for anxiety disorders. Finally, only 40% of those thus diagnosed received appropriate anti-anxiety medication, and only 25% received those medications at minimally adequate dosage and duration (2).

Of particular note is that these indicia of under-diagnosis and under-treatment of anxiety disorders were found in the primary care practices of university health systems known for their leadership in the area of behavioral health and primary care integration.

Also as with depression, undiagnosed or under-treated anxiety increases patients' utilization of health care services, increases diagnostic testing and hospitalization, consumes large amounts of PCP time, increases misuse of alcohol and prescription and street drugs, and compromises management of co-existing chronic illnesses like diabetes, CHF and COPD (3).

Abundant data point the way to effective management of psychiatric illness in primary care, and to integration of the two disciplines. The remaining challenge - and it is substantial - is translational: Getting what we know from the research setting embedded more firmly and generally in the world of day to day practice. For decision support regarding diagnosis and treatment of the various anxiety disorders, visit the Anxiety Disorders Guideline area of the Federal Agency for Healthcare Research and Quality (AHRQ - Anxiety Guidelines).

(1) Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, Wittchen H-U, Kendler KS: Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey. Arch Gen Psychiatry 1994; 51:8–19 (2) Stein, MB, Sherbourne, CD, Craske, MG, Means-Christiensen, A, Bystrinsky, A., Katon, W, Sullivan, G, Roy-Byrne, P: Quality of care for primary care patients with anxiety disorders. The American Journal of Psychiatry 2004; 161(12), 2230-2237. (3) Roy-Byrne PP, Stein MB, Russo J, Mercier E, Thomas R, McQuaid JR, Katon WJ, Craske MG, Bystritsky A, Sherbourne CD: Panic disorder in the primary care setting: comorbidity, disability, service utilization, and treatment. J Clin Psychiatry 1999; 60:492–499

Integrated Telepsychiatry

Integrated Telepsychiatry in the Medical Home and ACO: Perform Like a Champion

First off, a huge congratulations to the U.S. Women's Soccer Team on their capture of the World Cup. It is particularly satisfying to see a group of individuals who have worked most of their lives to perfect a skillset come together as a group to achieve at such a high level.

Now, the U.S. healthcare system can learn something from the Women's Soccer Team. In team sports, it's not only the skill of the individual that prevails, it is also the extent to which the Team has a system and a plan, and the degree to which the players buy into and execute that system and plan.

At least two "systems" appear to bring promise of organizing skilled clinicians into health care teams that can produce at a high level and reasonable cost: Patient Centered Medical Homes and Value Based Contracting. As an example, the Boston Consulting Group analyzed recent claims data from 3 million Medicare members in either traditional fee-for-service Medicare or in Medicare Advantage (value based payment) environments.

As displayed below, using three widely accepted measures of health care success, their analysis demonstrated clear performance superiority for the MA programs.

As noted by the Robert Graham Center for Policy Studies in Primary Care and Family Medicine, as well as by many other health care analysts, in order for Medical Homes (and, by extension, clinics in value based contracts) to achieve their goals, they must have behavioral health services readily available and fully integrated. Where behavioral health specialists are not readily and timely available - significant swaths of the U.S. landmass - telemedicine and telehealth linkages serve an essential purpose.

While fee-for-service Medicare pays for telemedicine only in certain rural and similar locations, CMS has made it clear that Medicare Advantage programs are free to pay for these services in any setting in which they deem it to be clinically and fiscally prudent - urban or rural. Abundant data demonstrate the clinical and cost value of widespread and integrated availability of these behavioral health services (see, e.g., Chiles et al, Blount et. al, Cummings, et. al) and, thereby, their central place in realization of the Triple Aim.

If you are in a Medical Home setting, a value based contract, or are a health plan offering pay for performance incentives, we hope you are already cognizant of the foregoing and have taken steps to make behavioral health services readily and timely available for your patient base. Perform like a champion!