Think of a visit to a psychiatrist and the picture that might come to mind is a patient lying or sitting on a couch and speaking while the provider listens close at hand.
Increasingly, another option is becoming available for patients to receive that same level of care in a slightly different way. Whether it’s the fast-growing telepsychiatry or another area of telehealth, industry leaders say the mode of care breaks down barriers and increases access for patients.
“Telehealth is reaching out to so many people that otherwise would not have access to health care,” says Dr. Sonea Mahboob, a psychiatrist who provides services remotely through Aurora Behavioral Health Center in Oshkosh.
While Mahboob says people sometimes have initial reservations about accessing mental health care remotely and whether it will feel the same as an in-person visit, most find they like it after trying it, and some even grow to prefer it. To mitigate uncertainty, the team at Aurora also walks patients through what to expect.
In many ways, remote mental health care doesn’t differ greatly from an in-person experience, Mahboob says. Her patients go to Aurora Behavioral Health Center in Oshkosh, where a nurse can triage and then escort them to a room. Using a system called Polycom, Mahboob enters a number and appears on-screen to the patient.
The system allows for seamless communication, whether it’s between Mahboob and nurses or patients. It also offers all the critical components of connecting with a patient for psychiatric care, including the ability to make eye contact and assess body language, Mahboob says.
“It’s completely as if I was in the office,” she says. “It doesn’t really take away from any of those important aspects of medicine.”
Beyond that, offering these services remotely reduces barriers. It brings care to people from a wide range of geographical locations, and increased access means people don’t have to wait as long for treatment.
Mahboob says there’s an immense need for mental health services, but there’s always been a nationwide shortage of psychiatrists. Remote care helps bridge the gap. In the past, patients may have had to wait a month or even two to see a psychiatrist, she says, and now some can get an appointment as soon as the next day.
Julie Meyer, director of behavioral health for ThedaCare, echoes Mahboob’s sentiments. ThedaCare has seen similar success with offering telepsychiatry services. The health care organization began offering telepsychiatry through
the services of one provider in 2013. Another went live this past October, and two more will begin seeing patients by the beginning of January.
To access ThedaCare’s telepsychiatry services, patients come to an office — locations include Shawano, Waupaca, Berlin and Weyauwega — for their appointment. The technology, which allows the organization to beam providers to rural locations, increases access and cuts down on commute times for patients, Meyer says.
It’s also become a powerful recruiting tool. Offering the opportunity to work remotely has allowed ThedaCare to retain two providers it otherwise would have lost to moves out of state and recruit two new ones. One of the two new psychiatrists, for example, lives in San Jose, Calif.
“It allows us to spread psychiatrists out geographically and also utilize psychiatrists that might not want to move to cold Northeast Wisconsin,” Meyer says.
Meyer say patients are resoundingly happy to have access to convenient care, and satisfaction surveys have come back “glowingly positive. Providers are also pleased with the system.
“I can see myself on the screen, and it reminds me to smile more,” says Dr. Yong Li, a ThedaCare Behavioral Health psychiatrist who delivers care remotely. “I don’t need to commute any more, and my life quality has improved.”
Telepsychiatry is just one application of telehealth, and the entire model of care is growing exponentially and quickly, says Bill Brazeau, director of cyber health for ThedaCare.
ThedaCare has offered e-visits for certain conditions since 2015. Last April, it began offering stroke care in rural areas via telehealth. It allows patients to be evaluated by specialists and then transferred if necessary. It’s also looking to expand telehealth options to critical care patients in intensive care units at its Berlin and Waupaca hospitals and infectious disease care to patients at its Shawano hospital.
Implementing these solutions could mean that a patient wouldn’t need to travel as far for care such as post-operative surgical follow-up. For example, a patient from Waupaca who has surgery in Appleton could go to ThedaCare’s hospital in Waupaca for follow-up and have his or her wounds evaluated there instead of traveling back to Appleton.
Brazeau says telehealth plays an important role in ThedaCare’s dedication to population health and providing the right care at the right time and place for the patient. It also enhances community care and allows for quicker expansion of specialties.
“It creates a lot of convenience for patients and access. If we can see patients sooner, we’ll do it via telehealth,” he says.
The rapid expansion of telehealth services has presented some challenges for health care systems, including payer barriers, Meyer says. Legislation is still catching up and evolving. For example, Medicare won’t pay for telepsychiatry in urban areas. More psychiatrists offer services remotely than in person, leading to a shortage of psychiatric care in urban areas, she says.
In November, Gov. Tony Evers signed a bill increasing Medicaid reimbursement for telehealth services. Among other provisions, it allows patients to receive telehealth services at a home, school or other non-clinical locations.
To help implement costly technology, ThedaCare received a U.S. Department of Agriculture grant that helped deploy two telehealth carts at each of its critical access hospitals — Berlin, New London Shawano, Waupaca and Wild Rose. A fully equipped cart costs between $20,000 and $30,000. The health care system will continue to look to grants and funds from its foundation as it expands telehealth services, Brazeau says.
In the not-too-distant future, services could include video visits, the ability to connect to providers via texting and access psychiatry services from home. This could lead to better outcomes for patients and remove even more barriers, Brazeau says.
“It’s going to grow. There’s definitely a need. We’re looking to expand. We’re not going to be content with where we’re at,” he says.