In early 2017, a psychiatrist on the medical staff at the Retreat — a not-for-profit specialty psychiatric and addiction treatment hospital — moved out of state but wanted to stay involved.
Brattleboro Retreat developed an inpatient model of telepsychiatry for the staffer to provide remote, real-time video consultation with patients.
“It was very well received early on by patients as well as our staff and the physician involved,” said Mark McGee, M.D., chief medical officer.
The Retreat has since hired several additional staff members to offer telepsychiatry services for adult inpatient and partial hospital programs. The practitioners work full-time from other states including Florida, New York, and Rhode Island.
McGee said southeastern Vermont is not unlike other rural communities in that recruiting for healthcare workers can be challenging. “Many young professionals want to live and work in urban areas,” he said.
“Telepsychiatry offers a unique opportunity for us to connect highly qualified physicians with patients in our healthcare system,” McGee said.
Also, “it allows physicians a great deal of flexibility and autonomy to choose where they wish to live and spend their time, but not be limited by geography in terms of their practice opportunities.”
Patients have reported positive experiences, McGee said, noting that real-time video conferencing services are nearly ubiquitous these days.
“Everybody has some experience, Skyping with their grandparents, for example,” McGee said. Young people have grown up with technology.
“Even older individuals who we may have expected might be reluctant find that it’s a high-quality service. The video feeds are broadband, very high definition. I think the acceptability is really quite high and the quality of services really quite excellent.” McGee said.
Research shows that teleservices are equivalent in acceptability. He said in some instances, a teleconference might be a preferred method of interaction, for example, with patients who experience anxiety sitting with an individual in a confined space.
McGee said not only are remote employees utilizing teleconference services – but the entire medical staff has access to them.
“All of our medical staff who need to evaluate patients after hours are now able to do so through telepsychiatry,” McGee said.
Many physicians live a good distance away from the Retreat, and some patients request discharge after hours. The medical staff can now evaluate patients for after-hours discharge without having to leave their homes and families and disrupt their personal life. “So (teleservices) can also improve work satisfaction of existing staff,” McGee said.
Brattleboro Retreat is also on the cusp of using telepsychiatry services in another way to help serve the needs of Vermont residents. It has an agreement in place with Brattleboro Memorial Hospital to provide telepsychiatry consultation to Emergency Department patients to help expedite treatment plans and reduce the number of psychiatric patients waiting long hours in hospital emergency rooms.
In April, Brattleboro Retreat was in the process of finalizing arrangements and hoped to kick off the program soon.
In many communities, small acute hospitals are often the primary entry point of individuals in the community experiencing a medical or psychiatric crisis. Yet, McGee said, of the 14 acute hospitals in Vermont, only three have any psychiatrists on staff.
McGee said the intent of collaborations such as the one with Brattleboro Memorial Hospital is to provide psychiatric assessments quickly in the ED and provide a detailed treatment plan that can be initiated there.
Those who need inpatient care can move through the system of care more effortlessly.
“There’s a tremendous amount of potential to get patients evaluated and treated much more quickly when they present,” McGee said.
McGee said Vermont is ahead of the curve in providing the necessary legislative supports for telemedicine.
In 2017, the state passed legislation specifying that all health insurance plans provide coverage for health care services delivered by health care providers at a distant site to the same extent that the services would be covered if they were provided through in-person consultation.
The legislation specifies that this requirement applies “whether or not” the patient is accompanied by a health care provider at the time services are provided by a health care provider through telemedicine.
The patient’s location can include a health care provider’s office, a hospital or health care facility and also may include a patient’s home or another non-medical environment such as the patient’s workplace or a school-based health center.
By Pamela Berard