PSYCHIATRIC TELEMEDICINE

Identifying Project and Provider Information: Category 1: Introduce, Expand, or
Enhance Telemedicine/Telehealth; Project Option 1.7.1: Implement telemedicine
program to provide or expand specialist referral services in an area identified as
needed to the region; 094109802.1.1; HCA Las Palmas Del Sol (094109802).
o Required Core Project Components:


Provide patient consultations by medical and surgical specialists as well as
other types of health professional using telecommunications.

Conduct quality improvement for project using methods such as rapid-cycle
improvement. Activities may include, but are not limited to, identifying project
impacts, identifying “lessons learned,” opportunities to scale all or part of the
project to a broader patient population, and identifying key challenges
associated with expansion of the project, including special considerations for
safety-net populations.
Project Description: This plan would expand coverage through the use of a
contracted vendor to provide for the evaluation of acute behavioral health patients in
the Emergency Departments. Currently, the process of obtaining a consult can take
up to two weeks or more, during which time the patient is in the Emergency
Department the entire time. A tele-psychiatric consultation could potentially have a
turn-around disposition time of about an hour. The availability of psychiatric
consultation in the Emergency Department through the tele-psychiatry model would
provide immediate access to psychiatric services currently not available to the
patient, provide needed guidance to the Emergency Department physicians, and
facilitate the management of psychiatric patients through the ED. We believe this
would enhance the quality and appropriateness of patient care, lead to earlier and
more appropriate pharmacologic interventions that will expedite the stabilization and
disposition of patients. To validate the effectiveness of the program, we will design
and conduct process improvement activities for this tele-psychiatry program once it
has been implemented to promote higher quality and efficiency standards. Validation
processes will include reduction of psychiatric hold hours in the Emergency
Departments, improve clinical outcomes, and increase patient satisfaction and
safety.
o Goals: Establish telemedicine capability in the Emergency Departments to
include 24/7 availability of tele-psychiatry to provide for the evaluation of the
acute behavioral health patient and provide guidance and support to the
Emergency Department physicians. Improve the quality and appropriateness of
care provided to behavioral health patients through earlier and more accurate
diagnosis. The availability of tele-psychiatry should lead to earlier implementation
of the most appropriate therapy. Earlier and more appropriate psychiatric
intervention may result in some behavioral health patients being stabilized in the
Emergency Department and not requiring transfer for inpatient psychiatric
services.
o Challenges: Analyzing impact and benefit from implementing a telemedicine
program to address psychiatric needs in El Paso; training physicians and staff on
new telemedicine equipment; software and connectivity issues; accurately
measuring the change in service availability and patient satisfaction; patient and
family perception of psychiatric healthcare delivery via this modality; collaboration
of care between the tele-psychiatric professionals and the local psychiatric
hospitals.

Starting Point/Baseline: Neither facility has inpatient psychiatric beds or services,
neither facility is licensed as a psychiatric facility, and neither facility has psychiatric
consultation available in its Emergency Department (ED).

Rationale:
o Behavioral health consumers frequently wait hours or even days in crowded ED’s
before receiving psychiatric evaluation and placement. Hospital reports show that
patients with behavioral health concerns typically stay longer and yield less
reimbursement than medical patients.
o One of the greatest challenges facing the U.S. healthcare system is to provide
quality care to the large segment of the population which does not have access
to specialty physicians because of factors such as geographic limitations or
socioeconomic conditions. The use of technology to deliver health care from a
distance, or telemedicine, has been demonstrated as an effective way of
overcoming certain barriers to care, particularly for communities located in rural
and remote areas. In addition, telemedicine can ease the gaps in providing
crucial care for those who are underserved, principally because of a shortage of
sub‐specialty providers.
o The use of telecommunications technologies and connectivity has impacted
real‐world patients, particularly for those in remote communities, especially
communities such as El Paso. This work has translated into observable
outcomes such as:
 improved access to specialists;
 increased patient satisfaction with care;
 improved clinical outcomes;
 reduction in emergency room utilization;
 cost savings.
o Nowhere are these benefits more evident than in Texas. With a land mass area
of 268,820 square miles and a growing population of 25.1 million, Texas is the
second largest U.S. state by area and population. Its population growth rose
more than 18.8 percent between 2000 to 2009, reflecting an increase that is
more than double the national growth in this period. This rapid growth is
attributed to a diversity of sources such as natural increases from the total of all
births minus all deaths, and to a high rate of net immigration from other states
and countries. Along with the increase in population, an ever‐growing aging
population has significantly affected the demand on the healthcare workforce as
demands for quality care increased.

Related Category 3 Outcome Measure(s): OD-2: Potentially Preventable
Admissions; IT-2.4: Behavioral Health/Substance Abuse (BH/SA) Admission Rate;
(094109802.3.1).

Relationship to Other Projects: This project is part of LPDS’s larger plans to
expand and develop primary care and specialty care services, while improving
access to care and containing the costs of care. Specifically, this project will
complement LPDS’s Physician and Mid-Level Recruiting and Training project
(094109802.1.4) and Outpatient Women’s Imaging Services Expansion project
(094109802.1.2); each of these projects is intended to increase access to important
health care services for patient populations with an identified need and an identified
lack of timely access. Furthermore, this project will complement LPDS’s Electronic
Medical Records project (094109802.2.1) to the extent that both projects will
strengthen the technological infrastructure in use at LPDS, and will maximize the
benefits of that technology from the standpoint of cost, quality of care, and access to
care.

Relationship to Other Performing Providers’ Projects in the RHP: TBD

Plan for Learning Collaborative: TBD

Project Valuation: $7,633,758. The valuation of each LPDS project takes into
account the transformational impact of the project, the population served by the
project (both number of people and complexity of patient needs), the alignment of
the project with community needs, and the magnitude of costs avoided or reduced
by the project. In particular, this project has been valued based on the costs that will
be incurred to develop the technological infrastructure necessary to the project’s
implementation, and the current severe lack of access to appropriate psychiatric
care for patients presenting at the emergency department.
094109802.1.1
1.7.1.X
HCA Las Palmas Del Sol
094109802.3.1
IT-2.4
Related Category 3
Outcome Measure(s):
Year 2
(10/1/2012 – 9/30/2013)
Milestone 1: Establish baseline for
metrics P-4.2 and I-12.1.
Metric 1: Establish baseline for future
years.
Milestone 1 Estimated Incentive
Payment: $1,874,284
1.7.1
PSYCHIATRIC TELEMEDICINE
094109802
Behavioral Health/Substance Abuse (BH/SA) Admission Rate
Year 3
(10/1/2013 – 9/30/2014)
Milestone 3 [P-4]: Implement or
expand telehealth program for
targeted health services, based upon
regional and local community need.
Year 4
(10/1/2014 – 9/30/2015)
Milestone 3: Estimated Incentive
Payment: $2,050,687
Milestone 2 Estimated Incentive
Payment: $2,044,743
Year 2 Estimated Milestone Bundle
Amount: $1,874,284
Year 3 Estimated Milestone Bundle
Amount: $2,044,743
Milestone 4 Estimated Incentive Payment:
$1,694,046
Year 4 Estimated Milestone Bundle
Amount: $2,050,687
TOTAL ESTIMATED INCENTIVE PAYMENTS FOR 4-YEAR PERIOD: $7,633,758
91343
Milestone 4 [J-12.1]: Increase number of
telemedicine visits for each specialty
identified as high need.
Metric 4 [J-12.1]: Number of tele-medicine
visits.
Baseline/Goal: 5% increase over DY4.
Data Source: HER encounter records from
tele-medicine program
Milestone 2: Designate hire
personnel of terms to support and/or
manage the project/intervention
Metric 1 [P-4.2]: Documentation of the
quantity of actual telehealth services
delivered after implementation.
Baseline/Goal: Provide services to
10% of all BH/SA patients in ED.
Data Source: Log of tele-services by
type of health care professionals
and type of service.
Year 5
(10/1/2015 – 9/30/2016)
Year 5 Estimated Milestone Bundle Amount:
$1,694,046