Make the most of telepsychiatry
Telepsychiatry shows promise as a way for hospitals to deliver scarce services to vulnerable patients, particularly in medically underserved areas. Often, telepsychiatry enables practitioners to evaluate and treat people who otherwise might not receive mental healthcare. For most organizations, technology is not the biggest hurdle; often the limiting factor is piecemeal regulation and/or lack of reimbursement.
The challenges for privileging telepsychiatry providers are similar to the issues with other practice areas in telemedicine, according to some MSPs.
“For originating sites, do they wish to credential all providers in-house, or are they going to accept the credentialing from the distant site, if the distant site is a Joint Commission–accredited facility?” says Anne Roberts, CPMSM, CPCS, consultant, medical affairs at Children’s Medical Center in Dallas. Children’s is developing a telepsychiatry program to offer services to remote sites.
“Initially, we will be the distant site, and we fully credential all of our providers. Sites that enter into telemedicine agreements will delegate their credentialing to us,” says Roberts.
Children’s is a large pediatric academic medical center, and it has been the distant site in all cases. The organization provides telemedicine services to rural hospitals in many of its subspecialty areas, Roberts says. She expects Children’s to serve as the distant site for the new telepsychiatry program as well. “The only time we would serve as the originating site (at this time) would be when a provider is delivering services via telemedicine to either one of our clinics or hospitals within our health system, located at one of our other campuses.”
Another challenge for privileging telemedicine providers is ensuring that there are mechanisms in place that allow sharing of quality information back to the distant site. This should be done on a regular basis and included in the provider’s OPPE data, Roberts advises.
For its current telemedicine services, the hospital sends copies of current privileges to the originating site and requires each originating site to complete a clinical evaluation on each telemedicine provider every six months. The hospital develops specialty-specific quality indicators for each telemedicine program, and these are a part of the measures included on the clinical evaluations that each site completes for each provider, she says.
The patchwork of state medical board requirements for remote practice across state lines requires health-care providers and MSPs to be extra vigilant. In Texas, for example, the state medical board requires an initial face-to-face visit between the practitioner and patient to establish the doctor-patient relationship in most circumstances, Roberts notes.