Three Signs a Telepsychiatry Program is Heading South

Good intentions don’t ensure things always work well. And telemedicine is no different. A well-planned Telepsychiatry program offers reliable signs of success, but just as easily, a less than ideal plan can and will present signs of stress. Here are three common problems:

Under / Over Estimating Behavioral Health Volume

Countless health systems that mean well as they launch Telepsychiatry programs miss the first step.  Which is to carefully pull the actual behavioral health patient volume in each participating facility’s emergency department (ED) before a Telepsychiatry program launches.

Why is this important?  It violates one essential rule, which is that you must properly size a program.  That means ensuring you have the right number of physicians needed to care for patients – never too few nor too many. 

Size must fit volume.

If the estimates on volume in the ED’s are either too high or too low, the telepsychiatrists will be too busy, or not busy enough.  Both problems quickly lead to unhappiness and soon after, turnover, which is what a strong Telepsychiatry program absolutely does not need.

Lesson learned:  Pull the last 6 months of data, by hour of day, by day of the week.  Make sure the data only totals the number of patients seen with behavioral health needs in the ED’s across the system.

Then use this data thoughtfully.  It will let you staff the program properly, making use of empirical data.  Not having clean data, or guessing at volume, are certain ways to derail or even end a program.

Too Much Optimism on Credentialing

Using Telepsychiatry to address significant patient care needs often means making use of more than a few physicians.  Especially if coverage is around the clock.

Getting multiple physicians credentialed and privileged at multiple hospitals simultaneously may sound easy enough, but in reality, it’s very difficult. 

Why?  Most medical staff offices (MSO’s) are not adept at handling an array of credentialing packets at the same time.  For example, getting 5 physicians credentialed and privileged at 10 hospitals typically means 50 applications going out to the various MSO’s.

By and large, this is more volume than a traditional MSO can handle effectively.  So delays happen from the outset.

True, a handful of progressive systems may make use of some form of delegated or by proxy credentialing to move things along. 

But the other 98% of health systems do things as they always have, which makes for a slow process that can take 3 or even 4 months for each physician to be fully privileged.

Lesson learned: carefully understanding committee dates for privileging, hospital by hospital, requires an enormous amount of attention to detail to properly time and schedule privileging for telepsychiatrists. 

Even with a great focus on the credentialing of physicians, privileging always holds things up the longest.  The best planners stay ahead of this throughout the process.

Lack of Buy In

Launching a Telepsychiatry program to serve multiple hospitals simultaneously remains one of the most impactful features of Telepsychiatry.  Why not take advantage of such an economy of scale?

However, while one physician could virtually see patients at any ED across a health system, the reality is many facilities want more time to understand the program – what it entails, the role of the physicians, their backgrounds and abilities, how much time or money is saved by use of virtual physicians.

Just when the participating facilities want to slow down and ask questions, the progressive systems, by having behavioral health and/or telemedicine centralized corporately, start pushing heavily for rapid adoption.

As important as this can be, this frequently leads to delays in launching programs, like it or not.  And, worse, these delays often take with them the enthusiasm of the skeptical facilities.  These hospitals don’t feel their opinions and needs have been properly vetted, and as a result they resist.

And resistance is guaranteed to cripple a Telepsychiatry program before it has even fully begun.  This can set back all other forms of telemedicine by months or even years.

Lessons Learned:  strive for inclusion at every participating facility.  Get the corporate players engaged in person with the clinicians at each facility.  Make the somewhat ironic choice to use the old school method of going “face to face” to get the deep level of adoption and buy in you need to make a Telepsychiatry program one that fundamentally improves patient care.