Covid-19 has posed an unprecedented threat to public health and introduced significant levels of stress and anxiety into our daily lives. Healthcare workers have borne the brunt of pandemic-related stressors. As an industry already struggling to cope with staffing shortages, healthcare faced additional losses because of burnout from treating a seemingly unending wave of sick patients.
According to the Bureau of Labor Statistics, hospital employment dropped by nearly 94,000 people between February 2020 and November 2021, with unit turnover increasing from 18% to 30%. The sector is only now beginning to rebound from the damage caused by the coronavirus outbreak, but is still down 306,000 jobs, or 1.9%, from its pre-pandemic tally.
Additionally, more than three-quarters of U.S. counties face a psychiatric shortage, and two-thirds of primary care providers have trouble referring patients to psychiatric providers.
Covid-19 overburdens limited psychiatric resources
Staffing shortages have been most profound on the healthcare frontlines, but behavioral health departments have also suffered. There has always been a shortage of behavioral health providers in the medical field. This disparity historically stems from training and residency priorities, which tend to put more focus on the surgical, subspecialty and emergency medicine fields. As a result, only 2% to 3% of medical students enter behavioral health fields like psychiatry.
Another factor contributing to the behavioral health shortage is the reimbursement model commonly used to treat patients. In psychiatry, care is predominantly delivered to patients on an outpatient basis, and nearly half of the providers in the field continue to operate exclusively under a fee-for-service reimbursement model, with many being cash only.
This approach allows providers to control their schedules and rates, which works out well for patients willing and able to pay hundreds of dollars a session to see a psychiatrist. However, this dynamic leaves fewer behavioral health professionals dedicated to treating the overwhelming majority of public sector (i.e., Medicare and Medicaid) patients who can’t afford these premium rates.
Behavioral health programs have also been historically under-addressed because these services typically don’t have a notable impact on a healthcare facility’s bottom line. Psychiatry only generates about 1% to 2% of the revenue for a health system, so investments in this area aren’t often given priority compared to other service lines.
Unfortunately, Covid-19 magnified these longstanding labor shortages and investment issues in behavioral health by causing an influx of patients to seek out mental healthcare from an already limited pool of providers. While this presented the industry with a challenging dynamic, innovative technology offered a remedy for patients and providers alike.
Telepsychiatry provides workforce support, patient consistency
Covid-19 forced healthcare providers to offer alternative care pathways to control patient flow and reduce the spread of infection. Telehealth quickly gained widespread adoption and use as a result, and behavioral health was able to pivot faster and more effectively to virtual care than other areas of medicine. One reason for this is that psychiatric services generally don’t require a physical examination, allowing these sessions to be delivered virtually just as effectively as when they are delivered in the clinic setting.
At a high level, telepsychiatry has allowed providers to supplement their behavioral health workforces to address growing patient volumes while also expanding the geographic reach of services. Since telepsychiatry providers can deliver care from any location, healthcare organizations are now able to attract high-quality psychiatrists and other behavioral health providers into communities that previously struggled to recruit for in-person jobs.
That means telepsychiatry now provides historically underserved areas with an equal playing field and access to the same high-quality mental healthcare available in more affluent communities. This capability not only provides greater access to care but can also help address key health equity issues related to the social determinants of health (SDOH).
Telepsychiatry also enables an ongoing connection between patients and providers that help ensure mental well-being between appointments. All too often, patients revert to visiting the ER or urgent care centers for mental health issues that could have been addressed outside of these facilities if the patient had an easy way to connect with their caregiver in real-time. Telehealth and secure messaging platforms provide a readily available lifeline that helps prevent relapses and provides more immediate appropriate care.
Telehealth is an augmenter, not a disruptor
The key to an effective telepsychiatry implementation is to ensure the technology augments what a healthcare organization is already doing. A telehealth solution should create as little disruption as possible by utilizing or replicating existing workflows.
The chosen telehealth partner should be flexible enough to leverage the electronic health record (EHR) in use at the healthcare organization it serves. Rules for patient flow, follow-up scheduling and quality control should also mirror existing processes.
Furthermore, telepsychiatry providers should view themselves as part of the clinic family where they see patients—not as employees of the telehealth partner. This mindset should extend beyond patient care and include day-to-day operations as well. Telepsychiatry providers should attend any medical staff or care management meetings desired by the healthcare organization.
Assimilating the technology, and the provider, into the existing environment helps clinic staff view telehealth as an extension of their organization rather than an outside technology.
Telepsychiatry is here to stay
As Covid numbers decline, many behavioral health clinics will push to get back to business as usual and once again position in-person visits as the preferred method of delivering care. However, the “new normal” will not be the same as the “old normal.”
The pandemic has awakened patients to the convenience and efficiency telehealth options can provide. It’s clear that, for the foreseeable future, a significant percentage of patients will still desire to receive their psychiatric care remotely. Being a good steward of patient-centered care means providing these options.
Furthermore, with the rise of value-based care, health systems are beginning to see the impact consistent behavioral health services have on reducing downstream care costs. Sufficiently addressing a patient’s mental health issues at the front end contributes to a reduction in relapses, ER and hospital visits, and overall medical usage rates.
Telepsychiatry will be central to many health system patient care plans, particularly to serve patients that face challenges related to SDOH, including location, transportation or other barriers to access. Behavioral health providers must adapt to telehealth not only to ensure optimal patient care but their own long-term success.
Photo: venimo, Getty Images
