University of Rochester serves rural patients, reduces ED burden with telebehavioral health
The debut installment of the new Cleveland Clinic & HIMSS Patient Experience Digital Series debuts next Tuesday, November 10.
The goal of the series, which will roll out in six parts over the coming months, is to build an online education and networking platform where attendees can gain insights into the many ways technology and human-centered experience are intersecting and being innovated across healthcare – and how they can be optimized for maximal empathy.
Some of the sessions will air live and others will be on-demand – one of which will focus on an innovative use case for telebehavioral health that has already improved patient care while gaining cost efficiencies for small and rural hospitals.
For the session, Building Empathy with Telebehavioral Health: Crossing the Urban-Rural Divide, I spoke with Dr. Jennifer Richman, associate professor of psychiatry at University of Rochester Medical Center, and Michael Hasselberg, NP, senior director of digital Health at U of Rochester.
They explained how an initiative launched in 2016, known as the Psychiatric Assessment Officer Telepsychiatry Model, has paid dividends across the health system, including lower costs through reduced resource utilization, fewer readmissions, and, most importantly, improved patient care through wider accessibility and more empathetic treatment options.
The challenge was one of geography: Mental health issues are just as prevalent as in rural communities as in big cities, but patients in those far-flung places, served by small, understaffed and resource-limited hospitals, lack easy access to the empathy and care they need.
In their presentation, Hasselberg and Richman describe how they developed the new telehealth model, which capitalized on the psychiatric skills of their colleagues in Rochester, while extending their reach into rural communities. The approach has had an array of benefits – for patients, of course, but also for behavior health experts and for the financial health of the University of Rochester Medical Center and its affiliated rural hospitals.
"These small and rural community hospitals that surround the greater Rochester urban region were almost bankrupt – some of them were bankrupt – because the patient population they typically saw was the Medicaid or uninsured population. And what we saw in the data was that behavioral health patients were very high users of these community hospitals," Hasselberg explained.
"A lot of these hospitals had very high, potentially avoidable ED presentation rates and very poor 30- and 60-day readmission rates," he said.
Moreover, when behavioral or mental health would present at the emergency department, "there were no onsite psychiatric resources," said Hasselberg.
Instead, they were often "put into an ambulance and driven 90 miles north to the big city of Rochester to be seen at one of the tertiary hospitals for evaluation."
"A lot of these hospitals had very high, potentially avoidable ED presentation rates and very poor 30- and 60-day readmission rates."
Michael Hasselberg, Rochester University Medical Center
Unfortunately, most of those patients then wouldn't meet inpatient psychiatric admission criteria in Rochester. In those cases, "we would put them in an ambulance and send them all the way back down to that rural community," he said. "But we didn't know the resources there, so we didn't have a good discharge plan for them."
It was in, short, a "vicious, revolving door cycle," said Hasselberg.
So four years ago, Hasselberg and Richman developed the Psychiatric Assessment Officer Telepsychiatry Model, which essentially consists of three components.
"The most important component is the onsite patient engagement, and that is done by the licensed clinical social worker and mental health counselor from the rural community," said Richman.
"The second component is the telepsychiatry component. We have a psychiatrist or a nurse practitioner in the academic medical center in Rochester, two hours away, who's available 9-5 every weekday to discuss cases with that onsite engagement specialist."
The third piece, which has its own set of unique benefits, is a telementoring program for behavioral health providers such as social workers and psychiatric nurses.
"When you're a rural mental health provider, you're very isolated. You don't have anyone who speaks your language. You don't have anyone to bounce ideas off," Richman explained. "It's very hard to maintain mental health providers in rural areas.
"So we do a virtual telementoring with a psychiatrist at the academic medical center and these various psychiatric assessment officers at these different rural hospitals, and we would meet weekly to talk about common issues, common patient scenarios – essentially developing a community of practice for a bunch of these rural providers who might not have anybody else."
"When you're a rural mental health provider, you're very isolated. You don't have anyone who speaks your language. You don't have anyone to bounce ideas off."
Dr. Jennifer Richman, Rochester University Medical Center
During their video session on Tuesday, Hasselberg and Richman go into much more detail about the implementation of the program – describing technology needs, new workflows, clinician buy-in, financial and operational returns, and, of course, patient experience.
As described this June in the Journal of Psychosomatic Research, an analysis of emergency department data from three of the rural hospitals enrolled in the telehealth program found a 36% reduction in all-cause ED revisit rate during the first 90-day period, and 44% reduction in the next 90 days. For cash-strapped community hospitals, that's significant.
In addition, the EHR-linked telehealth program has helped Rochester clinicians better collect clinical data and social determinant information for patients who live in those communities, helping the medical center better assess and triage them when necessary, said Hasselberg.
Richman said other communities with similar challenges should take note: "We really think it's a pretty easy model to initiate, with not many resources," she said. "So we hope to see the spread, not only in New York State, but in other states that could be helped by this."
Learn more next Tuesday, November 10, from 1-1:30 p.m. at the Cleveland Clinic & HIMSS Patient Experience Digital Series.