To maintain patients’ access to mental health care during the pandemic, an FQHC in Pennsylvania expands their clinic-based telepsychiatry program to include at-home services. No-show rates have dropped and patient satisfaction has improved as a result.
River Valley Health & Dental is an independent, non-profit, Federally Qualified Health Center (FQHC) in Williamsport, PA that provides medical, dental and behavioral health care and social services to underserved residents in central Pennsylvania. In 2019, they introduced integrated telepsychiatry services to supplement their onsite behavioral health and social services team in order to help address the growing need for mental health care in their community. This telepsychiatry program gives patients access to an adult psychiatrist as well as a child and adolescent psychiatrist who specializes in ADHD and Autism Spectrum Disorder.
Prior to COVID-19, patients would come to the clinic to meet virtually with their telepsychiatry clinician. Now, in the wake of the coronavirus pandemic, patients have the ability to access these telepsychiatry services from home. Medical providers at the clinic are now also using telehealth – phone and televideo – to provide care for patients.
In a recent interview, Susan King, LCSW, Program Coordinator at Community Services Group and behavioral health coordinator at River Valley Health & Dental, describes how River Valley swiftly implemented technology to allow for at-home telehealth visits in order to provide ongoing support for patients during the COVID-19 pandemic. This has allowed them to minimize patients’ exposure to the virus while continuing to meet their healthcare needs. Medical and behavioral health care clinicians deliver care via telephone or web-enabled video for most patients. If necessary, in-person visits are still an option and are scheduled appropriately to minimize traffic in the facility and maintain social distancing.
Please describe the impact that COVID-19 has had on your organization.
We are a busy FQHC. We provide primary health care, including medical, dental, behavioral and reproductive health services to the most vulnerable members of our community. As such, we have been designated as essential for both medical and behavioral health services. Not taking care of our community is not an option. Continuing to deliver care was not a question of if, but rather of how. While COVID-19 has had a frightening impact on the nation as whole, our team has risen to the occasion, moving quickly to telehealth visits, adjusting staffing patterns and schedules and working with patients and families to adapt to the new technology and new model of care delivery. While we certainly miss the day-to-day camaraderie of staff and patients interacting together in-person, we are grateful that technology allows us to connect virtually so that patients can continue to receive the medical and mental health care they need during this time. We’re proud that as a healthcare organization, we were able to adapt to the challenges posed by COVID-19 and make things work for the benefit of our patients.
How has COVID-19 affected your patients and their access to care?
Many of our patients have been flexible enough to adapt to the idea of a phone visit. Those who have access to smart phones and computers have been also able to utilize televideo visits through our portal. Since we are essential, our physical clinic space also remains open for visits for patients without access to technology. We have worked hard to ensure a variety of ways to meet patient needs.
What changes have you had to make in your operations in response to COVID-19?
Our clinic remains open for needed or emergent in-person visits for both physical and behavioral health care; however, we have adjusted provider and support staff schedules to reduce foot traffic in the building. Many clinical staff are working full- or half-time from home. Staffing changes have also helped conserve valuable personal protective equipment (PPE). We implemented physical health monitoring for staff for early detection of signs of illness. We also adapted our mobile dentistry RV to serve as a respiratory triage unit to ensure that patients with COVID-19 symptoms are safely assessed and tested while minimizing exposure of staff in the physical clinic space.
Have you noticed a difference in your telepsychiatry program pre-COVID-19 and now? Are patients more receptive to the idea of virtual care?
The biggest difference we have noticed is that patients who are unable to leave their home, for various reasons, or patients who work and for whom taking time off to come to the office for a visit, are better able to engage in services. Prior to COVID-19, we had a lot of no-shows. We’re finding that now, given the convenience of at-home virtual care, there are fewer missed appointments. Patients are more likely to attend their appointments and are logging in on time for their scheduled sessions. Patients' time investment in the visit is much shorter when they are able to access these services remotely. And, we are able to serve more people more efficiently.
How have the relaxed telehealth regulations and expanded reimbursement options in response to COVID-19 benefited your organization?
Simply put, people are able to continue accessing quality psychiatric care when chronic or persistent mental health needs are exacerbated by fear associated with the pandemic. The expanded allowance for telehealth has also allowed our medical staff to continue to take care of our patients during the pandemic without missing a beat.
Why is telehealth important to your organization and how does it help your patient population, in particular?
As is the case nationwide, psychiatry is a specialty in short supply in our area. The community we serve struggles with significant socioeconomic risk factors and is among the most physically unwell population in our state. We implemented telepsychiatry in our clinic as part of our commitment to treating the whole person, mind and body. Access to telehealth helps our center uphold that value.
Can you describe a patient who has benefited from the change from clinic-based to at-home based telepsychiatry services during the pandemic?
One of our existing patients is a gentleman who struggles with psychotic symptoms. Because of his diagnosis, he is extremely reluctant when it comes to technology, particularly phones and computer screens. We were worried about how he would respond to the switch to online care. However, he has been remarkably receptive to it since it allows him to access care at home, with his mom nearby to comfort and reassure him. Our hope is that telepsychiatry will help keep him out of a long-term in-patient psychiatric hospital.
What would it mean for your organization if the positive regulatory changes that were put in pace in response to COVID-19 were rolled back and we returned to the way things were prior to the pandemic?
The addition of telepsychiatry has enhanced the behavioral health services that are available to our patients. Since psychiatrists are in short supply in our rural area, a return to requiring patients to physically present in our office for care amounts to putting a barrier back in place. A rollback is akin to making work, transportation, symptom presentation, childcare responsibility etc. a barrier to specialty mental health care for our 17,000 medical patients.
Our Health and Human Services Department recently put out a request for comments to learn what’s working and what’s not in terms of healthcare delivery. They are also seeking provider recommendations on what healthcare delivery should look like post-COVID-19. Telehealth has certainly proven its value in maintaining patients’ access to care during the pandemic; so hopefully it is here to stay. I cannot imagine that we’ll return to traditional service models after the pandemic ends. I envision some type of hybrid approach that blends the best of in-person and virtual care so patients can access the care they need how and when it works for them.
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