Covid-19 poses an unprecedented threat to public health and brings enormous stress and anxiety to our daily lives. Healthcare workers bear the brunt of pandemic-related stressors. As an industry already grappling with staffing shortages, healthcare faces additional losses as burnout is caused by treating a seemingly endless wave of patients.
According to the U.S. Bureau of Labor Statistics, hospital employment fell by nearly 94,000 between February 2020 and November 2021, while unit turnover rose from 18% to 30%. The industry 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 total.
In addition, more than three-quarters of U.S. counties facing mental shortagetwo-thirds of primary care providers have The hassle of referring patients to psychiatrists.
Covid-19 overburdens limited psychiatric resources
Staffing shortages have been greatest on the front lines of medical care, but the behavioral health sector has also been affected. There has been a persistent shortage of behavioral health providers in the medical field. This disparity has historically stemmed from training and residency priorities, which tend to focus more on surgical, specialty, and emergency medicine areas. As a result, only 2 to 3 percent of medical students enter behavioral health fields such as psychiatry.
Another factor contributing to the behavioral health shortage is the reimbursement model typically used to treat patients. In psychiatry, where care is provided primarily to patients on an outpatient basis, nearly half of providers in the field continue to operate entirely on a fee-for-service reimbursement model, with many offering cash only.
This approach allows providers to control their schedules and rates, which works well for patients who are willing and able to pay hundreds of dollars a visit to a psychiatrist. However, this dynamic has reduced the number of behavioral health professionals dedicated to treating patients for whom the vast majority of the public sector (i.e., Medicare and Medicaid) cannot afford these premiums.
Behavioral health programs have also historically been overlooked because these services often do not have a significant impact on a facility’s bottom line. Psychiatry generates only about 1% to 2% of health system revenue, so investments in this area are often not prioritized compared to other service lines.
Unfortunately, Covid-19 has exacerbated these chronic labor shortages and investment in behavioral health, leading to large numbers of patients seeking mental health care from an already limited number of providers. While this presents a challenging dynamic for the industry, innovative technologies offer a remedy for both patients and providers.
Telepsychiatry Provides Workforce Support, Patient Consistency
Covid-19 is forcing healthcare providers to offer alternative routes of care to control patient flow and reduce the spread of infection. As a result, telemedicine has rapidly gained widespread adoption and use, and behavioral health has been able to move to virtual care faster and more efficiently than other fields of medicine. One reason for this is that psychiatric services often do not require physical examinations and can therefore be delivered as effectively as they are provided in a clinic setting.
At a high level, telepsychiatry allows providers to supplement their behavioral health workforce in response to growing patient numbers while expanding the geographic reach of services. Because telepsychiatry providers can deliver care from any location, healthcare organizations are now able to attract high-quality psychiatrists and other behavioral health providers to communities where it was previously difficult to recruit in-person jobs.
This means that telepsychiatry now levels the playing field for historically underserved areas and has access to the same high-quality mental health care services that more affluent communities do. Not only can this capacity provide greater access to care, it can also help address key health equity issues related to social determinants of health (SDOH).
Telepsychiatry can also create ongoing connections between patients and providers, helping to ensure mental health between appointments. Too often, patients return to emergency rooms or urgent care centers for mental health issues that could otherwise be addressed outside of those facilities if they had an easy way to connect with their caregivers in real time. Telehealth and secure messaging platforms provide a readily available lifeline to help prevent relapse and provide more immediate appropriate care.
Telemedicine is an Enhancer, Not a Disruptor
The key to effectively implementing telepsychiatry is ensuring that the technology enhances what healthcare organizations are already doing. Telehealth solutions should be as minimal as possible by leveraging or duplicating existing workflows.
The selected telehealth partner should be flexible enough to take advantage of the electronic health records (EHRs) used by the healthcare organizations they serve. Rules for patient processes, follow-up arrangements, and quality control should also reflect existing processes.
Additionally, telepsychiatry providers should consider themselves part of the family of clinics they see patients, not employees of telehealth partners. This mindset should go beyond patient care to include day-to-day operations. Telepsychiatry providers should attend any medical staff or care management meetings requested by the medical facility.
Integrating technology and providers into existing environments helps clinic staff see telehealth as an extension of their organization rather than outside technology.
Telepsychiatry is here to stay
As Covid numbers decline, many behavioral health clinics will work to resume normal business operations and once again position in-person visits as the preferred method of delivering care. However, the “new normal” is not the same as the “old normal”.
The pandemic has made patients aware of the convenience and efficiency telehealth options can offer. It is clear that a large proportion of patients will still want to receive psychiatric care remotely for the foreseeable future. Being a good steward of patient-centered care means providing those options.
Additionally, with the rise of value-based care, health systems are beginning to see the impact of consistent behavioral health services in reducing downstream care costs. Adequately addressing patient mental health issues on the front end can help reduce relapses, emergency room and hospital visits, and overall medical utilization.
Telepsychiatry will be at the heart of many health system patient care plans, especially serving patients facing SDOH-related challenges, including location, transportation, or other barriers to access. Behavioral health providers must adapt to telehealth to ensure not only optimal patient care, but their own long-term success.
Photo: venimo, Getty Images
