Original Content

Finding the Right Provider for Your Needs

Alex Bachert, MPH October 25, 2018

This is the first article in Genoa Healthcare’s series on how to develop an effective telepsychiatry program for community mental health centers, federally qualified health centers, and other organizations that work with the underserved.

A nation-wide shortage of psychiatric providers is a conundrum affecting healthcare organizations across the United States, influencing frequency of mental and behavioral health care and detracting from community health and wellness.

Mental Health America, the nation’s leading community-based nonprofit dedicated to addressing mental illness, estimates that there are more than 4,000 areas across the country — home to approximately 110 million residents — that are considered to be mental health professional shortage areas. Many of these areas, noted the report, are rural and low-income per capita regions, requiring clients to travel long distances and endure lengthy wait times to receive care.

Given the dire landscape for local staffing resources, an increasing number of community behavioral health organizations and federally qualified health centers are choosing to leverage the power of technology to work with remote psychiatrists and APRNs. Over the past ten years there’s been a 45.1% annual increase in telemental health visits among rural clients with any mental illness, and research suggests that the use of telepsychiatry to enable access to care for underserved communities is likely to increase in the future.

However, increased access to care is only sustainable if the right provider is selected for a clinic and clients’ needs. “Probably the biggest determinant of a telehealth success is the quality of the match between the clinical professional and the clinic,” explained Mehdi Qalbani, MD, a psychiatrist at Integrated Behavioral Health in New Orleans. “If the doctor and clinic have good partnership and repertoire, things get resolved more easily.”

Here are four tips for finding the right provider to help your organization’s telepsychiatry program reach its full potential.

1. Focus on providers whose specializations match your clinic needs.

When seeking a provider to work with your organization, it’s important to start with the heart of your need: the clients. Understanding your client population allows you to better build a team of providers with clinical expertise and a passion for serving the specific needs of your clients.

Increased access to a network of specialist providers affords clinics the luxury of identifying providers who understands the complex, chronic health conditions most commonly seen among your clients.

For example, clinics with a large Latino or immigrant populations can seek providers that speak the same language, while those who are seeking care for their corrections population or disordered eating unit may have their own set of criteria. If your organization has a geriatric population, you’ll want a provider with experience treating dementia and co-occurring mental illnesses.

This also positions clinics that work with substance abuse clients and medication-assisted therapy communities to focus on providers with a federal waiver to prescribe buprenorphine, something that’s greatly needed in rural communities where there is a severe shortage of prescribers and the average prescriber treats far fewer clients than allowed under law.

2. Consider your clinic’s caseload and operational workflow

The foundation of any successful provider search focuses on which clients require additional care and how many hours of care are needed. If you’re uncertain about the exact number of hours, consider factors such as appointment times, sessions per hour, and percent of SMI clients to help identify a sustainable estimate.

“Using the telepsychiatry application for outpatient psychiatry visits within our Specialty Clinic has allowed us to provide a service that is very difficult to find in a rural area,” commented Cindy D. Finley, RN, BSN, Chief Nursing Officer at Iron County Medical Center in Pilot Knob, MO, who has been using Genoa Healthcare Telepsychiatry for over a year to provide care for her clients.

“Having qualified mental health providers available in our Emergency Department 24/7 has allowed us to provide necessary screenings and to develop treatment plans for our patients much more quickly and efficiently than in the past.”

3. Consider expanding your provider search across MD, DO & APRNs

While the term “mental health provider” encompasses a wide range of specialists, Genoa Healthcare’s telepsychiatry program works with psychiatrists and APRNs specializing in behavioral health care.

Psychiatrists can have one of two degrees: an MD (Doctor of Medicine) which is 4 years of medical school or a DO (Doctor of Osteopathic Medicine), plus 3 years of residency for general psychiatry and an optional 1-2 years of fellowship. APRNs are nurses with at least a Master’s Degree in Nursing, including FNP (Family Nurse Practitioner) and PMHNP (Psychiatric Mental Health Nurse Practitioner).
Opening your search to psychiatrists and APRNs increases the pool of providers to choose from to support your program. As of 2017, there were 13,815 psychiatric mental health APRNs practicing throughout the county, and the National Council for Behavioral Health predicts that this will be closer to 18,000 by 2025, an advent which they referred to as a “welcomed addition to the psychiatric prescribing workforce.”

Use of APRNs can increase access to care, while also helping to control health care costs, and is supported by organizations such as the National Council of State Boards of Nursing and the National Academy of Medicine. Nurse practice laws and regulations currently vary on a state-by-state basis, with nearly half of states allowing full practice, while others permit reduced or restricted practice. Practice laws authorize APRNs to evaluate, diagnose, order diagnostic tests, and manage treatments, including prescribing medications, according to the state board of nursing.

4. A shared prescribing philosophy is essential to safely and effectively treating clients

Alignment on prescribing philosophies is often the final piece in forging the right clinic and provider match. Understanding a provider’s stance on prescribing controlled substances is crucial to determine whether they are the right choice to contribute to your organization’s circle of care.

When interviewing providers, clinics should be prepared to share specific case scenarios to understand how the provider would treat a client. Questions around general approaches to common drug concerns, as well as class of medications, can also help clinics determine the quality of fit. Many providers consider themselves to have a conservative stance on prescribing, so these talking points can help parse out where on the conservative scale a provider might fall.

As the government continues to explore telemedicine initiatives to combat the opioid epidemic, organizations will have increased liberty to choose a provider with similar prescribing philosophies for clients with substance use disorders.

Finding the right provider can take time, but it doesn’t have to be limited based on location. Leveraging telepsychiatry broadens your provider pool beyond zip code and better positions your team to find someone that understands your clinical needs, prescribing philosophies and the nuances of your client population.

Interested in learning more about telepsychiatry providers for your clinic needs? Contact Genoa Healthcare Telepsychiatry to learn more.