Expansion of the consultation-liaison psychiatry paradigm at a university medical center: integration of diversified clinical and funding models

Cost issues with telepsychiatry in the United States

Videoconferencing has increased patient access to psychiatric care by linking specialists at academic or regional health centres with primary health care professionals in shortage areas (Hilty et al, 1999, 2002). Preliminary studies have demonstrated positive outcomes and user satisfaction (Hilty et al, 2002). Information is still being sought regarding costs because of a paucity of clinical outcome studies, cost data and randomised trials.

Telepsychiatry for Inpatient Consultations at a Separate Campus of an Academic Medical Center

BACKGROUND

Many hospitals do not have regular access to psychiatry consult services. This is well understood as a common shortage at nonacademic community hospitals (especially in rural environments, and may also be a problem at noncontiguously located smaller hospitals that are affiliated with academic medical centers in urban settings. The authors sought to deliver timely inpatient psychiatric consultation-liaison services via telemedicine to a local but physically separated hospital affiliated with an academic medical center.

MATERIALS AND METHODS

The authors collaborated with an office dedicated to the advancement of telemedicine technology at their academic medical center. They developed a telemedicine-based care model to deliver inpatient consultation-liaison psychiatry consultations to an affiliated (but physically separate) small academic hospital that did not have its own on-site consultation-liaison psychiatry team.

RESULTS

The authors were able to successfully complete 30 consultations, each within 24 h. Only 1 patient was ultimately unwilling to participate in the telemedicine interview. As consultations were accomplished on same day as request, patient length of stay was unaffected.

CONCLUSIONS

This pilot study suggests that telemedicine is a viable model for inpatient consultation-liaison psychiatry services to hospitals without on-site psychiatry resources and represents a viable alternative model of service delivery.

Telepsychiatry reduces geographic physician disparity in rural settings, but is it financially feasible because of reimbursement?

Telemedicine has been shown to improve rural patient outcomes in two randomized controlled trials, to increase access to many patients, to serve underserved minorities, and to train primary care providers. Yet, programs are dwindling even after successful grants due to inadequate reimbursement. Studies have been thoroughly done to gauge the payor status of potential rural telemedicine patients, as the "floodgates" are not generally open to all-including those who cannot pay-in typical grants. Or the population of one community may not be representative of others. This study is part of a grant that explored the use of telemedicine for rural service delivery, attempted to get a clear snapshot of whom would be served if all were invited (paying or not), and to understand issues with the reimbursement systems. This article (1) examines the receipts of reimbursement and insurance coverage during the 1-year grant period by determining actual versus projected reimbursements, (2) identifies what payor(s) typical patients use, and (3) identifies problems and barriers for future study. Other administrative issues pertinent to telemedicine and costs are briefly discussed (eg, no-show rates, staffing, scheduling).

Practice patterns in pediatric consultation-liaison psychiatry: a national survey

The purpose of this survey was to describe the current status of pediatric consultation-liaison (C-L) services in the United States. A total of 144 pediatric C-L programs were surveyed, with a response rate of 33%. Financial and staffing constraints were cited as common problems; 61% of programs reported an increase in consultation requests over the past 5 years, however, 30% of services reported a decrease in funding. Collection rates for professional billings average 30%; 57% of services reported an increase in clinical service demands at the expense of teaching and liaison activities. Discussion includes recommendations based on the results of the survey.

Systemic Issues Involved in Working with Professional Sports Teams

Sport psychiatrists face a number of systemic and intra-psychic issues when treating professional athletes. Although only a modicum of literature exists to aid sport psychiatrists, there are several steps they may take to become an integral part of an athletic organization and to be successful in the treatment of the athletes themselves. The ability to delineate their role within the sports club is crucial to mental health professionals' organizational success. Equally important, it is incumbent upon sport psychiatrists to recognize and transcend intra-psychic issues that occur between athlete and physician.

Psychiatric Diagnoses of 901 Inpatients Seen by Consultation-Liaison Psychiatrists at an Academic Medical Center in a Managed Care Environment

The authors reviewed the diagnoses from all inpatient psychiatric consultations conducted by faculty psychiatrists during calendar year 2001 (N = 901) at an academic medical center In about 25% of the consultations, multiple psychiatric diagnoses were made. The most frequent diagnosis groups were mood (40.7%), cognitive (32.0%), and substance use disorders (18.6%). Among 671 consultations in which only one diagnosis was made, the rates of these diagnosis groups were 35.4%, 20.1%, and 10.2%, respectively. The findings were compared with the findings of 19 previous studies published over the past 27 years. Mood, cognitive, and substance use disorders remain major foci of consultation-liaison practice in the managed care era, although the rate of cognitive disorder diagnoses has increased. No evidence was found of a change over time in referral rates.