Telepsychiatry Helps Recruitment And Patient Care In Rural Areas | WGLT

Telepsychiatry Helps Recruitment And Patient Care In Rural Areas

Sep 9, 2019
Originally published on September 13, 2019 5:31 pm

It used to take at least nine months for a patient to schedule an initial appointment with a psychiatrist at Meridian Health Services in Indiana. Now, it takes days, thanks to a program that allows doctors to connect over the Internet with patients, reaching those even in remotest corners of the state.

That has also helped with recruitment. Over the last several years, Meridian's staff of psychiatric specialists, including nurse practitioners, tripled from four to 12.

"In my opinion, it's lifesaving," says Dr. Sarfraz Khan, Meridian's chief medical officer. Meridian increased its investment in telepsychiatry in the last six months, in part because of what Khan says is a burgeoning addiction crisis. "There are drugs and then more drugs and then more and more drugs."

Growing problems with addiction and depression have made the country's shortage of mental health professionals much more acute for rural areas. Geographic isolation exacerbates a vicious cycle. A shortage of doctors means patients can't get timely care. The health system atrophies, and doctor recruitment gets even tougher.

As a potential workaround, telemedicine is one of the most promising and lucrative opportunities in healthcare. The way it has transformed both psychiatric care and recruitment for Meridian is a case study of its appeal.

"There was a time when we were seriously considering: Would it be viable for us to provide psychiatric services because nobody would like to come to small towns?" Khan says.

Now, such care is readily available. And it makes more money for Meridian, a provider of mental health and primary care, because Medicare and Medicaid pay more for care provided to underserved areas.

Meridian set up what it calls a "hive" in Indianapolis, where it's easier to recruit talent. Patients drive to a local Meridian office, where a nurse measures their vitals and observes their demeanor, and sits them in front of a computer. On a split screen, the physician appears at the other end of a secure connection.

Patients seem to embrace it.

At Meridian's offices in Muncie, Mariah, a visually arresting 20-year-old woman emerges from her first telepsychiatry appointment. She wears a metallic kitty-ear headband over a florescent green wig that matches her dramatic eye shadow.

"Yesterday, I had heart-shaped freckles that were like colored glitter, and it also looked like I was crying glitter," she explains.

Elaborate costumes help her mask a years-long struggle with depression and anxiety, says Mariah, who declined to use her last time to protect her medical privacy.

She says she prefers talking over a computer to an in-person appointment, because it feels less confrontational. "It's easier because they're not there, so I feel like I can tell more, and speak more and truly just be fully real," she says. "If they're sitting right there, I might not want to say everything or say as much."

For all its benefits, telemedicine hasn't solved all of Meridian's recruitment needs.

"In my offices, I've got probably close to 50 positions that are vacant," says Gerard Cyranowski, one of the company's vice presidents covering the eastern part of Indiana. "It's a tight labor market, there's a limited number of practitioners. They can name their price."

So Cyranowski says the company is interested in expanding its use of telemedicine to address staffing challenges in other areas, including primary care and psychotherapy. In the past few months, Meridian has been using it to treat patients in emergency rooms, addiction treatment centers and even schools.

Copyright 2019 NPR. To see more, visit https://www.npr.org.

MARY LOUISE KELLY, HOST:

Well, this month in All Tech Considered, we are looking at some of the issues that matter most to rural America. One issue is the shortage of health care workers, particularly mental health workers. NPR's Yuki Noguchi discovered one Indiana medical center has found a workaround. It is tackling a shortfall in psychiatrists by using remote care.

YUKI NOGUCHI, BYLINE: On a recent Tuesday morning, psychiatrist Abdul Subhan swivels at his desk, then leans in to face his patient who sits 60 miles away.

ABDUL SUBHAN: Morning, Arnold (ph).

ARNOLD: Morning, Doctor.

SUBHAN: How are you doing today?

ARNOLD: I seem to be doing pretty good.

NOGUCHI: Seeing his patient this way - through a computer - bridges what would be an hour's drive between Muncie and Subhan's office in Indianapolis.

SUBHAN: Hearing voices, any paranoia?

ARNOLD: Not here, I don't have any of that.

SUBHAN: OK.

NOGUCHI: Video conferencing has lowered barriers to medical care. It used to take at least nine months to schedule an initial appointment with a psychiatrist. Now it takes days. Over the past several years, the number of psychiatric specialists on Meridian Health Services staff, including nurse practitioners, tripled from four to 12. Telemedicine has become one of the most promising and lucrative opportunities in health care. The way it's transformed both psychiatric care and recruitment for Meridian is a case study of its appeal.

Sarfraz Khan is chief medical officer for Meridian, a mental health and primary care provider.

SARFRAZ KHAN: In my opinion, there's lifesaving.

NOGUCHI: Meridian increased its investment in telepsychiatry in the last six months, in part because of what Khan says is a burgeoning addiction crisis.

KHAN: There are drugs, and there are more drugs. And there are more and more drugs.

NOGUCHI: Along with spikes in depression and suicide. Geographic isolation exacerbates all that. Many rural health systems face a vicious cycle. A shortage of doctors means patients can't get timely care. The health system atrophies, and doctor recruitment gets even tougher. Khan says a digital connection can't compete with a local in-person visit. But for many years, that hasn't been realistic.

KHAN: It definitely makes a difference when somebody is sitting and talking to you. But the problem is, it is not there.

NOGUCHI: So Meridian set up what it calls a hive in Indianapolis where it's easier to recruit talent. At one end, a nurse measures the patient's vitals and observes their demeanor. A physician at the other end of a secure connection then talks to the patient.

And has it helped your recruitment?

KHAN: Oh, humongous - humongous. There was a time when we were seriously considering that - would it be viable for us to provide psychiatric services because nobody would like to come to small towns?

NOGUCHI: Now such care is readily available, and it makes more money for Meridian because Medicare and Medicaid pay more for care provided to underserved areas. And patients seem to embrace it. At Meridian's offices in Muncie, I meet a visually arresting 20-year-old woman named Mariah. She's wearing a metallic kitty-ear headband over a fluorescent green wig that matches her dramatic eye shadow.

MARIAH: Yesterday, I had heart-shaped freckles that were, like, covered in glitter, and I also had it look like I was crying glitter.

NOGUCHI: She says the elaborate costumes help her mask a years-long struggle with depression and anxiety. Mariah declined to use her last name to protect her medical privacy. She had just emerged from her first telepsychiatry appointment with a doctor based in Indianapolis. She says she prefers talking over a computer to an in-person appointment.

MARIAH: It's easier 'cause, like, they're not there. So I feel like I can tell more and speak more and truly, like, just be fully real, versus, they're sitting right there. I might not want to say everything or say as much.

NOGUCHI: For all its benefits, telemedicine hasn't solved all of Meridian's recruitment needs.

Gerard Cyranowski is one of the company's vice presidents covering the eastern part of Indiana.

GERARD CYRANOWSKI: There's a lot of demand out there. There's vacant positions. In my offices, I've got probably close to 50 positions that are vacant.

NOGUCHI: Especially in primary care. So in the past few months, Meridian has started experimenting using telemedicine to solve staffing problems in emergency rooms, addiction treatment centers and even schools.

Yuki Noguchi, NPR News. Transcript provided by NPR, Copyright NPR.