As one study by the Centers for Disease Control and Prevention (CDC) noted, many nonmetropolitan areas have a higher percentage of deaths from the five leading causes — cancer, heart disease, stroke, chronic lower respiratory disease and unintentional injuries.
What’s often overshadowed by studies such as these are the significant behavioral health needs patients in rural areas face. Recent figures from the Substance Abuse and Mental Health Services Administration (SAMHSA) reveal that nearly one out of five (18.7%) residents in nonmetropolitan counties had some sort of mental illness in 2016, which amounts to more than 6.5 million people.
Exacerbating the problem is the increasingly short supply of behavioral health providers in many parts of the country. As pointed out by a 2017 report from physician search firm Merritt Hawkins, the shortage of psychiatrists represents an escalating crisis.
In order to move forward, rural providers must adopt a new approach that emphasizes better documentation and collaboration, expanding access to care and streamlining operations.
Since this is no easy feat, it may be easier for rural behavioral health providers to address these challenges individually.
Documentation and Collaboration
Most behavioral health patients require ongoing care and need to be engaged with frequently. While most primary care physicians use EHRs to collect and exchange information, many behavioral health providers do not. This is potentially problematic, as integration between behavioral health providers and primary care providers is the cornerstone of improving health outcomes and reducing expenditures.
At a minimum, insight into changes to medication can provide meaningful insight if a patient displays any side effects. Providers need to consider whether their existing EHR solution accommodates the documentation practices and care coordination necessary to adhere to new care models – and satisfy patients’ behavioral health needs.
Anytime access to care
For patients in rural communities, getting the timely care you need when you need it is a game changer. Everyone knows telehealth is one of the best ways to bridge gaps in care, by offering patients access to providers wherever they are. Behavioral health providers in particular often think there are two options—leverage free virtual communication tools, such as Apple’s FaceTime, that are not HIPAA compliant or invest upwards of $50k for devices, cameras and other equipment. Neither is an attractive option for rural behavioral health providers.
What does make sense: Implementing virtual care solutions that are already embedded within an EHR, or virtual care applications that can be incorporated into a provider’s existing technology system. By having telehealth capabilities embedded into your EHR, providers can more easily access a recent visit without having to open multiple systems. Scheduling follow-up appointments is also streamlined, and reviewing recent changes to a patient’s chart is made seamless.
Fortunately, the reimbursement climate is growing more favorable for these endeavors. In February 2018, the House and Senate passed a budget deal that included the Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care Act of 2017 that allowed Medicare to cover more services for treating chronically ill patients. Further, in the most recent Centers for Medicare & Medicaid Services (CMS) proposed rules, the provisions in the proposed CY 2019 Physician Fee Schedule would support access to care using telecommunications technology by expanding Medicare-covered telehealth services to include prolonged preventive services.
Billing and remittance
Streamlining billing is one of the best ways to improve efficiencies, especially as rural healthcare providers expand their scope of care. The still-common manual process of scanning and submitting practice notes with super bills may be fine if you’re seeing one type of patient, but for more dynamic patient billing scenarios – e.g., patients who are seen by multiple BH providers and PCPs in a shared-risk pool – billing can become pretty complex. A healthcare organization should ask itself whether its existing RCM solution is equipped for more collaborative payment schemes, and a broader range of reimbursable services – behavioral health and otherwise.
As healthcare providers try to do a better job of addressing behavioral health needs for rural patients, it’s important to consider whether existing resources are sufficient in moving forward. According to a 2016 analysis by U.S. Health Resources & Services Administration, the U.S. needs to add 10,000 providers to each of seven separate mental healthcare professions by 2025 to meet the expected surge in demand.
Healthcare providers who seek out sustainable solutions to helping rural behavioral health patients today will be better prepared in handling any future surges in patients with BH needs.
Baha Zeidan is founder and CEO of Azalea Health.