For many people staying in assisted living facilities (ALF), being able to travel to doctors’ appointments is difficult, if not impossible. For the past year, psychiatrists at Larkin Community Hospital have made it easier for these patients to receive evaluation and medication management through the use of telemedicine.
“Many patients don’t have the capacity to travel to an outpatient setting, either because of physical issues or chronic mental conditions,” explained Juan D. Oms, M.D., FAPA, chairman and residency program director, Department of Psychiatry, Larkin Community Hospital. “Or they may not be able to arrange transport, either through a family member or caregiver, or through the ALF where they are staying.
“We’re also seeing a trend in that psychiatrists are no longer traveling to ALFs for multiple reasons, including the fact that they are getting lower reimbursements from Medicare and no reimbursements from Medicaid for ALF visits,” he continued. “Yet the fact remains that to stay compliant, these patients need to be seen.”
By using telemedicine, Dr. Oms and Larkin psychiatry residents are able to provide follow-up visits with patients in assisted living facilities one to two times a week, which enables them to evaluate each patient’s status, adjust their medications, and if the patient is decompensating, refer them to the hospital. “We are able to make sure that patients are not missing their medications, or running out of medications,” said Dr. Oms. “Ultimately, this helps decrease hospital admissions and recidivism.”
While telemedicine has been used in other states, mainly for performing evaluations in emergency rooms, its use was limited in Florida because psychiatrists were not able to prescribe controlled substances, such as benzodiazepines and medications for sleep, without physically seeing the patient. Dr. Oms received a waiver to prescribe controlled substances to psychiatric patients via telemedicine in November.
“When an assisted living facility approaches us about providing psychiatric services, we send an outreach team to work with them to see if telepsychiatry might be a viable solution,” explained Larkin ER Coordinator Grettel Arzola on how the process works. “We have equipment set up in our own outpatient clinic that links to equipment in a private room at the ALF; when the time comes for the patient appointment, both parties connect to the software and we are able to provide whatever services they need.”
