Our Services

Telehealth Psychiatric and Psychological Services

At MediTelecare, we are proud to offer a comprehensive telehealth program that meets the many unique needs of our patients. Our multidisciplinary teams administer thorough psychological and cognitive evaluations that assist in individualized treatment planning. We provide medication management services for psychiatric patients with the goal of medication reduction when possible, as well as intensive psychotherapy and behavioral services.

Psychiatry


Our goal is to improve the quality of care and life for the 1.5 million people served by nursing homes in the United States.
The appropriate use of medications is paramount in ensuring the safety and well-being of residents in skilled nursing and assisted living facilities. CMS has announced an initiative to reduce the inappropriate use of antipsychotic medications in nursing homes.
Our psychiatric telehealth program protocols are developed by a board certified psychiatrist. We visit with patients frequently, allowing us to provide care that is proactive rather than reactive. Not only does this help improve long-term outcomes, but it also helps to reduce hospital readmissions and improve quality of life.

Psychology


Research supports combined psychotherapy and medications are superior treatments than either treatment alone.
At MediTelecare, our clinicians are trained to provide thorough mental health assessments and treatment for patients with the goal of optimizing functional ability and improving quality of life. We work with interdisciplinary teams and provide psychiatric referrals when medically necessary.
Our clinicians include licensed psychologists, licensed professional counselors, post-doctoral residents and licensed clinical social workers. They work together to provide individual and family therapy with an emphasis on geriatric needs.
MediTelecare clinicians provide:
  • Comprehensive mental health assessments and interventions to help residents adjust to chronic and debilitating illnesses (both medical and psychiatric) that require long-term acute, skilled nursing, and/or long-term residential care.
  • Neuropsychological assessments to determine degree of dementia and cognitive functioning.
  • Evidence-based interventions that manage maladaptive behavioral reactions to medical and cognitive decline.

Benefits of Our Services


Medication Reduction
At MediTelecare, we emphasize an increase in behavioral treatment and reduction in reliance on psychotropic medications. For residents, reducing medication means minimizing side effects caused by those drugs and lowering the risk of adverse reactions. It also improves performance in CMS quality measures and ratings.
Documentation
Our telehealth clinicians provide the same services as non-telehealth clinicians, including accurate and timely documentation. This detailed documentation is extremely helpful in providing support for psychotropic medication prescription.
Frequency of Visits and Accessibility
Telehealth’s unique mode of visitation ensures that everyone who can benefit from behavioral therapy has access to it. We immediately establish a plan for regular visitation, as well as assessments for new residents as they move in to the community. We meet with patients on a weekly or bi-weekly basis, and facilities and providers enjoy on-demand access to specialists as needed.
No Out-of-Pocket Expenses
All equipment required to access our telehealth services is provided at no charge to the facility. This includes a HIPAA compliant two-way interactive video conferencing platform. We also provide a dedicated facilitator that will physically visit each facility on a weekly or biweekly basis, alleviating the burden of clinic time on staff, facilitating all aspects of the telehealth services, and acting as a liaison to interdisciplinary staff members.

Eligibility


Our clinicians are Medicaid and Medicare providers, and we contract with most major private insurance companies.
Many facilities throughout the U.S. qualify for Medicare telehealth payments – some of which may not be aware of their eligibility. The U.S. Department of Health and Human Services qualifies many different types of sites, including:
  • Offices of a Physician or Practitioner
  • Hospitals
  • Critical Access Hospitals
  • Community Mental Health Centers
  • Skilled Nursing Facilities
  • Rural Health Clinics
  • Federally Qualified Health Centers
  • Hospital-Based or Critical Access Hospital (CAH)-Based Renal Dialysis Centers (including satellites)
For more information about Medicare eligibility, contact our office to speak with an intake specialist. We can review your facility’s needs and location to determine whether your site qualifies for Medicare telehealth payments.

Psychotropic Medication Policy


At MediTelecare, we take the prescribing of psychotropic medications very seriously. In accordance with the Final Rule published by The Centers for Medicare and Medicaid Services, we ensure that each and every patient being prescribed a psychotropic medication has a specific psychiatric condition that warrants the need for that medication.1 In addition, residents who take psychotropic medications receive gradual dose reductions unless clinically contraindicated in order to discontinue these medications whenever possible.
We believe efficacious and safe psychotropic medication prescribing can only be done with comprehensive, patient-specific medical assessments. This is why our team utilizes every available resource in order to recommend the best available treatments. This includes the use of pharmacogenomic testing, evidence-based clinical guidelines and coordination with psychologists and behavioral specialists in order to only resort to medication treatment when absolutely necessary.
In the past, the use of psychotropic medications, such as antipsychotics, has been widely accepted to address behavioral issues in nursing home residents. This practice has been especially common among residents who show behavioral or psychological symptoms of dementia (BPSD). According to the American Psychiatric Association (APA) guidelines on the use of antipsychotics to treat agitation or psychosis in patients with dementia; “Nonemergency antipsychotic medication should only be used for the treatment of agitation or psychosis in patients with dementia when symptoms are severe, are dangerous, and/or cause significant distress to the patient.”2 This may be interpreted that antipsychotic medications should be reserved as overall “last-line” therapy when all other therapies have been exhausted. Therefore, our team ensures that every patient that is prescribed antipsychotic treatment is thoroughly assessed and gradually reduced from that antipsychotic when appropriate.
Our mission is to REDUCE the inappropriate use of psychotropic medications in nursing homes. Through efforts such as gradual dose reduction, we determine if the psychotropic medication will be of continued benefit and need by the resident. Gradual dose reduction (GDR) is a stepwise dose reduction in a given psychotropic medication. GDR is used to determine if symptoms, conditions or side effects can be managed by a lower dose of that medication or if the medication can be discontinued altogether. This is a necessary approach even when the resident’s psychiatric symptoms have stabilized. Furthermore, GDRs are necessary due to the increased risks of serious adverse events in geriatric patients taking psychotropic medications. For instance, the FDA warns against the use of antipsychotics in aging patients with dementia, stating that, “Elderly patients with dementia-related psychosis treated with atypical antipsychotic drugs are at an increased risk of death compared to placebo.”3 For this reason, our team is committed to preventing serious complications due to the prescribing of psychotropic medications.
At MediTelecare, we understand that every patient is unique. What may be a safe and effective treatment for another is not always the case for every patient. We thoroughly scrutinize the prescribing of psychotropic medications, so as to prevent serious adverse events and provide the best available treatment methods.
For more information about how we work to reduce the use of psychotropic medications in skilled nursing facilities, contact our office to speak with one of our helpful representatives.
References:
  1. Final Rule Homepage. Centers for Medicare and Medicaid Services. Available from: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/GuidanceforLawsAndRegulations/Nursing-Homes.html
  2. Reus VI, Fochtmann LJ, Eyler AE, Hilty DM, Horvitz-Lennon M, Jibson MD, Lopez OL, Mahoney J, Pasic J, Tan ZS, Wills CD, Rhoads R, Yager J. The American Psychiatric Association Practice Guideline on the Use of Antipsychotics to Treat Agitation or Psychosis in Patients With Dementia. Am J Psychiatry. 2016 May 1;173(5):543-6. Available from: https://psychiatryonline.org/doi/book/10.1176/appi.books.9780890426807
  3. Steinberg M, Lyketsos CG. Atypical antipsychotic use in patients with dementia: managing safety concerns. Am J Psychiatry. 2012 Sep;169(9):900-6. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3516138/