CFHA members (click to join) as usual stepped up to the plate to support each other and to begin to collectively frame a response to the COVID-19 pandemic. As a service to members and to the general public we will be posting weekly updates of our conversations and resource sharing efforts here. Because these are taken from email conversations, examples provided may refer to single clinics or situations. We hope this inspires, encourages and educates everyone as to the work that integrated care team members are doing in near real-time to the evolving pandemic.

Questions CFHA Members Are Asking

• Members are interested in teletherapy policies and possible negotiations with insurance companies to provide adequate reimbursement.
• Members are interested in mental health resources and/or programs for health care providers. 
• Clinics are interested in resources for workflow and plan development for drive-through COVID testing.
• Members are interested in the role(s) of behavioral health staff during the COVID-19 crisis.
• Members are wondering if all insurance companies are reimbursing LCPCs and LCSWs for telehealth services. 
• Members are interested in possible solutions for language barrier and interpretation while providing telemedicine services.
• Members are interested in how to document the Review of Systems and Physical Exam for non-visual telehealth visits (i.e. phone visits).

Member-Provided Information

Should behavioral health come in to work?

•  Some behavioral health consultants are following the lead of primary care providers in regards to non-acute in-person medical visits by minimizing patient contact (eg. rescheduling). Patients are also screened the same way as medical patients and will receive telehealth care once primary care providers make the transition to remote visits. These clinicians are in clinic but seeing diminished duties.
• Most members have switched behavioral health consultants to phone visits for the time being with most working from home. Some clinics are employing one or a few behavioral health clinicians to take in-person visits and have modified hours for mental health crises. Non-critical scheduled visits are being handled via telemedicine resources.
• Early reports indicate that patients are grateful for the tele-access
• Concerns remain around how integrated work will proceed with telemedicine approaches (e.g. how will warm handoffs occur?)

Supporting Healthcare Professionals

• Headspace (https://www.headspace.com/health-covid-19) is providing a free subscription through 2020 for health care providers: only a NPI number is necessary. 
• Some health care professionals are educating employees about operational stress and how to manage the fatigue and distress that goes along with stress.
• Some clinics are educating their behavioral health interns in psychological first aid  in an effort to help physicians and healthcare staff. 

Across The Age Spectrum

• Interventions for pediatric populations can include parent/family brief intervention to help structure time at home. On the other end of the age spectrum clinics are working with senior housing staff to set up a telehealth office on site for senior residents. 
• Some health care professionals are using telemed visits to provide care to children. Older, already established patients speak on the phone while younger patients use speaker phones in the presence of a parent.

Billing

• Some health care professionals are using telephone visits for all scheduled behavioral health outpatient appointments until telehealth and telemed is accessible to their clinics and employees. However, some appointments will not be reimbursed.
• Some health care professionals are utilizing video sessions and normal billing codes (mostly with modifier 95) to provide care. Medicaid and location codes are still in development. 
• Some insurance companies are reimbursing LCPCs and LCSWs for telehealth services if they are ‘qualifying providers’ for behavioral health services.
• PacificSource and Care Oregon in Oregon reimburses telehealth visits when provided via audio and synchronized video in addition to telephonic-only medicare codes. Services are to be billed with the GT modifier and location identifier. 

Telehealth Solutions

• Some clinics are using doximity to call patients; doximity has expanded its list of members able to perform calls (https://doximity.com/care_team). Doxy.me pro (https://doxy.me) allows up to five members on a call while screen sharing to allow better interpretation.
• Other options discussed include Zoom, integrated options within EHRs and other commercial platforms
• Many clinics are making extensive use of telephones for care delivery

Summary Questions Posed To The Network:

• What is my system/clinic trying to accomplish? (eg. Is my medical clinic serving only acute medical issues?)
• How does BH fit it to what the system is trying to accomplish?
• What are our site’s patient needs and how does BH fit in?
• What are the site’s staff/provider needs & how does BH fit into a support role for them?
• How do our individual BH providers feel about their role and responsibilities to staff, patients as balanced with their own health concerns?
• How does our level of integration impact the above (eg. Colocated versus fully integrated)?
• When do public health needs trump all of the above?

Additional Healthcare Provider Resource Links: 

• https://learn.nctsn.org/enrol/index.php?id=38
• https://www.facebook.com/groups/607784656443292/
• https://integratedcareconsultation.com/all-resources/websites/?fwp_resource_topic=covid-19
• https://www.psycheanalytics.com
• https://covid.slack.com
• https://docs.google.com/spreadsheets/d/1mXxjFJxd2J6t_pwioWKBYSaCbO5kVOjbb2dsXlpZmRs/htmlview#
• https://www.cstsonline.org/resources/resource-master-list/coronavirus-and-emerging-infectious-disease-outbreaks-response

Distance Learning Links

• https://www.amazon.com/Psychophysiologic-Disorders-Interprofessional-Diagnosis-Treatment/dp/1696486866
• https://ppdassociation.org/online-course

Telemedicine Links

• https://www.cchpca.org/?utm_sourc=Telehealth+Enthusiasts&utm_campaign=a1c516ec33-EMAIL_CAMPAIGN_2020_03_16_10_31&utm_medium=email&utm_term=0_ae00b0e89a-a1c516ec33-353219337
• https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet 
• https://doxy.me
• https://blog.doximity.com/articles/covid-19-we-re-here-to-help
• https://doximity.com/care_team
• https://zoom.us

Healthcare Provider Selfcare Links

• https://www.headspace.com/health-covid-19
• https://www.ptsd.va.gov/covid/COVID_healthcare_workers.asp
• https://www.cdc.gov/coronavirus/2019-ncov/hcp/caring-for-patients.html
• https://www.cdc.gov/corona/virus/2019-ncov/about/coping.html
• http://health.ny.gov/assistance

Thanks to Emma Serrano, CFHA intern, for her assistance with compiling the above information.