Is starting a cash-based private practice your best way to gain practice freedom and be empowered to treat patients without getting second-guessed by middlemen? Whether pharmacist or physician, switching over can be scary. And is it really worth the trouble? Join our guest Chris O’Brien, PharmD as we discuss why he decided to go completely virtual and cash-based. Learn how he has built a thriving private practice and how he overcame his worst fears about doing telepsychiatry. Get practical tips on finding the right tools and technology, navigating telehealth regulations, recruiting, and marketing to potential clients. Get all our telehealth podcast @ vsee.com/webinars

1. How to make cash-based
telepsychiatry for work you
By Dr. Christopher O’Brien, PharmD, BCPP, APh

2. What we will Cover
What is an
Advanced
Practice
Pharmacist?
How pharmacists
collaborate with
physicians
Pros & cons of
cash-based
telepsychiatry
Important
considerations
of switching
over
Practical tips on
getting started
Questions Questions Lunch

3. Goal
Increased access to quality patient care

4. Definition of Telehealth
• Telehealth: has been defined
as the intervention of a
telecommunication device in
the diagnosis and the overall
care of patients that are
separated from providers by a
distance
• Telepsychiatry: a subset of
telemedicine, is the delivery
of psychiatric services using a
telecommunication device for
clinical, educational or
administrative purposes

5. What is an Advanced Practice Pharmacist
(Aph)?
• New category of pharmacists created under CA Senate Bill 493
• Other Countries: UK, Canada, Australia
• Other States: 38 stated permit Collaborative Drug Therapy Management
• 2-4 years of additional training, clinical supervision & testing
• Physician extenders focused in specialized areas of
pharmacotherapy

6. Board of Pharmacy Specialties Recognized
Specialites
• Ambulatory Care Pharmacy
• Critical Care Pharmacy
• Geriatric Pharmacy
• Nuclear Pharmacy
• Nutrition Support Pharmacy
• Oncology Pharmacy
• Pediatric Pharmacy
• Pharmacotherapy
• Psychiatric Pharmacy

7. APP Qualifications
• APP License requirements (California State Board of Pharmacy)
• Meet two of these three criteria
• Possess board certification in relevant area of practice
• Complete postgraduate residency
• Complete 1,500 hours of clinical experience under collaborative practice agreement
within 10 years
• Board Certification
• > 12 board specialties (Ambulatory care, pharmacotherapy etc.)
• Psychiatric Pharmacy
• PGY1 and PGY2 residency or combination with clinical experience
• 4 years of practice experience with 50% in psychiatry
• Passing score on the Psychiatric Pharmacy Specialty Certification Examination

8. Advanced Practice Pharmacist (APh)
• CA Business & Professions Code, Section 4052.6(a) 1-4:
• Perform patient assessments
• Order and interpret all drug therapy-related tests
• Refer patients to other healthcare providers
• Initiate, adjust, modify and discontinue drug therapy
• Performed under protocol and in collaboration with treating prescriber

9. Collaboration

10. Pros and Cons of cash-based telepsychiatry

11. Good
• Patient
• More available so patient feels better cared for (with some precautions)
• Enhanced therapeutic relationship
• Much smaller patient panel
• No waiting rooms
• Easier collaboration on difficult cases
• Great for families when there is more than one child
• Convenience and access to care offset out of pocket costs
• Clinician
• Enhanced wellbeing
• Cannot be hit (focus better on assessment and treatment planning)
• Responsible only to the patient
• Wear shorts

12. Bad
• Patient
• Can’t use insurance (Can be barrier for larger institutions, and less healthy
people)
• Have to manage first experiences (Camera, microphone, speakers)
• Must have access to reasonably fast internet access
• Delay in receiving Schedule II medications (methylphenidate etc.)
• Clinician
• If 100% telehealth based you must plan professional and social encounters
• Less patients can use services (generally healthier and employed)
• Reliance on others for physical assessment, blood pressure monitoring etc.

13. Ugly
• Patient
• Relying on outpatient telepsychiatry for emergency situations
• Clinician
• HIPAA violations (patient videoconferencing from Starbucks)
• Children bursting in during a session
• If you promise 24 hour availability then you must keep the promise

14. Important Considerations of Switching Over
• Do you know why you want to change to a cash-based telepsychiatry
practice?
• Some of your patients will need to be referred to another clinician
• Can be a greater challenge for people receiving psychiatric care
• Are you comfortable “selling” your services?
• Do you have referral sources?
• Do you have sufficient savings as you work on obtaining new patients?
• Have you discussed with your insurance carrier?
• Do you have a patient record auditing process?

15. Practical Tips on Getting Started
• Have a business and marketing plan
• Use marketers with health industry experience
• Know how you will obtain patients
• Have amazing customer service
• Use proven technology platforms
• If a new practice, take your time obtaining new intakes
• Your practice will organically grow, but it takes time. Be patient.

16. Philosophy
Low Clinician to
Client Ratio
Service driven
High Availability
Same Day
Services
Client Centered
High Quality Care

17. Questions?
•