By Peter Betz, MD
Executive Medical Director – Psychiatry
Centra Health, Lynchburg, VA
As of late 2023, more than 60 Emergency Psychiatric Assessment, Treatment, and Healing (EmPATH) units have been established nationwide. These units are present in over 30 states, including at Centra Health in Lynchburg, Virginia. Notably, South Carolina’s Department of Health and Human Services initiated a $35 million grant program in 2023, funding the establishment of 13 EmPATH units within the state. The adoption of EmPATH units continues to grow as healthcare systems recognize their effectiveness.
Hospitals seeking to improve psychiatric crisis care while reducing the strain on emergency departments (EDs) should consider the EmPATH model. Since launching in September 2023, Centra Health’s EmPATH unit has demonstrated significant benefits, from reducing inpatient psychiatric admissions to enhancing overall ED efficiency. This guide outlines the advantages, challenges, and key considerations for implementing an EmPATH unit in your facility.
Why Consider an EmPATH Unit?
The traditional ED is not designed to effectively manage psychiatric emergencies, often leading to prolonged stays, increased use of restraints, and higher rates of patient distress. The EmPATH model provides a dedicated space where patients receive immediate psychiatric care in a calm, therapeutic setting, leading to:
- A 30% reduction in inpatient psychiatric admissions, increasing bed availability.
- Shorter length of stay and improved ED flow.
- Decreased patient elopement and lower 30-day readmission rates.
- Cost savings from reduced sitter services and restraint-related interventions.
Key Design and Staffing Considerations
An EmPATH unit requires thoughtful planning in both layout and staffing to optimize patient outcomes and operational efficiency:
- Create a Therapeutic Environment: Open-concept design with recliners instead of beds, a reflection room, and an outdoor space to promote healing. Calm aesthetic, including relaxing colors and art.
- Implement Safety Measures: Ligature-resistant fixtures, secure bathrooms, and sufficient spacing (80 square feet per patient) ensure patient safety.
- Lay out Your Staffing Model: A dedicated psychiatric team, including psychiatrists, psychiatric advanced practice providers, crisis-trained RNs, and mental health technicians, provides continuous and specialized care.
Billing and Coding Considerations
The EmPATH unit operates under an Emergency Department Observation (EDO) billing model, ensuring appropriate reimbursement. Facilities should consider the following billing structures:
- Transfers: Clearly document patient movement between the ED, EmPATH, and inpatient psychiatry for billing accuracy.
- Prior Authorizations: Some payers require authorization for EmPATH services.
- Key Billing Codes:
- 90792 – Initial psychiatric evaluation with medical services
- 99231-99233 – Subsequent inpatient or observation care
- 99238 or 99239 – Discharge day management
- Revenue Opportunities: Licensed therapists (LCSWs/LPCs) and psychiatric providers (MDs/DOs/NPs/PAs) can bill for additional services, increasing financial viability.
Challenges and Solutions
While the EmPATH model offers significant benefits, implementation requires addressing potential obstacles:
- Space Constraints: If space is limited, consider repurposing existing ED areas or integrating modular units.
- Staffing Needs: Recruiting psychiatric specialists may be challenging; leveraging telepsychiatry and cross-training ED staff can help bridge gaps.
- Administrative Buy-In: Demonstrating cost savings and improved patient outcomes is key to securing leadership support.
Looking Ahead: Expanding the EmPATH Model
Centra Health’s EmPATH unit currently operates with an eight-chair capacity, with plans to expand, integrate an all-seasons room, and accommodate higher-acuity patients, including involuntary holds. The model is highly adaptable, allowing hospitals to scale based on their patient volume and resource availability.
By implementing an EmPATH unit, hospitals can transform psychiatric emergency care without the need for excessive financial investment. With strategic planning and strong interdisciplinary collaboration, this model can enhance patient outcomes, improve your ED efficiency, and create a safer environment for all.
