Behavioral Health

Lehigh Valley Hospital and Health Network is the largest provider of Behavioral Health Services in the Lehigh Valley, providing 90,000 annual visits. We have a full (comprehensive) continuum of behavioral health services from psychiatric emergency care to residential care. Our high quality, state-of-the-art facilities and services are integrated with physical health care. There are 14 (or large group of) board-certified psychiatrists on staff.

Ambulatory Psychiatry

Located on all 3 hospital campuses and other sites in the Lehigh Valley, Ambulatory Psychiatry consists of 3 “Partial Hospital” programs, 4 major outpatient programs, and 4 Physician practices. Our patients are served by over 120 staff, including 14 LVPG Psychiatrists, 9 independent contractor Psychiatrists, 2 Psychologists, 6 Nurse Practitioners, Physician Assistants, and Clinical Nurse Specialists, 56 Clinicians, and other support staff.

Multidisciplinary teams offer a wide variety of individual, marital/family, and group therapies, along with medication assessment and management, to children, adolescents and families around from the Lehigh Valley and surrounding area.

Outpatient services address emotional problems such as depression, anxiety, marital & family problems, grief & bereavement issues, the effects of trauma and abuse, stress management, and coping with physical illness.

Our 2 Adult and 1 Adolescent Partial Hospital programs offer more intensive treatment, where patients typically attend 6 hours per day, 5 days a week, as a safe alternative to inpatient treatment, or to safely decrease their inpatient stay. Intensive group & individual therapy in such an ambulatory setting, with a strong focus on patient education, allows the patient to heal and reconstitute with less disruption to family life and other support systems.

Mental illness touches all ages and socioeconomic strata, of course, and since the 1970’s our 2 public clinics on the LVH-17 and LVH-M campuses have served thousands of patients without the economic means to access private therapy. Currently, as in past years, we serve about 3,000 active patients between the 2 sites. The Department of Psychiatry continues to address the ever-increasing financial challenges of maintaining such programs, which remain critical to our mission of serving the behavioral health needs of the community, regardless of their financial means.

The following chart breaks out FY 2004 volumes, first by general category of service throughout all programs, and then per individual program:

Fiscal Year 2005 Projections

Volumes by Category
Partial Hospital Days 13,142 Days

Professional Bills
Outpatient Visits 54,592
Electroconvulsive Therapy 646
Hospital Visits 11,013
Consultations 2,584
Nursing Facility visits 12
Miscellaneous 111
Total 68,958 Visits

GRAND TOTAL 82,100

Volumes by Program

Adolescent Transitions - 1255 South Cedar Crest 3,637
Adult Transitions - 1259 South Cedar Crest 5,007
Alternatives - LVH-M 4,498
Total 13,142 Days

Muhlenberg Behavioral Health (incl. Cancer Support) - Banko, LVH-M 13,743
The Guidance Program (incl. Cancer Support) - 1255 SCC & JDMCC 9,633
Base Service Unit - LVH-M campus 12,213
Mental Health Clinic - LVH-17 11,760
Dr. Campion practice - 1251 South Cedar Crest 3,855
Drs. Karper & Wiley - LVH-M, 1255 SCC & HealthSpring 6,547
Consultation / Liaison Psychiatry - 1251 South Cedar Crest 5,967
LVH-M Psychiatry (Drs. Lerman & Schwendeman) 5,239
Total 68,958 Visits

GRAND TOTAL 82,100

How do we serve the Dept of Psychiatry continuum, LVHHN network, and community?

Ambulatory Psychiatry provides a key layer of services in our overall continuum, which also includes Inpatient treatment, residential treatment, crisis stabilization & referral by our Psychiatric Evaluation Service (PES) in all 3 ED’s, along with other programs.

Our patients often require rapid movement between levels of care; for example, a patient may be seen initially by the PES in the Emergency Department, referred for Inpatient treatment for several days, then receive services at one of our Partial Hospitals for a week or 2, and finally be referred to outpatient care.

A variety of Committees, e.g. Dept. of Psychiatry Performance Improvement & Education Committees, and other structures strive to enhance the continuity of care between all levels. A brief weekly Dept. of Psychiatry Administrative Committee gathers Psychiatry Administration and all program Directors & other key staff, to identify problems to be addressed with timelines for solution. Our monthly Ambulatory Care Committee further enhances that process. Recent activities included assuring systems to identify high-risk patients when they transfer to another level of care, or interventions when they cancel a scheduled appointment, or no-show.

Current projects to strengthen linkages of patient care throughout the continuum include our ongoing Electronic Medical Record, via NextGen. Although demanding a high level of customization to behavioral health needs, the EMR will ultimately enhance the transfer of diagnostic, medical and other information between sites. Eventually, the Psychiatric Evaluation Service social worker in the ED will be able to access data, 24 hours a day, on a patient currently seen in one of our ambulatory programs – including critical medication information.

Other recent initiatives to enhance continuity of care include retreats and follow-up on uniform Treatment Planning methodology, as well as on refined definitions of clinical quality and developing systems to measurably improve outcomes.

Of course, we link not only with other programs in the Dept., but also continue to offer clinical support to other network programs, such as Family Practice, OB-GYN, Pain, and especially cancer services. A dedicated team comprised of a Psychologist & Masters-trained clinical therapists, at both The Guidance Program and Muhlenberg Behavioral Health, specialize in the care and support of cancer patients, in close integration with the Division of Oncology and our Consultation Liaison Service. Links with the Heath Spring and Hamburg practices are other examples of network support.

Finally, in the larger community we provide Psychiatrist and therapist services to several local nursing homes, and to colleges as well, including Lehigh, Lafayette, and Cedar Crest. Some of our Ambulatory care staff play key roles on community committees and boards.

What are some ongoing critical challenges?

As in other areas of the network, access is a key issue, especially with regard to securing care to an outpatient Psychiatrist. The hiring of additional Physician Extenders will [allow us to move toward a solution], and we are currently evaluating other strategies to address this critical problem. Part of a nation-wide shortage, especially critical has been the lack of additional Child & Adolescent Psychiatrists on our team. We are pleased to report that we have hired a second full time C&A Psychiatrist to begin in August, and continue our intensive efforts to secure yet another.

Improving clinical quality is a constant focus, and following a recent retreat we are researching more refined outcomes measures, tailored to ambulatory Psychiatry and allowing comparisons to national benchmarks.

Documentation compliance remains a critical project. Typical of many Partial Hospitals throughout the country, Adult Transitions was the focus of an intensive Medicare review for [over 18 months]. We’re proud to report that we successfully met their extraordinarily onerous standards, and are now off review. We’re especially pleased, given that many Partials throughout the country and locally either decided not to take Medicare patients or to simply close altogether.

On the outpatient side, documentation compliance has improved dramatically. The continued roll out of the NextGen EMR, and other systems and oversight, further assures our success in this area.

As billing experts tell us, Psychiatric billing is exceedingly complex, and we continue to work on systems to diminish denials and write-offs, and to find more efficient ways of providing services and maximizing revenue. The recent hiring of a Behavioral Health Business Specialist, formerly a Senior Auditor with Capital Blue Cross, will be crucial in analyzing our revenue streams and expense challenges, to assure the continued financial viability of our ambulatory programs.

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