SOC Telemed’s Fishkind Instrumental in Over $17.7M in Cost Saving for Rural Texas Hospitals Through Innovative telePsychiatry Program

Dr. Fishkind Co-Pioneered Mental Health Emergency Center Celebrates 10 Years of Success

RESTON, Va. – Dec. 19, 2018 – SOC Telemed (SOC) today celebrates the foresight and leadership of General Manager of Behavioral Health Services, Avrim Fishkind, M.D. A decade ago, Dr. Fishkind co-pioneered the Burke Mental Health Emergency Center (MHEC) that provides emergency telePsychiatry services to rural communities in 12 counties of eastern Texas. Commemorating the 10th anniversary of the initiative, a study was commissioned by Burke CEO Susan Rushing to explore the financial impact the emergency center has had in the region.

Pioneering Mental Health Services Delivery for Rural Communities
By the early 2000s, the state of Texas was in the midst of a widely recognized multi-decade crisis from lack of mental health services for people in need. Psychiatric facilities were above capacity, leaving patients in mental health emergencies with either jail or emergency rooms (ER) as their only options. The ones correctly identified as in need of emergency care were taken to an ER where they could wait for days or even weeks for an open psychiatric bed. Something had to be done. So, in 2004, Dr. Fishkind was tasked by the state of Texas with helping design a plan for bringing psychiatric emergency services to the entire state.

“Texas is a big place, and many people with mental illness had to travel 500 to 600 miles in the back of a police car just to find an inpatient psych hospital bed somewhere. It was a huge drain on ER and police resources and a disservice to these patients. I was honored to help solve this problem,” notes Dr. Fishkind, co-founder and former CEO of JSA Health, which was recently acquired by SOC Telemed. “I waited many, many years to spring emergency telePsychiatry on an unsuspecting world, so when we drafted the plan for the state, we based it around telePsychiatry and other cutting-edge methods.”

In 2007, with a state plan in place, the Texas legislature dedicated funding to improve the ailing state mental health crisis system. A percentage of those funds was earmarked for special projects in crisis response, contingent upon a 25 percent local match to be provided by the state. This availability of funds fueled regional mental health authority Burke into action. Having a year earlier developed an organized network of key stakeholders within the region, Burke was able to rally allies and additional funds to bring about much-needed regional change.

“We covered an area over 11,000 square miles and did not have a single psychiatric hospital that could take people in crisis, nor did we have funding to solve the issue. We realized nobody was going to magically fix this state crisis for us,” explains Susan Rushing, who has worked in various roles at Burke since 1980 and as CEO since 1990. “We knew the private hospital model was not the answer —three had already gone under in our region. So, we worked with and surveyed many stakeholders to create a formal needs assessment, and what we concluded was needed was a dedicated place where patients in crisis could go, where hospitals could send people who were presenting in their ERs, and where law enforcement could take people they apprehended who needed immediate psychiatric help. From there our emergency care model was born.”

The newly available state funding, along with local matching funds and the state’s new crisis plan, enabled the establishment of the Burke MHEC. The initiative opened in 2008 as an innovative option to hospital emergency room services for area residents experiencing a mental health crisis. Located in Lufkin, Texas, it is the first freestanding, rural comprehensive psychiatric emergency program in which psychiatric services are performed entirely by emergency telePsychiatrists.

SOC’s Dr. Fishkind co-designed with Burke the physical plant and clinical programming for MHEC, with his company providing access to 16 psychiatrists and one advanced practice nurse who administered care remotely, aided by Burke’s onsite staff.

Measuring a Decade of Success
The Burke MHEC has become a significant provider in the area’s healthcare safety net. Before MHEC, the first stop for all mental health emergencies was a hospital emergency department for medical clearance and transitioning to the next level of care. This process took an average of 9.2 hours, with one out of every 19 emergency visits resulting in medical-surgical hospital admission because of a lack of psychiatric beds. Since opening ten years ago, MHEC has treated nearly 11,000 county residents in crisis while providing more than 30,000 bed days —all to patients who mostly fall in the category of low income. Without MHEC, these patients would have been transferred to area hospitals.

Interested in understanding the financial and health impact to the community, Rushing commissioned a study that focused on the impact of prevented ER visits. In estimating ER cost avoidance, two analyses were conducted.  The first looked at the cost avoidance associated with ER visits, and the second went beyond the ER cost to estimate the cost avoided for the entire hospital stay of which ER costs are a subset. Data used for this analysis was gathered from the Department of State Health Services’ (DSHS) two hospital databases, capturing both inpatient costs as well as hospital outpatient data, including ER data, from 2010 to 2016.

Taking into consideration the annual number of MHEC admissions, influence of each hospital in the 12-county area, patients who fell under the MDC (major diagnostics category) code and other variables, the study considers the estimate of MHEC-created cost avoidance in area hospitals to be a cumulative value between $17.7 M and $22 M, over the seven-year period measured.

The report, “Exploring Cost Avoidance in Area Hospitals: The Impact of Burke’s Mental Health Emergency Center,” can be reviewed in its entirety at


About SOC Telemed

SOC Telemed (SOC) is the largest national provider of telemedicine technology and solutions to hospitals, health systems, post-acute providers, physician networks, and value-based care organizations. Built on proven and scalable infrastructure as an enterprise-wide solution, SOC’s technology platform, Telemed IQ, rapidly deploys and seamlessly optimizes telemedicine programs across the continuum of care. SOC provides a supportive and dedicated partner presence, virtually delivering patient care through teleNeurology, telePsychiatry and teleICU as well as enabling healthcare organizations to build sustainable telemedicine programs in any clinical specialty. SOC enables organizations to enrich their care models and touch more lives by supplying healthcare teams with industry-leading solutions that drive improved clinical care, patient outcomes, and organizational health. The company was the first provider of acute clinical telemedicine services to earn The Joint Commission’s Gold Seal of Approval and has maintained that accreditation every year since inception. SOC Telemed is backed by Warburg Pincus and CRG.  For more information, visit