The Medical University of South Carolina opened its adult emergency psychiatric assessment, treatment and healing unit — known as EmPATH — in Charleston in July 2025 with eight bays. For the first six months, daily utilization sat around 12%. It is now close to 40%, according to Lalithkumar Solai, MD, chief of mental health at MUSC.
“EmPATH is going overall well; I think it’s a new concept, so bringing it into a large health system, there’s a lot of learning curve that needed to happen,” Dr. Solai said.
MUSC’s emergency department had long relied on a traditional psychiatric holding space known as the D-pod, which originally had 12 bays and includes a seclusion room for agitated or violent patients. Dr. Solai said clinicians defaulted to the D-pod out of habit, even after the EmPATH unit opened.
“We became very strict on our inclusion exclusion criteria,” Dr. Solai said. “We were looking for an ideal patient and we kept saying there is no ideal patient for EmPATH. You move patients into EmPATH, make the assessment, then you determine whether you need to put the patient in D-pod.”
MUSC has since reversed that default approach. Starting July 1, 2026, the health system began treating the EmPATH unit as the primary space for psychiatric patients in the ED, with the D-pod as backup for patients who need seclusion. As part of that shift, MUSC gave six of the D-pod’s 12 bays to the medical ED team.
“It’s a habit that needs to be slowly modified as a team. There were some individuals that were more comfortable than others, and those who are more comfortable and in tune with the services then educated the others,” Dr. Solai said.
MUSC also brought in outside experts — Scott Zeller, MD, who is lead consultant for EmPATH Consulting, and his team — who visited a few weeks prior to July 1 and delivered feedback on operational efficiency.
“Right now we are looking at that as a system to see what are some of the low-hanging fruits on this feedback that we can make happen,” Dr. Solai said.
A new overnight coverage model
MUSC also overhauled its overnight psychiatric coverage in the ED. Previously, a psychiatrist and an advanced practice provider were available from 7 a.m. to 11 p.m., with no clinician available overnight.
“If a patient came in at 11:01 and needed psychiatry to evaluate, we were holding the patients in the ED space and wouldn’t move them,” Dr. Solai said. “They were waiting for seven, eight hours before they were seen.”
Under the new model that began in July 2026, advanced practice providers now cover until 3 a.m., a psychiatrist is available by phone overnight, and on-call residents cover from 3 a.m. to 7 a.m., giving the EmPATH unit around-the-clock coverage.
MUSC is also considering allowing intoxicated patients or those withdrawing from drugs or alcohol into the EmPATH unit, a change Dr. Zeller’s team recommended.
“Let’s let people sober up in the EmPATH space itself, because all they need is 12 to 24 hours to sober up, and it’s a safe space,” Dr. Solai said Dr. Zeller told him, provided the patient is not showing major withdrawal-related vital sign changes.
Effect on length of stay
Before the EmPATH unit opened, patients with a behavioral health complaint — severe panic attacks or suicidal thoughts, for example — stayed in MUSC’s ED for an average of 20 to 22 hours, compared with two to four hours for a typical medical complaint, Dr. Solai said.
“Since [then] we opened our adult EmPATH, and the numbers have gone down significantly. It’s now in the 12 to 13 hours range,” Dr. Solai said.
Dr. Solai said the remaining gap is concentrated overnight and in the early morning, and that MUSC’s goal is to bring the length of stay down to eight or nine hours. However, he does not expect to reach the four-hour benchmark of medical patients, in part because South Carolina does not have enough inpatient psychiatric beds statewide.
The EmPATH unit has also cut wait times for patients who need an inpatient bed. Those patients previously waited an average of 24 to 28 hours in the ED.
“Because we moved more patients into our EmPATH, and we have less patients waiting for a bed, their length of stay waiting for a bed has become much less: it was around four hours,” Dr. Solai said.
On the inpatient side, MUSC has also set an 11 a.m. target — with a buffer to 1 p.m. — for identifying patients who can be discharged, freeing beds for patients waiting in the ED.
Pediatric patients
MUSC does not have a dedicated psychiatric space for children, so pediatric patients are seen by the psychiatry team in the medical ED and, once medically cleared, moved into the EmPATH unit. The unit overnight had faced the same delays as the adult side, Dr. Solai said, with pediatric patients waiting six to seven hours.
MUSC has also started using the EmPATH unit to hold pediatric patients who are waiting for an inpatient bed. Dr. Solai said some of those patients end up staying a day or two and are discharged home instead of being admitted, because they improve in the unit’s therapeutic environment — though he cautioned that observation is anecdotal so far.
According to health system data, MUSC’s adult EmPATH unit had served about 552 patients since it opened in July 2025 through March 2026. Volume was slow initially — 10 to 12 patients in the first few months — before scaling up steadily. Dr. Solai said the unit’s average daily census has grown from one or two patients to five or six of its eight bays being occupied on a given day.
Reimbursement
MUSC receives an hourly reimbursement rate from Medicaid for a patient’s first 24 hours in the EmPATH unit, treated as an observation stay, followed by a daily rate of about $400 after that.
“Previously, for patients who were stuck in the ED, we were paid nothing because they were boarding, and we were paid for the professional fee for the physicians to see them every day and then maybe some basic amount of reimbursement for their services in the ED,” Dr. Solai said. “I am seeing some positive trends of the finances. Instead of us losing millions of dollars in our ED space, now we’re losing less of those dollars.”
Dr. Solai cautioned that it is still early to draw conclusions, in part because Medicaid reimbursement can take three to four months to arrive after a claim is filed. MUSC has agreed to share operational and financial data with its Medicaid partners over the program’s first two years to help determine whether the current rate is sustainable statewide.
“If we don’t, then we kind of tell them what will be the reimbursement rate that will make it sustainable,” Dr. Solai said. “So it’s a two-way street at this time.”
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