Years ago, it was much more common to “fly by the seat of our pants”, making business decisions that “feel” right. A few billionaires can do that effectively. Organizations that insist on making decisions by committee, with no real leader in decision making, can simply do nothing, which really makes for an organization that goes nowhere, does little new and exciting because so many plans just die in committee.
The rest of us need to base our decisions on something tangible. Other organizations’ successes can teach us, as can data. The Electronic Health Record (EHR) is where the data comes from, and since every interaction with a consumer requires some sort of data scribbled on a piece of paper (little value) or entered into the computer (high value), an organization measures its own success and future planning on that data. Although other factors enter the mix, this one’s value is provable and covered nicely by The National Council’s recent study on Enhanced Access and Engagement Quality Improvement Initiative Strategies to Increase Therapy Adherence (quite a title, eh?)
When a consumer doesn’t show for an appointment, a practitioner is oftentimes stuck sitting around with nothing to do…that’s a waste of the person’s time, and a drain on facility revenue. People need to work to have insurance and Medicaid pay the bill. This is a major problem nationwide, so the question of the moment is “How do we entice consumers to put their appointments on the top of their priority list?” Thinking now is that care provider and consumers are both tied into the equation.
A mental health or substance abuse treatment facility that is making ineffective decisions, flying by the seat of somebody’s pants, or one that makes little progress because the committee can’t make up their mind to do something, ends up with morale problems. If a care provider has low morale, then how do the consumers feel after walking out of a session with that person? Attitudes are contagious.
If, on the other hand, an agency is making strides to improve, collecting more money for what they do, you see the evidence in a new coat of paint, a gleam of excitement in a practitioner’s eye when they say ”Hello!” to the consumer, as well as general attitude and physical improvements throughout the agency. A dingy facility with bummed-out practitioners isn’t a place consumers want to go, so more appointments are broken in those environments.
So, what’s required in order to improve is change. Change that’s driven by data works better than the other two methods I’ve been talking about. What with today’s Rapid Change Cycle to make those changes, the implementation excitement’s over pretty quick, so the new coat of paint and improving attitudes are just around the corner, which help consumers justify putting treatment at a higher priority level.
Once the EHR is properly implemented, suiting workflows that make it the least disruptive to the staff and consumers, a facility gets the data required for good business decisions rather quickly. It’s simple to get quality data when central scheduling is in place and care is consumer-centered, involving the consumer and the practitioner in assessing the problems, developing the plan to recover, and recording the progress in notes. The data gathered in the process leads to improvement for the facility, practitioner and consumer.
Once again, the EHR saves the world. OK, maybe not the world, but isn’t it nice to see facilities improve?Read more →
Got issues? Come to treatment, keep your appointments, do your homework and follow-up as it’s assigned, and have faith you’ll get better. That’s probably the job of the consumer, and sometimes the desire to do that job is undermined by long waits between the intake appointment and the first session or medical visit. A number of appointments are broken on a daily basis in facilities because of what amounts to frustration with poor service.
Mental health and substance abuse treatment facilities are doing more these days to reduce the frustration of long waits between appointments and other service-oriented issues, hoping that will assure consumers show up for their treatment they need. Recently The National Council (the mental health community’s most popular support organization) published a study that compiled data from ten Community Behavioral Health Organizations (CBHOs) that sheds some light on the road to a consumer’s successful treatment.
The first, solid business tenant cited as a key to success in improving the way people work in treatment facilities was executive involvement. The chief needs to know what the consumers and staff are really doing in order to apply their experience in fine-tuning processes. Fine tuning a business process, like reducing the time between intake and that first appointment, needs review by a number of different eyes in order for good ideas to come into play. If the chief’s eyes have seen a lot of different ways to improve processes, plus read a few recent articles and a book or two on the subject, good direction can follow.
Don’t be surprised if you see the CEO of an organization going through an intake. Sometimes we need to see a business process from the eyes of a consumer in order to improve the business process. It’s good for a consumer to talk with the executive director of a facility they’ve come to for help and maybe voice a couple reasons they feel treatment has been successful, or how the system in that facility is frustrating and counter-productive. Top executives are becoming more willing to include listening to these stories in their management process.
The same goes for professionals. In small organizations, everybody knows the boss, and usually an open-door policy is in play. Business process improvement ideas can come from the troops who actually do the work…larger organizations need to find a way to encourage this sort of information flow without supervisors’ issues causing information bottlenecks and stopping the flow of good suggestions getting to the top.
This is one reason the computer system is so important. The data provided by the same system used to enter the intake and assessment information, treatment plans and progress notes is used to gather statistics. Reducing the time between intake and the first session is a key to reducing frustration and keeping people in treatment. Spending time in the solution is better than living in the problem.
In the study cited above, Involvement of the executive director decreased the time between intake and the first session or medical appointment by 13%…if it originally took two weeks to see a professional, that simple visibility of the boss encouraged the troops enough to cut that time by a couple days.
OK, so a couple days isn’t a lot. If you improve a couple more processes, more days are shaved off the lag-time between intake and the first session….eventually that lag time between intake and treatment could be cut in half.
I’ll address more ideas facilities are putting into play to improve the consumer experience soon.Read more →
Telemedicine is being called a boom, and when a nurse shares that she can “see” 20 patients in a day, as opposed to 6 or 7 patients for the same treatment, the positive business results are obvious. Devices are being used to monitor conditions in the home, electronically reporting the results to the healthcare provider, resulting in longer-term, more accurate information as well as better care. Psychotherapists are providing telephone sessions. Webcams and other devices bring us together with care providers without either party having to go anywhere.
When travel is removed from an equation, the overhead drops and profits increase. Additionally, office space costs money. Companies with “troops in the field” commonly maintain less office space to account for them. If 10 employees are in the field, they may be able to share 5 desks at headquarters, resulting in less rented space, less heat, less water in the water cooler…and more productive time because those troops aren’t clustered around that water cooler and can focus exclusively on the tasks they’re being paid for.
Meridian Health in New Jersey (http://www.meridianhealth.com/) was featured in a CNN story about telemedicine, and the positive results look to be good for business, good for the healthcare professional, and good for the patient. Now if we can only get somebody to pay for it.
Actually, insurance companies see promise in telemedicine, and the Center for Medicare and Medicaid Service (CMS) sees the value, determining that states can choose to include telemedicine as viable treatment alternatives that can be paid by Medicaid. Whether any states are actually paying for mental health or substance abuse treatment services will have to wait for another entry on this subject. The general outlook I see toward telemedicine is bright and positive, so if it’s not in your life today you may be on the phone, using devices or communicating via the internet through secure connections soon.
If the Electronic Health Records (EHR) would require modifications to account for telemedicine in mental health and substance abuse treatment, they would be minor, like changing the location code for a service, and perhaps adding a telemedicine provisional statement in documentation of those services. These sorts of things and the training and quality control measures of the EHR shouldn’t pose any problems for facilities considering adding telemedicine to their treatment arsenal.
With all the positive information I’ve run across, and the apparent willingness to pay for at least some telemedicine procedures, I felt compelled to dig up something negative to balance the scales.
The New York Times covered the negative side of the story. A recent article discusses how the technology might affect the doctor/patient relationship, decreasing the trust factor.
I’m a big fan of face-to-face connections. When I was in the sales profession, seeing somebody’s eyes was the most effective contact in gaining a person as a customer, so I tend to agree with Dr Pauline W Chen’s coverage in the Times story, trust is built stronger with personal contact. Today I find balance is necessary. In order to cultivate strong relationships and trust, I use all the communication avenues I can, and face-to-face contact is a key factor in those relationships.
A friend of mine uses the phone to connect with her therapist and gladly pays for the sessions out of her pocket, since they aren’t covered by her insurance. She lives in Manhattan, and her therapist is on Long Island. Needless to say, the relationship started years ago, and after many sessions, the travel got to bee too much. She wasn’t about to shop for another therapist, after spending years to find a professional she could relate with, open up to, and reap positive results.
Telemedicine certainly has a place in our world, and I’m sure I’ll be discussing more on the subject as the “boom” continues.Read more →
When it comes to teenage depression, better treatment results make for a more cheerful home life and deliver a better day for everybody involved in the treatment. Over half the teenagers diagnosed as depressed who are resistant to treatment have a chance of dramatic improvement, quickly, according to a recent National Institute of Mental Health (NIMH) study.
Helping somebody get better by switching medications and possibly adding Cognitive Brain Therapy (CBT) are good business moves. When a teenager improves, the entire family notices it and spreads the word to the community. There’s a chance they’ll give credit where it’s due, to the professionals and center who administered the CBT or issued the prescription to change medications. Success stories are good marketing, and testimonials are even better.
The other side of the equation indicates almost half of the teenagers diagnosed as depressed and resistant to treatment didn’t get better. I postulate the study results above are an example of considerably effective research, simply based on the fact that if a medication switch was not tried, or CBT wasn’t brought into the picture, nothing was done to help the kids who did get better. People may have kept doing the same old thing that wasn’t working (and getting paid for it); the same old depression would be affecting the person and their family and result in some bad business. If I go to a treatment center, and the treatment doesn’t work after a reasonable time, I hope I’d consider doing something else, which would be bad for business at that center.
Another element of this story says that CBT accounted only for 14% of the success stories. The question is not whether CBT should be tried; if a professional determines it might be effective, why not? Either nothing will change, or a recovery will be forthcoming due to a change in behaviors added to the switch in medication. I’m a proponent of changing behaviors that can adversely affect recovery, and CBT appears to be a valid treatment.
The difficulty with CBT is whether it’s worthwhile to the offering center and will pay for the training, materials and general expenses it takes to institute and continue a CBT program. I suspect if the center is too small, CBT contributing to only 14% of the improvement in the study cited above would be too expensive to offer as an alternative. Larger facilities would have more patients to offer the treatment and get paid enough to support it.
Medications are effective in treating mental disorders, so centers get paid to prescribe and monitor that effectiveness. Psychiatrists are expected to evaluate the treatment and modify it as necessary. The way I understand it, the therapist treats issues at the root of the problem that the medication may be masking. Insurance companies like prescribing medications because they are the quickest cure, and a prescription and medication can cost less than therapy.
It strikes me that despite all this good news about good results from medication, the long term solution is still uncovering and accepting issues and learning to move on. I worry that by accepting the quick fix, some folks may cover up their issue by medicating the symptom, so a full, happy life may elude them.Read more →
After snoozing the alarm only once I woke up to a commercial for a doctor’s office on the radio.
Where have I been? When did this happen? Do mental health professionals advertise like this, too? Long ago, when I had hair, I sold radio advertising. It was an enjoyable seven year career for me, and I learned a lot. One of the tenants was about doctors: Don’t bother. They’re above advertising (we ignored the yellow pages, which was then what the Internet is now).
I predict the ad for the family practice I heard on the radio will be tremendously successful. One reason is that it’s hard to find a doctor accepting patients on Long Island. Another is that it was clear, and devoid of false airs that tend to accompany image advertising. The image approach apparently works for Prada, but family practices and mental health professionals need a different approach if they want advertising to be effective.
Websites are great, however they aren’t intrusive. In addition to the fact that I’d never heard a doctor’s office advertised on the radio, the intrusiveness of the medium got to me. It came into my home when I was fresh and couldn’t help but pay attention.
I left advertising during the “blitz ’em with a deal!” era…Buy NOW, because if you don’t the sale will be over and you’ll miss these once in a lifetime savings of FIFTY PERCENT! I don’t see healthcare professionals doing that. The ad I heard this morning didn’t.
In addition to the ad I heard locked into a news block this morning, there are other ways professionals advertise, and I question their effectiveness.
Charity events are far too popular in mental health and substance abuse treatment. While working for a software company on Long Island, I bought tickets to a customer’s golfing event simply because it was a chance to play a course I’d normally not be allowed to set foot upon. It was great fun, and a successful fund raiser for the substance abuse treatment agency that threw the party. The advertising included telephone, direct mail, and a lot of talk. I had three people connect with me prior to the outing prior to the event. It wouldn’t leave me alone, and I was sold on the idea enough to sell my bosses into buying expensive tickets for some programmers and myself. I wound up being quite popular among those programmers for a while.
The reason the event was successful was the work that went into marketing that relied heavily on personal contact. As I said, I was sold.
I just received an expensive, glossy, professional newsletter from Stony Brook University Medical Center. I get a number of these from local hospitals. It didn’t work for me, and none of them have. The lead story was for the new Stony Brook Children’s Hospital. My kids are in their 30’s, and don’t live anywhere near here, and there are no grandkids yet anyway. How many other folks did SBUMC waste the $3.00 flyer on? This is definitely a long term sell that won’t work with me any time soon. I have a very effective hospital and primary care system I work with, and the hassles of securing care for physical and mental health are over for me until something changes. Then again, perhaps I’ll cultivate a nice resentment against a psychiatrist.
I’d like to hear testimonials for my neighborhood counseling center on the radio. If the staff of these organizations get out into the community and meet me, casting an attractive message my way, they might sell me into making a change.
I liked the radio ad.Read more →
I’m a dyed in the wool proponent of the Electronic Health Record (EHR). I’ve earned my daily bread because of it for decades. Along with that dedication to the field comes some conviction that the EHR is good. Good for treatment, good for business, just plain good for everybody involved. A friend forwarded me an on-line discussion about the EHR, and it amazes me that people still fight the future that started developing so long ago. It’s here; the EHR is a part of treatment, so get used to it.
Here are the basics of why the EHR is good:
I could continue the list, at risk of becoming quite bored…so I won’t.
I share quite a bit about legislation that affects how insurance and Medicaid is changing. In some ways, consumers are getting a square deal, gaining back some of the ground lost over decades of effective lobbying on insurance companies parts. It’s good to see that consumers will be supported in getting healthcare paid for when it should be. On the other end of that equation, the back office of your local neighborhood Community Mental Health Center (CMHC) goes through fits over changes in billing practices.
Mental Health and Addictions professionals have come to rely on electronic treatment authorizations, billing, and even audits.
Computerized authorizations and billing is old hat, and changes are minor, usually easily adjusted to, and problems have commonly been resolved somewhere else, so solutions can be borrowed from other facilities. Audits are another story. The accreditation folks, the accountants, and a bundle of state and local agencies get into the picture. Audits go a lot easier with the EHR. Run some reports, provide some records, and poof! Another audit passed…provided comprehensive information was entered into the computer in the first place.
Yup. The EHR is good.Read more →