Late in the Viet Nam conflict, I was loitering around the hootch when one of the troops burst out of the low slung building to spew vomit across the compound.
Gross.
That was my first-hand introduction to the effects of smoking heroin. It turns out that the nausea is part of the deal, it’s necessary if you want to get the most out of the high. This is a physical reality of opiate addiction.
Opiate addiction was an extensive problem for American soldiers. The disease of addiction destroyed morale, took lives, and killed my peers. It was the quest to get out of one’s own skin, to be somewhere, to be somebody we were not. Viet Nam was a good training ground for that.
Let’s say my recovering friend, we’ll call him Kenny, says that explanations of what it’s like to be an alcoholic/addict are lost on folks who haven’t been in the user’s shoes, so those with the disease just give up trying to explain. Delusions and hallucinations are part of the high…they keep it interesting for the user. To lose feelings of inadequacy, the feeling that the user doesn’t belong where he is, and get the rosy glow and elevated mood anybody who takes opiates for pain can experience are what the alcoholic/addict thinks they seek. Kenny says that users are really “filling the hole in the soul”, or “getting out of themselves”.
I read a cover story in Time magazine when I was 18 years old that explained that researchers had found the “alcoholic gene”…complete with a spectrograph featuring the twisted, gnarled gene. Appropriate, eh? I was sold, and still agree that alcoholism is genetic.
Kenny’s winning me over to the theory that if you drink enough and use enough drugs, you can warp that gene in a person born a “normie”. This leads to fun in addiction land, as defined by the book Alcoholics Anonymous: a mental craving accompanied by a physical allergy, which gets worse, never better. When an addict or alcoholic uses, a chain reaction is set off. They crave the great drug: MORE! When they don’t get their drug, the user gets sick; that’s the physical sickness most folks identify as the problem, especially concerning opiates like Oxycodone. Kenny says the general public has no idea that there’s more to addiction than the physical symptoms, and the drive to drink and use is overpowering, the user must fill that hole in his soul.
Kenny has friends who would kill to get the kind of hallucinations you may get when taking oxycodone…they love talking with people who aren’t there…people who are there are frequently a pain in the butt who just want the user to quit using drugs and alcohol. Their nightmare is who they have to face after the hallucinations go away…themselves.
Finally, Kenny says the oxycodone and other medications found in medicine cabinets across the country are like heaven in a bottle to an addict. If you don’t need them for pain, dump them. Anybody who has a problem is driven to look in that cabinet by an unstoppable compulsion. Leaving them hanging around is called enabling my friend, which would call for another story featuring a different friend, we’ll call her Marie.
Read more →Alcohol and substance abuse treatment is not a “big money” field. I remember people calling it “the underbelly of healthcare”, because it seemed to be the last stop in the government money stream, with continuously decreasing support in government. 
Insurance companies even set an entirely different set of rules for treatment with ever decreasing reimbursement.
Increased funding and equitable insurance payment has become available for treatment lately, due to lobbying efforts and key new advocates in government. It hurts to lose effective advocates. One of those advocates in a position of power has been Tom McLellan, Deputy Director of the White House Office of National Drug Control Policy (ONDCP) who plans to resign in May. He says, ”There’s no deep dark secret here — I’m just ill-suited to government work,” according to Alcoholism and Drug Abuse Weekly.
McLellan has been a leader in the science of treatment, and his organization developed a handy tool, the Addiction Severity Index (ASI). Anybody who has seriously looked for mental health or substance abuse help has taken an assessment. The ASI is an assessment on steroids, designed to assign a level of addiction to alcohol or drug use. It’s in the public domain (free), so it is in wide use, even required by some government systems. The ASI is a scientific advancement that helped establish assessments as required tools to measure outcomes of treatment.
McLellan can’t be faulted for not having an open mind. He is a researcher who knows what he’s talking about, even acquiescing in a recorded talk for NIATx that faith-based treatment was effective…an opinion based on scientifically analyzed data.
People traditionally work in this area of health care because they want to do some good. These good people lower crime (clean addicts steal less), and pull people out of the gutter to build lives. CEOs and CFOs of corporations, people serving ice cream, people from all walks of life are recovering from alcoholism and drug addiction due to McLellan’s and other scientists’ efforts.
There is a hole in government with McLellan’s wisdom exiting the ONDCP. What larger-than-life advocate will fill that hole?
Read more →Your choices for mental health and addictions treatment could be severely limited by financial pressures very soon.
People search for therapists, and it can be a job to find one who fits. Neighborhood counseling centers are a great choice; delivering personal care. The counselor really knows you and spends time on your case. Many of these small businesses are in jeopardy because of today’s financial pressures and the requirement to implement an expensive, certified Electronic Health Record (EHR).
The EHR can make it possible to collect additional Medicaid incentives that help keep your therapist in business. The EHR is a major aid to increasing efficiency and quality in healthcare, and can help your neighborhood therapist serve more people with close, personal attention. This technology keeps your case information at their fingertips (safe and secure), and reduces energy placed on expensive financial and credentialing audits, then puts that human energy back into personalized service. In short, the EHR is a survival tool.
The health system is biased against Mental Health and Addictions, even with adoption of the HITECH Act that offers funding for the EHR, and other Acts that increase health insurance availability and force insurance companies to treat and pay mental health and addiction services equal to physical health conditions.
Good news arrived recently. Representatives Patrick Kennedy and Tim Murphy introduced a bill to congress extending HITECH funding for EHRs to many neighborhood counseling centers and other mental health and addictions treatment environments. The government money has been sitting there, unused, and this bill makes it available to more of these businesses.
Over the next couple years, the American Recovery and Reinvestment Act (Obama’s big money for health care) will offer “meaningful use” incentives for health care. With passage of the Kennedy/Murphy bill, and proof these mental health and addictions treatment centers use current, certified technology in their practice’s EHR, they earn more survival money from Medicaid incentives. If they can’t, they risk unprofitability and why have a business if you can’t make a profit?
Talk with your counselor about this. They probably don’t know about the funding that passage of the Health Information Technology Extension for Behavioral Health Services Act of 2010 would create. They may want to talk to their congressperson and senator about getting it passed.
Read more →It seems our money is being spent a little smarter these days.
Remember Target Cities? A ton of money came into our field about ten years ago with the Target Cities grants. A bunch of professionals were hired and nebulous work was performed, and then the money was gone and Target Cities went away. Tom McClellan mentioned this in his January 12, 2010 talk (now a recorded webinar) to NIATx members. Target Cities went away and I forgot about it. Today’s sweeping change in behavioral health & addictions treatment seems better thought out, driven to produce better treatment outcomes and become self sustaining.
We’ll know how effective it is in about ten years.
New York State’s clinic restructuring is a good idea. It changes every ambulatory clinic in the state, it’s driven by the Office of Mental Health, and the incentive is survival. No single adjustment, or small group of business modifications will be enough to improve business processes and make them profitable. It’s truly a change or die situation in New York.
We work in an amazing time, and are driven to excell, to be better at what we do. Goals for the restructure include: • Create a mental health system that is focused on recovery for adults and resiliency for children • Redefine clinic treatment services • Restructure the financing of the mental health clinic treatment system.
In a great part, these changes will be made possible by updating workflows in clinics: • Concurrent Notes: Clinicians are giving in to writing a note while the patient is in a session in the office, and that traditional resistance will be eliminated in the interest of redirecting thousands of hours spent documenting services after the fact into increased revenue generating time. • Central scheduling: Working with APGs requires a knowledge of not only which procedures can be offered, but also what procedures will make a difference in the patient’s treatment outcome; in order to make financial ends meet, two billable procedures will need to be scheduled for each client visit • Enterprise billing and QA automation: Most clinics have at least parts of this effort implemented; in your facility is there a chain of data that reduces paperwork and auditing demands? —o Assessment feeds problems to the treatment plan —o Treatment plans designed with “point and click” libraries for problems (coming from assessments automatically), goals and objectives —o Progress Notes related to the treatment plan and a service record that is automatically created for billing so a person doesn’t have to do that later —o Integrated Scheduling for follow-up visits —o Alerts to Central Scheduling to review the upcoming service and assure an appropriate second procedure is scheduled to encourage the best outcomes for the patient
And the list goes on.
The problem, still, is that everybody in your organization is too busy to make sure this happens. In order to implement these survival measures, a professional is the ticket to success. Click on “About Terry McLeod” above for more.
Read more →Appearing outrageous is a good way to get in the public eye. Tom Corbett, Pennsylvania’s Attorney General and probable next Governor appears to be in the middle of derailing the recently signed Health Care Reform Law, and that’s an attention-getter.
He says nothing could be farther from the truth.
One section of the bill requires Americans to have health insurance or face tax penalties. In our industry, we see indigents who wouldn’t dream of filing taxes, and with no income they’re a low priority for the IRS, so it’s a mute point for them. I’m a Viet Nam Veteran, currently relying on VA benefits for health care. On the surface it looks like I’m not insured, so tax penalties may apply (I’ll confirm this soon, and may have a rant for this publication).
Tom Corbett and other Attorneys General to the rescue! He says the charge of derailing the Health Care Reform Law is bogus; the Attorneys General seek a judicial decision that will relieve Americans from essentially being forced into buying insurance. Some people feel insurance payments, always an expense until needed, would encroach upon their ability to seek a better life. Would Corbett’s successful effort be an amendment to the law? Would it negate the whole bill and force congress to start over? I’m not a lawyer, but I’m asking one to weigh in on this issue.
I’m from Oregon. It’s in my genes to support local control and discourage big government from forcing me to buy health insurance when I don’t want it or need it (most Americans don’t mind helping out a Viet Nam Veteran with VA benefits). To complicate the issue for me, I work with behavioral health and substance abuse treatment agencies, so my living depends to some extent on the EHR projects funded by ARRA; health care reform has opened doors for me to be gainfully employed and some days I want to buy into it hook, line and sinker.
On the surface I must support Tom Corbett. So why am I so mistrustful? Perhaps it’s just because I’m a Democrat, but more likely because of the holes in this post. Perhaps it’s because I see I’m not alone in my skepticism when I Google the issue. Due diligence on my part may clear things up.
I still support Wendell Potter at the Center for Media and Democracy . I wonder if this is simply another angle to keep American seniors frightened and focused on minutia while the recovery is working . Look at the stock market, friend, your IRA and 401K should be growing.
Read more →Apparently we’re not supposed to know what’s happened to Ron Hunsicker, the CEO of the National Association of Addiction Treatment Providers who was suspended almost three weeks ago.
A recent Behavioral Healthcare article shared the particulars that NAATP wanted us to hear, including vague reasons why Hunsicker was suspended. Cathy Palm, the NAATP Board Chairperson, simply said he was being investigated by the Pennsylvania Attorney General.
I attended a NAATP conference a number of years ago in San Antonio, TX, and found it to be a well-run affair. Hunsicker has reportedly revitalized the organization over the past ten years.
What happened? I have searched around and found nothing. I’ll let you know if I feel like turning into an investigative reporter today.
Read more →People wish to avoid change. Implementing an EHR is change on steroids.
I recently attended a NIATx web presentation entitled “How technology can improve your clinical practice”, which presented yet more actual case evidence that an EHR improves efficiency, raises treatment quality, and helps maintain compliance with rules and regulations
…and the results show up in the CFO’s numbers that are reported to the management team and board of directors.
The inevitable conversation ensued about using Dragon and other voice activated software so staff could avoid learning to type. Challenged people have a fuller life if they rise to the challenge, so my solution is to teach the user how to type on company time. It doesn’t take long, and it doesn’t cost much.
There are a number of shareware and freeware typing software packages on the web that teach touch-typing skills. Download one or two and test them out. It’s dull, repetitious learning, and it works. Soon enough, our hands and minds join, and the typing issue goes away.
When I implement software I regularly suggest to customers that they host on-line typing classes, required for users who don’t type and optional for folks who wanted to brush up on their skills. The class is a half-hour or so, three times a week, and pays off in much faster production of progress notes and other written documents, plus, keeps your agency in compliance. Success shows up in key indicators: fewer complaints, a quicker and less expensive software implementation, and better performance metrics once the system is up and running.
Read more →Since the estimate for an average vendor to upgrade their product be certified so their customers can collect Medicare/Medicaid incentives is $2.4 Million, and that expense needs to be met over the next few years, the cost will likely be passed on to the customers in one way, shape or form. Today’s discussion centers on projecting fiscal impact on the provider.
It’s simple to compute what will likely be passed on to your agency in some way.
• How many customers does your vendor have who intend to seek the Medicare/Medicaid incentives?
• Tack on 30% or so (I’m guessing that’s what the market will bear) for profit
• If your vendor is tremendously flush on cash after these past two years of an interesting sales environment, they may amortize this over a few years to lower the up-front investment for you and your peers as well as create a new revenue stream
• EXAMPLE: If your vendor has 30 customers to pay for the average certification cost, somewhere, you will see at least $104,000, probably amortized over a few years if the vendor can afford to do that
• TIP: if you’re not involved with the user group for your software vendor and want to keep costs down while increasing software value, sign up for the next meeting, or facilitate one for your peers
Your best tact is to work closely with your vendor in this matter. If you haven’t upgraded to the latest version, which will probably be a requirement; and that may have a price tag that inflates to accommodate certification. If the vendor just won’t talk about it, arrange a serious C-Level conversation to discuss the likelihoods so you can budget. If you have solid business reasons to consider jumping ship and seeking a new EHR, do it now, one big change is easier on the users than two.
Some providers have invested a ton of money into home-grown systems, and are considering taking certification expense on themselves, rather than switch to a commercially manufactured system. Think about that: it’s an annual expense to get re-certified. Here comes IT budget inflation. The question most providers ask themselves is “is it worth the incentives to invest in certification?” It has to be done sometime, there’s a possible risk losing Medicare/Medicaid funding altogether in a few years. Home-grown systems have worked for many organizations, and will continue to be viable for a number of those folks.
I predict a few more home-grown systems on the market soon. This is not a new phenomenon, and if the agency has deep pockets, the resulting new software company may survive. This would be unlike Betty Ford Center’s SATIS system, which was sold off to a large software vendor at the demands of the board of directors due to lack of profit and an abundance of expense.
If your prescriber(s) spend 30% of their time working with Medicare / Medicaid patients, you probably qualify for the incentives for all your providers. Will the incentives make the upgrade and certification worth while?
Information Technology is an investment, not an expense…software tools are designed to increase efficiency, improve quality, and increase compliance to commandments from folks like JCAHO, CARF and OMIG. If that’s not happening at your agency, click on “About Terry McLeod” above and contact me, because together we can make your EHR pay off.
Read more →For most providers, the certification for meaningful use will cost whatever the software vendor decides to charge. This will be a major effort for most vendors; most will feel it’s only reasonable to spread the cost of certification among the customer base who will benefit from the effort. 
The ONC stated that the Medicare/Medicaid incentives were intended to pay for the software improvements.
It’s been years since CCHIT certification was created for the benefit of providers and patients, and most software vendors serving our Health & Human Services niche market still haven’t become certified. That’s because behavioral health standards development has lagged behind physical healthcare efforts. A couple of larger companies in our sector got tired of waiting (and could afford the effort), so they became certified for ambulatory environments, but most companies were reluctant to lay out over $25,000 in hard-earned cash for certification that wasn’t even required for our sector yet. And that didn’t include the additional programming effort that few companies have staff to perform, which could push the CCHIT certification into many more hundreds of thousands of dollars.
Now, with the advent of the Medicare/Medicaid incentives becoming a reality, software vendors are playing a waiting game and saving their pennies. The certification effort will be substantial, reducing support resources for most manufacturers. It’s going to be interesting to see who bothers with this and who doesn’t, simply because they can’t see the payoff.
Here is the short story of particulars about what certification for eligible professionals will cost a software vendor (outpatient environments): •With previous certification o One time cost: $50,000 – $150,000 •Without previous certification o One time cost: $1,200,000 – $3,600,000
Based on the costs for vendors who have not previously become certified, the estimated average upgrade cost is $2,400,000 per software vendor (except for the two who are already certified in some capacity).
Next time, I’ll wrap up this discussion topic with tips on how to get the ballpark estimate you need to budget and consequently determine whether you want to continue considering taking advantage of Medicare / Medicaid incentives.
Read more →After all the definitions, foundations, policies and standards embraced by the ONC are discussed, explained and re-discussed, the meat of the matter comes down to two concerns: – What do I have to do to receive Medicare / Medicaid incentives? – What’s it cost?
Here’s the big picture of what needs to be done, and in Meaningful Use 6 I’ll explain the elements of cost, and share some ideas of what it could cost your agency.
Elements of criteria for certification of the EHR are clearly explained in the tables of the Federal Registry document I’ve been analyzing in this series. My MU_Criteria document contains the tables with details your agency should be concerned with. A bundle of the requirements that must be met to collect the incentives are met by your vendor or even your home grown system just by being HIPAA compliant and compliant with the HITECH act requirements.
Table 2 A in the linked document concerns standardizing electronic data interchange and language used across different health care environments, and yes, there’s a plan to help us all speak the same language.
Table 2 B is all about data security and maintaining confidentiality. That’s as it should be. Electronic encryption and decryption has been around a long time. Not all software vendors are conversant in this technology, so be sure to ask your vendor what it will take to get you there (usually a major modification or product upgrade will be required)…it’s not likely you’ll want to tackle this yourself.
Here are some elements you will want to review with your IT department and software vendor very soon. These requirements are coming, and somehow need to be met. If your vendor won’t certify this sort of functionality, your agency will need to take responsibility for the one-time and ongoing costs in order to collect the incentives. Let me know if you need help determining the value of doing this yourself. – CPOE: Order entry and tracking is not just for medications: Lab results, radiology/imaging, provider referrals are required. Not all electronic prescribing tools do this. – Medication Library: Pop-ups abound! Make sure the specific rule-based “pop-up” alerts are to be included in your software for interactions, etc. Some software vendors will insist you do this yourself, using tools that come with your system…and that may require an upgrade the vendor may charge for if you’re not running on their latest and greatest version – This type of programming amounts to telling the programmers how to program, so there may be some resistance, but the ONC document is firm and clear, so be firm in your dealings with your vendor – Electronic Transmission of medication orders, presumably to the pharmacy; this may require a subscription and business arrangement with a company like Sure Scripts – Electronic submission of reports to CMS or your state Medicaid agency…most vendors will not want to take this cost on for themselves – Decision Support: Make sure your agency’s top 5 rules in this regard are included in the software…there may be different procedures in following of the decision tree for your various programs, so be sure to have plans for all programs – Patient Portal: Ooooooh! A number of hospital systems and insurance companies already have this technology. It’s pretty new to our sector; The technology may or may not be included by your vendor already; if not, there may be a way to connect to Google Health or Microsoft Health Vault…Creativity may win the day on this issue
That’s not the whole story, but I hope it gives you enough to think about for the time being. Next installment: How much does this certification cost, and who pays for it?
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