Is it right to jerk somebody’s professional license to practice their profession if they are busted for selling illicit drugs? Sure, and the devil is in the details of when and how that’s done. Hitting somebody in the wallet for behavior that damages society has been a favorite of the courts (and professional self-regulating bodies) for a long time. People need to feel consequences to their actions. Addiction masks those feelings when the consequences befall others, and amplifies the consequences when they happen to they hit home.
A second story about a Florida attorney disbarred for drug trafficking came my way recently, and I’m not convinced it was the right move, simply because of the attorney, Noah Daniel Liberman’s continuous sobriety for six years. This guy probably has some marbles back and has demonstrated willingness to turn his life around. If the court’s disbarment decision had taken place five or six years ago, the punishment might be appropriate. Show the guy some consequences to his actions and give him a bottom, quick…but six years? Come on.
I know another fellow who is a nurse who was caught stealing narcotics. In short order, he was forbidden to practice his profession, losing his license. A few years later, he’s clean and sober and happy in his plumbing job, and considering not even bothering to get his nursing license back.
These two cases are similar, because they are both willing to recover. They differ in recognizing recovery. The nurse’s punishment was appropriate, and in an appropriate amount of time, the perpetrator feels contrite and has demonstrated a willingness to get clean and stay clean. The attorney has demonstrated the same thing, and in the inappropriate amount of time was disbarred.
What’s wrong with the Florida courts system? Florida is home to more rehabs that storks, and the courts don’t seem to have in inkling of an understanding about addiction and recovery. In fairness, two Florida justices, Barbara Pariente and Peggy Quince dissented, recognizing Liberman’s exemplary lifestyle over the past six years of staying clean. Still…he hasn’t worked as a lawyer all this time and was disbarred. That’s inappropriate punishment, Florida.
The good news is that enough time has passed for Liberman and my friend to apply to their respective professional accrediting and licensing bodies to be reinstated to their professional status. Disbarment, however, is quite a stain on one’s record. I wouldn’t blame Liberman if he decided to take up plumbing.
Read more →Everybody likes to see results.
How many consumers really have a handle on their progress in treatment? A couple innovations involving the Electronic Health Record (EHR) have received a lot of attention lately, because they work…and that’s backed up by data from the EHR. 
Concurrent or collaborative documentation with the consumer and effective scheduling are perhaps the two most important tools that professionals and consumers can add to their tool box to deliver a clear vision of treatment effectiveness.
If a counselor cancels an appointment with a consumer, what message does that send? As a consumer, I might get the impression that it’s OK to miss appointments, with or without notice. Either way, missing appointments leads to less concentration on treatment goals and hampered recovery. Gathering data from the electronic central-scheduling module can help analyze who’s canceling appointments, and who’s simply not showing up for appointments. Once we know where the disconnect is, we can discover the reasons and overcome them.
I recently attended a web presentation by Bill Schmeltzer of MTM consulting discussing collaborative documentation (The slides are to be posted at http://www.omh.state.ny.us/omhweb/clinic_restructuring/resources.html), and I liked the approach because it had a focus of improving treatment results. The idea is to jointly recap the session (something most people receiving mental health services are used to) at the end of session, recording what the professional and consumer did together in the session, and how that discussion focused on one of the goals in the treatment plan, as well as any plans for the patient to employ tools like active listening or breathing techniques to improve daily life. Once again, this information will be available in the EHR. When the patient returns, the notes are handy reminders of where the professional and consumer left off; this might be a good place to resume discussions.
In many treatment centers, scheduling has been a topic of heated discussions over professionals’ control of their time. 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 how important scheduling is.
One organization had a counselor with 30 “no-shows” by consumers. That seems like a lot. It certainly affects the bottom line, so agencies want to know more about this, because this consumers weren’t the only ones perpetrating the trend. As it turned out, the counselor didn’t show up for 24 of his appointments…legitimizing the idea of missing appointments. That’s a solid example of a work culture that needs to be changed.
The answer to decreasing no-shows and increasing effectiveness appears to be involving the consumer more in the nuts and bolts of treatment. Collaborative documentation keeps consumers and professionals focused on the goals of treatment, what the consumer actually wants to improve, as opposed to the mini-crisis of the moment. I like that, I learned that most of my crisis’ are bogus anyhow…a result of behaviors I have long-since changed.
One agency I heard about on Long Island hired a scheduling person with a master’s level education. This person was savvy enough to read a chart and consider treatment goals and objectives, as well as no-shows by both the counselor and consumer when scheduling appointments and determining what sorts of effort needed to go into getting the parties together to collaborate on effective treatment. Although the scheduling person was very expensive, filling the position with this type person paid off in the bottom line in reducing no-shows, and therefore paid sessions.
Yes, she used the scheduling module in the EHR to access the information needed to make these decisions, and she couldn’t be effective in the job without the treatment plan, progress notes and scheduling history information in the computer.
So, the foundation of success for both consumers and counselors, and even the treatment facility winds up being all wrapped up in the EHR. I love that.
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 →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 →It’s peculiar how control of important elements of our lives, and especially our health slip away from us.
If “value” is defined as getting back your money’s worth, health insurance value dwindled over the years to the point that consumers were discouraged from seeking help for mental health problems. The consumer’s portion of the payment for service has grown through high deductibles, excluded treatments and medications, and other methods. The Department of Health & Human Services (HHS) is calling this “insurance company abuses”.
The new rules and regulations are giving some control back to consumers by enabling them to appeal insurance company denials to pay for service. Insurance companies use both internal and external appeals processes, and according to HHS, processes will be simplified and easier for consumers to negotiate. Chasing down satisfaction and eventual payment has traditionally been a pain, and the changes sound like a very real way consumers can experience the newly enhanced value of the health system in America.
Whether decisions to deny payment for your claim come from a person inside the health plan or an independent decision maker, you have this increased control over your ability to get treatment, especially for mental health and addictions issues. I remember being denied payment for a claim years ago, and having previously negotiated the insurance company’s appeals program and lost, I gave up, paid the bill and quit seeking treatment. That caused me grief as the problem got worse.
On a human level, who wants to spend the time and energy over fifty bucks to fight the entire insurance industry over a denied claim? At what point does it become worth the fight? As the dollar amounts that must be paid for treatment increase, the value of the appeal increases. The control we are gaining has tremendous value. Treatment can take a number of sessions, repeated assessments to measure improvement, and other services. If the insurance company is denying payment for treatment, that fifty bucks can grow into thousands, or tens of thousands if treatment is avoided.
OK, so you have a right to appeal…how do you do that?
Many states have offices (different names nationwide) to help consumers appeal claims denials, and states that don’t have such offices have access to a pile of money ($30 Million) to help establish one. This is really good news, increasing value of time spent appealing claim denials by lowering the consumer’s amount of effort to get the claim paid. These offices will share information that can help consumers convince the insurance company to pay the denied claim…and according to these new rules & regulations, the insurance company has to listen to you.
This will be a relief to anybody who has a child prone to anxiety attacks, or in the throws of a suicidal episode and an emergency visit to the hospital is needed, as well as follow up treatment. Situations like this can involve multiple care givers, and the hospital may not have a mental health department, so a referral might be needed. These complications equate to dollar signs, and when you look at your paystub and see the amount that’s taken out to cover the child, you want the healthcare value in return for that payment. If it’s not there, fight it.
You have friends in high places.
Read more →I was robbed a number of years ago, and it didn’t feel good.
It was like that old game show where contestants got a free shopping spree, leaving my possessions of less worth strewn about the house, and the ones worth anything were gone within the five minute shopping spree. I felt violated…and poorer. The new healthcare world could lead to lower crime, and I’m all for that. I’d rather you didn’t have to experience that sort of violation.
Most cops who pay attention to this sort of agree that methadone clinics in the neighborhood lower crime. If people with mental illness issues are treated, there is less panhandling, self-medicating with drugs and alcohol (which leads to crime), and homelessness. If a cocaine addict in addiction treatment pays the rent instead of heading to the dealer on payday, crime has instantly dropped.
Recent healthcare legislation has made treatment is more easily available to those who need it. In a recent Forbes article, Rachel E. Barkow and David B. Edwards say that of the 20 million American substance abusers, a little over 10% are getting treatment. By improving access to treatment, assuring treatment providers are paid on par with physical health counterparts, and policing treatment quality, the country is on track to improve that ratio.
A number of years ago, I read somewhere that 85% of prisoners in the California prison system were residents either because their crime was alcohol/drug related or they were high while doing the crime. Other than offering proof that sober criminals are better criminals, this anecdotal information asserts that crime and alcohol/drug abuse are related. Making it easier to get treatment can lower crime. Currently, over 25% of the 6.5 million people on prole, probation or supervised release are using illicit drugs according to Forbes. That in itself is a crime, and sets up the neighborhood for burglaries and such.
This makes me a bit nervous. I also think that number may be a bit low, but that’s another story.
We’ve known alcohol/drug abuse and crime are related for centuries, and we’ve started doing something about it. It’s not just a few cops on the street who notice the drop in crime when treatment is available. It’s people like you and me. Reports nationwide show drops in crime with increased access to treatment. The National Treatment Improvement Evaluation Study (a big one) showed a 64% drop in arrests and a 78% drop in drug sales. Holy cow! That’s cleaning up the neighborhood!
Since the proof is so overwhelming, you’d think opposition to supporting treatment in the neighborhood would disappear. Not so. I recently wrote about the insurance empire fighting Mental Health Parity, wherein these treatment centers (which are helping to lower crime) would be paid on-par with physical health providers. It seems that no matter how good an outocme may be, there will be those whose income is affected negatively, and they will fight for the money.
The fact is, I haven’t been robbed lately. There are a number of addictions and mental health treatment centers in the neighborhood. They are in jeopardy, however they’re solving their problems, in part due to improvements to the healthcare system. A drop in crime is a good thing.
Read more →It’s tougher today for a lawyer to get clean and sober in Louisiana.
That statement comes from a very common story in our world today, this time played out in the halls of justice.
It seems this lawyer and crack cocaine user, John Clegg, lost his job over his problem with that substance: He tested positive for the drug twice after completing rehab. That’s not unusual, nothing special. People lose their jobs if they have drug problems and fail to get recovery quickly enough. What can I say, John? It takes what it takes, I hope this is your bottom and you get clean and sober.
The problem in this story was one of confidentiality. A friend of mine who works for The National Law Journal pointed out the story to me, and upon reading it, I became distressed that the Legal Assistance Program has been compromised. The court cut the legs from underneath this helping organization by saying it’s OK for a firm to report a lawyer to disciplinary authorities even if the substance abuser is trying to get help. John was enrolled in the Lawyer’s Assistance Program, had gone to rehab, and was doing the best he could and sometimes people in recovery relapse, in his case, two relapses were reported.
A person with the disease of addiction sometimes has no choice but to chase his drug. The cravings can get that bad. It’s said that alcoholism is an allergy to alcohol, accompanied by an irresistible compulsion to drink. A lot of folks in recovery and in addictions treatment feel it’s the same for drug users. They say a drug is a drug, is a drug, asserting alcohol and crack cocaine are different vehicles to get to the same place: out of the addict’s own skin.
In the old days, if you weren’t destitute, with no job, no friends and without a big pile of debt, you hadn’t hit bottom and needed to go out and use some more till you really wanted to get clean…or hit one of the other three options, jails, institutions or death. It’s not that way any more. The idea that seems to be working for some is to raise the bottom so people get clean without all that drama and tragedy and pain to self and others. That’s all well and good. In many places, the police and courts realize addiction is a disease. Treatment takes what it takes, and they’re fairly tolerant until stupidity like drunk driving or violence or endangering others enters the picture.
The court in Louisiana doesn’t seem to believe in tolerance in this case. Apparently, there’s a law that guarantees confidentiality to enrollees in the Lawyer’s Assistance Program, but it means nothing. When the firm John worked for took enough of a bath in paranoia, they decided to turn his case in to the disciplinary authorities, who ultimately suspended our friend John. The court said that was OK.
I really don’t mind that John relapsed and lost his job. It’s too bad. He’ll get another or start his own firm. What burns me up was the action that led to that. He could have been fired without being reported to disciplinary authorities and subsequently having reporters and people like me plastering his plight all over the web.
That can be bad for a career and a life.
Good luck, John.
Read more →While doctor and politician Howard Dean believes it’s better to have passed the recent healthcare bill than not, he says it’s not healthcare reform…It is coverage expansion.
It’s a simple concept, really. Everybody needs to put food on the table…and preferably have a table to put it on and a place to put the table. That assumes jobs and paychecks come into the mix. By guaranteeing medical coverage, payment for healthcare becomes guaranteed, healthcare providers earn a living, and people’s health problems get attention.
With healthcare payment guarantees, mental health issues become the next topic of discussion. There is resistance to comply with recent legislation assuring health and addiction treatment services getting paid on par with physical health issues. I recently discussed the battle the insurance industry is waging to escape restructuring their business to comply with Mental Health Parity. Additionally, millions of senior citizens need treatment services not likely to be paid for by Medicare, according to Dr Dean’s interview in The National Council’s Healthcare Reform Magazine It seems that Medicare has been exempted from the reforms of the healthcare bill. It appears that insurance companies and Medicare are in the same ethical boat when it comes to mental health and addictions treatment. Everybody says they want people to be well and have better lives and nobody wants to pay for it.
The place I see ethical responsibility in action is with treatment providers.
I was talking with a friend who runs a small addiction treatment facility recently, and I was stricken with his sincerity. He wants to help addicts stay off drugs and have a good life. In my experience, that’s true throughout the business. Whether you talk with helping professionals in your local community mental health center, addiction treatment facilities or social services organizations, they want to help others.
My peers write on a personal level about coping with issues, relieving symptoms of disorders and generally improving our mental health. I believe they, and most professionals in this business are sincere. They want alleviate suffering. The ability to help is slowly being improved.
The payment system for these professionals has appeared to be one to avoid paying for their services. Authorizations to provide services are dictated in many cases by insurance companies. For years I’ve heard many mental health and addictions providers say it’s murder trying to get insurance to pay for services that need to be delivered now. They took the attitude that when a person needs help, help them…not after treatment is approved by a bureaucrat for payment. These folks wound up providing free services in many cases…which doesn’t put food on the table. This leads to the most important point Dean made in the interview cited above.
Treatment decisions need to be in the hands of treatment professionals, not insurance bureaucrats, so this rebuilding of the system is necessary. It takes involvement and working within the system to rebuild the system. That’s happening now. The legislation I cite is the first step, a decision to assure payment for help that improves people’s lives with quality mental health and addictions treatment. My hope is that the professionals gain more control in healthcare decisions and are treated with the respect due a trained, experienced professional. As that happens, smart, caring, people with a sense of moral responsibility to help others will enter the helping professions, joining many others who are active in changing the system to enable treatment professionals to control treatment.
Active integration of moral responsibility into the business side of this business, my friends, will be true healthcare reform.
Read more →