It’s no secret that Information Technology (IT) is changing the way professionals work in mental health and addictions treatment…and what’s that mean to you?
For treatment professionals, information is king, the key to delivering solid help to people who need it. That information is available in existing banks of information, contributing to an effective decision support system. The systems help assure the information is used properly to diagnose and treat problems, and without the information, both from professional resources and the consumer’s personal health disclosures, systems can still lead down the road to a bad statistics and ineffective treatment.
As workflows change in provider agencies like your local CMHC or addiction treatment facility, you’ll see a lot more of your records on screen…the record is not a secret, consumers have a right to know what’s in their record. By now, consumers should be walking through assessments for a quick evaluation of problems and measuring improvement during a visit. Counselors are involving consumers in building a treatment plan on the computer screen. Progress Notes are being included as a part of a session to make sure the next steps for the consumer and professional are mutually understood.
It’s all good. It wasn’t that long ago that most consumers wouldn’t have thought to ask for access to any of this paperwork. The fact is, in that paperwork are the keys to a better life.
Throughout all this paperwork, decision support is becoming interwoven, and valuable treatment information is being presented when it’s needed most.
The Internet and a number of paid research sources available on the computer can help the professional provide a diagnosis and treatment to a problem that may otherwise be mis-diagnosed and mistreated…as many as 70 percent of mental health problems are in this category. Dennis Morrison’s article in The National Council’s magazine on Healthcare Reform brings up an interesting case of mistaken diagnosis and treatment with potentially catastrophic outcomes. His case has a happy ending, because the right information was available on the computer. This example of effective decision support shows how IT can lead to lowering the ratio of mis-diagnosed and mistreated mental health problems.
Occasionally, I still hear mental health and addictions professionals complain that they are not “computer people”. Who is? We’re all on this planet with each other.
The computer is just a machine to record and spew out data…a decision support system will hopefully assure the data that presents itself leads to happier lives for real people who are being treated, not a happier computer. Decision support systems deliver information at the right time during treatment to offer alternatives that make sense, and some that don’t. If a professional is not presented alternatives to the same old way of treating consumers, nothing changes. If nothing about treatment changes consumers don’t improve, and that abysmal figure mentioned earlier, up to 70% mistreated mental health problems, doesn’t improve.
The American Recovery & Reinvestment Act has spawned a number of ways for provider organizations to improve their IT systems. Most computer systems out there these days have some decision support alternatives available. For the ones that don’t, perhaps market pressure to provide that sort of functionality needs to be applied. The money’s available in a number of healthcare grant programs, and political pressure is coming to bear to provide more help for mental health and addictions specifically.
Some providers, like Dennis Morrison are getting the picture and moving full speed ahead. Decision support will help improve care, and Information Technology drives these improvements.
Read more →A host of business problems contribute to you being able to walk into your friendly neighborhood Community Mental Health Center (CMHC) and talk with a counselor quickly.
You may ask, “How can that be a problem?”
If it happens as a course of daily business, this condition can spell financial trouble for the CMHC. David Lloyd is a consultant in the field, and in a recent article for the National Council he points out that what amounts to poor service to you can equate to big money problems for the CMHC. A key situation lies with “medication-only” patients who need medication reviews.
It turns out over one-fifth of the appointments at a sample of hundreds of CMHCs are either cancelled or “No Show”. That’s pretty high. A restaurant losing 20% of its reservations would soon close the doors.
The cancellation is something that can be dealt with handily with sufficient notice. Simply schedule another appointment to fill the staff’s time with a money-generating task. The no show is another matter. Somebody has been scheduled to do some work, and that work won’t get done and is not likely to get done. That can affect somebody’s paycheck, and the baby needs shoes.
It’s like any profession that survives through billable hours…like lawyers. That professional time is being paid for, and in order to keep the doors open, the staff member’s direct work with consumers needs to generate cash. Whether the consumer is on a sliding fee scale and paying the bill, or an insurance company, Medicare, or Medicaid are being billed, work needs to get done in order for the CMHC to get paid.
Cancellations and no shows slashing income can really cramp an organization’s style.
Agencies are taking a number of actions that can affect the consumer. People who are stable, happy and healthy with medications controlling their disorder are less likely to show up for a counseling session, simply because they feel fine.
Looking forward, these medication-only patients are likely to be connected with a nurse instead of a counselor, in order to free that counselor up for scheduling to see somebody who needs therapy. That may be bad news for “walk-in” business, requiring a longer wait to see a counselor, and that’s another problem being dealt with to be included in a future discussion.
This is a common sense solution, addressing a medication issue with a medication professional and making sure therapists help folks who are not feeling fine. In the process, nurses get to do their job and the CMHC benefits in two ways: The therapist’s time is paid because they’re doing the job they want to do, and the nurse is taking care of a consumer that’s been rightly directed to them, which is another billable service.
I love a win-win scenario.
Read more →Is it possible our local neighborhood insurance professional wants to discriminate against our neighborhood mental health professional?
In high school (about a hundred years ago, it seems), I recognized that the insurance industry had possibly the strongest, best organized lobbying effort in the country. In that industry’s defense, a regulated industry needs friends in high places, or a lot of employees and executives would not be able to pay the bills, send the kids to college and generally live the American dream.
On the other hand, the push-pull of our system encourages the search for loopholes whenever a law is passed that is intended to better the lives of folks needing help. A few laws have come to the books lately, and one under attack by the insurance industry is the Wellstone/Domenici Act of October, 2008, “Mental Health Parity”.
Mental Health Parity is meant to assure that people working in mental health and addictions treatment get paid on a like-basis as physical health services. Traditionally, mental health practitioners have had a tough time getting services authorized and paid by insurance companies, and some avoid dealing with insurance altogether. This hurts the practitioner who needs to make a living, and the consumer who needs help with mental health issues. Higher insurance co-pays and deductibles for mental health services and limits on services were common prior to mental health parity. This law just came into full effect recently.
With billions of dollars at stake, the fight is on. The National Council says lobbyists working on behalf of the insurance industry are undermining Mental Health Parity.
The essence of the issue is discrimination, not just against mental health professionals, but against consumers who need help with mental health and addictions issues. A licensed mental health practitioner, a psychologist or psychiatrist puts a significant chunk of change into their education in order to engage in a profession of helping people. If I want to help people and have a choice to spend what could be eight years or more of my life pursuing the education to do that, I might swing toward physical health if the paycheck were to be significantly bigger. The dollar bill could rule my decision, even if I am better suited and my passion is directed toward mental health and addictions treatment. Under circumstances like this, consumers lose.
Lines are being drawn over this issue on Capitol Hill and people are choosing sides: the insurance empire, or the people who help folks with mental health or addictions disorders. We don’t have to choose a side or do anything…but we could. I recently cited a New York Times article on this subject, in which the insurance industry’s side of the story was made clear. The following day, an interesting letter to the editor was published. The National Council’s Chief Executive, Linda Rosenberg weighed in with a very important fact: suicides and incarcerations were the out come of some denials for access to mental health and addictions treatment.
Read more →$5 Billion just came available to help early retirees with healthcare insurance. If your employer is making money-saving moves by encouraging early retirement, make sure continuance of healthcare insurance is part of the package…not doing so can really cramp your style in retiring young. Health care insurance can be expensive.
If your employer or union wants you to retire before you’re eligible for Medicare benefits, they can receive considerable sums to offset insurance expenses, possibly lowering insurance claims risk enough to keep you on the insurance plan. The benefit is offsetting some expensive claims, which lowers overall risk, and could make it possible for you to see a mental health professional when you need to. This is all courtesy of an Affordable Care Act program that came available in June, 2010.
It’s not good to practice medicine on ourselves with or without a license, and for some retirees, that’s happening, simply because the retirement plan didn’t include the ever-increasing expense of health insurance for a young retiree, and mental health professionals need to buy shoes and feed the baby, so they need to be paid.
Last year, Clemens Tesch-Romer, director of the German Centre of Gerontology shared on the subject to AARP International stating that although increased mental health difficulties seemed not to be an issue for folks retiring at age 65, early retirees and those forced into retirement were having increased problems. This increased risk of mental health problems for early retirees increases the need for insurance that covers mental health treatment. Without insurance, it’s tempting to simply live with the problem, spiraling downward into that problem and self prescribing.
Self-prescribing a drink or twenty to relieve the boredom, or an extra few pills to quiet the chatterbox of mental negativity in the mind may not be so uncommon when a person who retires faces empty days. That can lead to increased dosage and problems. Loneliness can set in after leaving a workplace full of familiar people, and the mind can become an unattractive place in which to dwell. If workers spend decades avoiding mental health issues by staying busy with work, those issues will need to be dealt with in order to enjoy retirement. It’s better to be insured upon retiring rather than waiting the better part of a decade until Medicare benefits become available.
Employers are struggling to survive, and it’s ironic that early retirement entered the picture so prominently over the past few years. If a person who’s been working for a company since age 23 retires at age 55, it saves a lot of money to replace that person with another 23 year old. It is, however a balancing act, and the expense of individually purchased insurance can deter folks from retiring early. This program could make a difference. People who worked hard all their lives could use a break, and being able to enjoy retirement while young enough to enjoy physical activities is a key to the success of the early retirement plan.
Read more →I participate in my own recovery.
Whenever a physical or mental health issue comes up, I engage the healthcare professional with questions without taking charge; I surrender that management job to healthcare professionals. I do the things I’m supposed to do, from taking a pill to reduce swelling to cutting down on caffeine which correspondingly decreases anxiety. In the business of mental health and addictions, this is becoming more common, and a number of organizations have adopted Recovery Oriented Systems of Care (ROSC). ROSC is not without its drawbacks and dangers to patients.
SAMHSA offered grants to treatment organizations to implement ROSC this fiscal year. A bit of industry press over the past few years has pushed this idea into the popular zone.
I’m a fan of peer recovery. Alcoholics Anonymous has been effective with millions of folks with problems since the 1930s. The New York State Office of Alcohol and Substance Abuse (OASAS) is currently re-vamping the treatment and Medicaid payment structure for methadone clinics, and peer support is one of the items that is rumored to be available to patients in those clinics and may be paid for by Medicaid in 2011.
I scanned through a couple white papers by important people today (you can find a bundle of them on the Internet, just Google Recovery Oriented Systems of Care). One grid I saw compared traditional treatment methods with ROSC. The element I see that could easily get out of hand is the level of peer-control, which is the idea of patients telling patients how to recover from mental illness and addictions.
When patients see success in their life by participating in ROSC, evangelism could easily be the next step. Evangelism turns off more people than it turns on. Evangelists may not have enough time and experience in order to pass along truly effective and appropriate solutions to other people’s problems. Avoiding that syndrome is supremely important in order to do more good than harm.
Professionals need to know their patients. Whether a man has a prostate problem, depression or is addicted to oxycontin, professionals need to be involved.
It will be interesting to see what the news brings from ROSC regarding professionals losing touch with their patients when patients are taking increased control over other patients’ recovery.
Read more →I’m not a guy who loves to fill out forms. Especially medical information, because chances are I’ve already shared the information with multiple healthcare practitioners who refer me to the next one in line…I remember filling out redundant form after redundant form.
No more.
It warms my heart to see my healthcare provider crank open his Electronic Medical Record (EMR) and have all the pertinent information for the visit on the screen. I receive my healthcare from a hospital-based system that shares an EMR amongst all its providers, and as a result, the aggravation of having to write down the same information over and over again and transport documents like test results has all but disappeared. This result means the EMR has been transformed into a true Electronic Health Record (EHR), a secure electronic sharing of data across my healthcare providers.
I know of a few ways this technology is being spread among multiple lines of care:
Physical health providers are screening more these days for addictions, suicide, and other problems they traditionally avoided because such treatments were out of their service line. Suicide screening is not a requirement for all situations, but for some, like addictions detox, it is. Lives are saved when a patient is instantly referred to the right practitioner with an electronic message. Healthcare providers are more likely to refer patients to mental health departments and clinics in their system, and for somebody in trauma, filling out forms is at the very least undesirable. One of the three situations mentioned above sets the stage for eliminating a lot of filling out forms.
Millions of people are served by nonprofit social services agencies for mental health/addictions problems, however, locations may not be convenient and some services may not be offered that you need. Mergers & acquisitions are increasing capabilities of organizations , and as a side benefit improving Information Technology (IT)…and the direction of IT is to help us fill out fewer forms because the data is already in the EHR.
The RHIO can be great help in getting health information from the physical healthcare provider to the mental health professionals when the businesses are not related. In some places, like Rochester, NY, state grants have supported Regional Health Information Organizations (RHIOs) to enable this.
All this adds up to a new, vastly improved healthcare environment. A marriage between primary physical healthcare and mental health treatment is slowly being consummated on a grand scale, and the benefits are much more that simply helping me avoid filling out forms.
Read more →Change can hurt. If the local Community Mental Health Clinic is changing the Electronic Health Record (EHR), policies or personnel roles, anybody can be affected.
Clients can feel business changes when they come in for appointments. Things may seem less organized, or staff may not be quite as cheerful as they normally are. Perhaps mistakes are made that wouldn’t normally show up, so appointments can be delayed.
Professionals feel business changes, too. Change can increase stress in the workplace. People get set in their routines pretty quickly, and some have a tough time modifying the flow of their day. Sometimes the plan for the change is faulty and needs to be tuned up.
Executives feel business changes. If change is poorly executed, a frustrated client may walk out the door without being helped. That not only affects the bottom line, it’s bad marketing and somebody who needs help isn’t getting it. Issues of complying with rules and regulations and increasing financial difficulties appear to be at record highs right now.
In order to pull out of a financial tailspin, many agencies are changing, or will soon. They’re implementing policy changes, modifying computer systems and managing workflows. They’re doing all these things to increase efficiency, reduce risk, improve treatment outcomes and other key business reasons. Changes meant to improve the entire treatment experience, can be felt in the waiting room. Somebody might end up distraught, usually staff, if change is not implemented well. That can cascade into an unpleasant moment for somebody who is there to get some help.
Change needs to be managed like therapy. Providers need to consider involving a treatment team of executives, staff and clients, with a policy of transparency. Let the right hand know what the left hand is doing. To be effective in this, a qualified person needs to be responsible for the change and be granted the power to make certain decisions about how change is brought about…this could involve things as simple as posting signs in the waiting room.
Use rapid change methods…Git ‘er done! If mistakes are made, big deal, everybody makes mistakes. Rapid cycle change methods have been in play for other industries for many years…so why not for mental health and addictions treatment? There are a lot of resources available, like NIATx with dandy plans for implementing business changes that minimize the negative effects of change. Most consultants like me spend their working hours embroiled in ways to help agencies change and deliver the least disruption to executives, staff, and clients.
The important consideration is the outcome of change, determined by the process used to make that change. For clients, change should mean improved treatment. For professionals, perhaps work becomes a more inviting place to be. Everybody appreciates it when change is smooth and the CEO gets a decent night’s sleep.
So, the pain of change is temporary. In changing, we strive for an admirable goal: an effective, rewarding and continuously improving treatment experience for everybody.
Read more →The last thing Americans need is another hit in the wallet, and the thought of upcoming increases in health insurance rates has been rolling around in the back of my mind for a while…it has to happen.
A lot of legislative movement has been made over the past few years in the interest of increasing mental healthcare quality and availability, and one thing limiting quality people from entering the field as treatment professionals has been the pay scale for counselors. People either avoid or get out of the mental healthcare industry and into supporting services like I did partly because the paycheck opportunities have been better.
Twenty years or so ago I considered a career change and getting out of IT, sales and business management altogether. I made the decision not to go back to school to earn a Master of Social Work degree and become a therapist concentrating on addiction recovery as I had considered during an employment crossroads at the time. The paycheck up-ramp was too slow. Mental Health Parity legislation is supposed to rectify this problem, increasing the availability of higher quality people in the field who receive higher paychecks for what they do. Theoretically, good mental healthcare providers will keep helping people if they can get paid on par with physical healthcare practitioners.
This also sets the stage for raising insurance rates…when mental healthcare costs more to provide, insurance rates increase.
Kathleen Sebelius, U.S. Health and Human Services Secretary praised New York Governor Patterson for taking control of insurance rate hikes by establishing a law enabling the state to pound a rubber stamp on premium increases. When an insurance company is not regulated, large profits have been included in rate increases simply because it makes good business sense to make more profit, and nobody said they couldn’t. The law delivers a modicum of control over greed.
The outcomes of this could be good, or not. Civil servants will be charged with the reviews, and if they’re anything like the people at the Office of the Medicaid Inspector General (OMIG), they will not be people to rub the wrong way (OMIG is charged with uprooting Medicaid fraud and recouping overpayments from healthcare providers when mistakes are made in billing). Will government-salaried Insurance rate inspectors be hyper-vigilant, or ambivalent? Will they be pit-bulls after the evil insurance empire, or will they be as susceptible to greed and corruption as the insurance industry has been?
Time will tell. The insurance industry’s lobbying machine has created a marvelously profitable world for a lot of people, and greed can make people do stupid things.
Being a Pollyanna sort, I have hopes toward the positive side that the intent will play out in reality, and the result will be improved level mental health and reduced addiction in America without undue chunks of my paycheck going to the insurance industry.
Read more →Face it, mental health providers are doomed to succeed, which is good, because consumers need mental health professionals to care for them.
“But wait!” you may say: “I saw it in the paper that mental health problems have increased due to job losses, so counselors’ caseloads are expanding, we are doomed to fail!” The picture painted here might lead consumers to believe their counselor could be out of a job tomorrow.
That’s entirely possible, but it’s a contradiction of business forces involved The scenario above is an example of a demand for services being created by disturbing events like recession and job loss (strange, but true). Mental health business is increasing as a result. Maybe a more positive message is in order.
Community Mental Health Centers (CMHCs) are facing a need to hire some of those folks who received grants to go to school seeking mental health credentialing. This increases treatment quality, delivering more effective help to consumers. In the name of satisfying increasing demand in the business, people are getting hired, and America is becoming more mentally fit.
As a bonus, America’s workers are also becoming equipped mentally to perform better at their jobs, increasing the ability for us to compete in the world market. The feds expect the economy to grow this year. Hundreds of thousands of jobs were filled in April. According to the Washington Post, the outlook for the economy is good.
Let’s consider this as proof that the American Recovery and Reinvestment Act (ARRA), Mental Health Parity and other legislation is having a positive effect on the economy.
High unemployment led to government funding for people to find new jobs, which in itself created government jobs to provide that help. Medicaid availability increased with eligibility edging up to 130% of the poverty level, so more people can seek mental health services. Parity for mental health is a relatively new law that assures mental health providers will be paid for services on-par with physical healthcare providers. These and a host of other factoids conspired to walk me through a simple, general scenario relating to how ARRA is actually working.
It’s the “trickle up” effect. By injecting the money into the Medicaid system, folks falling below that 130% of poverty line can get the help they need to at least be mentally and physically prepared to work when a job opens for them this year, as projected by the feds. That injects money into the healthcare system now, so folks with jobs or getting jobs in healthcare can keep them.
With workers that are mentally fit, production and quality increase and America competes more effectively on the world market.
Like I said, we’re doomed to succeed.
Read more →“How are you?” I asked, looking up from the desk. “I’m sick, to tell you the truth.” She was a trim, attractive young woman of around 20, dressed in the style, with a beautiful smile in spite of feeling sick from opiate withdrawal..
I was in a methadone clinic for the first time in a couple years, and realized that a client had been hollering with violent intent in the lobby. That’s against the rules, but not unheard of in a methadone clinic. My young friend nervously and fearfully slid across a rack of documents toward the corner. She said she had issues, I would guess raised in a violent or somehow abusive household, which is a safe bet with people who become hopelessly addicted to drugs at such a young age.
That sort of background for the young opiate addict is common among women. There’s no quicker, more effective way to feel really good than by using an opiate, so it’s a great escape from an abusive life…or any other life if you like.
Addicts who came to methadone clinics for help in the early 1990’s and before were self-avowed heroin-injecting addicts. These days it’s oxycontin, pills, smoking heroin…that sort of thing. Don’t get me wrong, there are plenty of used, abused and discarded spikes lying around, but fewer people need to stick a needle in their arm to get tremendously high when the heroin is good enough to smoke, like it was in Viet Nam.
The clinic director, a friend of mine, advised that when people came to his clinic years ago, more of them truly wanted to get well, and they had a tendency to come, get serious about treatment, and if methadone treatment was going to work for them, it did. They stayed in treatment, followed the rules, led better and sometimes productive lives free of street drugs. These days it’s different. People come, they get over being sick (withdrawal), and then are back on the street copping dope or in doctor’s offices scamming prescriptions. These days, something’s different. Perhaps bottoms aren’t low enough, perhaps there’s too much enabling available in our society. More addicts these days are willing to go to any lengths to get and stay high, including methadone clinics to avoid withdrawals till something can be stolen and sold for another fix of the good stuff.
Being in active addiction on the street is a lot of work. Typically the road into chronic addiction, being mostly high, is more fun than the road coming out of addiction. The road out of addiction is plagued with cravings, romancing the elements of old life style that brought pleasure and typically, relapse. A person living in the middle of their recovery is working hard every day just to stay clean and sober. It ain’t easy.
What’s this mean to you? It’s simple. When an addict is active and on the street, the typical way to make a living is stealing your stuff. Since this person needs a fix every day, he needs to steal every day. After a while this affects the community. If there’s a methadone clinic in the neighborhood, they probably help a few of their clients stay off street drugs, in spite of the trend outlined in this discussion. These clients have a shot at getting jobs, they have therapy to help them keep the job and go through life, and they are in a form of recovery.
Do something nice for your local methadone clinic. At the very least, the clinic’s presence increases the likelihood of your car being in the driveway tomorrow morning.
Read more →