A number of non-profit agencies in New York State (and probably across the nation) will disappear over the next couple years. It’s imperative to change perspective in these agencies to a for-profit viewpoint.
Surviving the Office of Mental Health clinic restructure and the OASAS switch of charging methods to APGs with fee-for service elements in New York will include a very tough lesson for some provider agencies. Agencies are discussing mergers and acquisitions to consolidate resources (which loses jobs) in order to increase efficiencies. Financial models are being created and most discarded because they just won’t bring in enough revenue and they expend too much human energy to deliver the services to earn the revenue.
People are feverishly working overtime to come up with plans to save jobs.
Although projecting income requirements is a big part of the survival work, I don’t hear much about the nuts and bolts of the matter: Service Pairing.
Since threshold visits are disappearing (one charge per day with most services performed for the client included in that charge), the new financial model for these agencies needs to include two separately charged services for a visit. A number of elements come into play in determining which services are scheduled, and when.
It’s no secret that agencies work differently; they all have a different personality. The business processes of each agency need to be evaluated and modified; exactly when the second service is scheduled and what it will be for a client visit will vary.
The questions bring up concerns and change from agency to agency.
Is your agency ready to include service scheduling at the time the treatment plan is written? Is your front desk person of the personality type to effectively juggle a few more balls, a few more considerations in scheduling visits? What workflow procedures need to be considered in the workflow models? Is the team ready to evolve on this business level with the client treatment needs?
Analyzing and redesigning business processes needs to be part of the restructure of your financial model. You may need to hire a masters level person at the central scheduling desk (expensive, effective in some situations). You may need to upgrade your enterprise software to the tune of thousands of dollars…oh, you don’t have enterprise software?
If your agency is properly staffed to survive, there just aren’t enough human resources to analyze, design and implement new processes and you need help: info@ehrsio.com.
Read more →You’re in a crisis. You need some mental-help, fast, and it’s not on the way. It can be wherever you are in the form of mHealth.
Lets say your therapist’s office or Community Mental Health Center is where you live in Brooklyn, Queens or the Rockaways and you work in Manhattan or The Bronx. It can take you an hour or more to get to treatment from work when you include waiting for the two trains and the bus that get you there, effectively knocking you out of up to a half-day’s work for a daytime appointment.
Good therapists are busy folks, and you want the best help you can get from them. Your employer wants you on the job. Going to a session during normal business hours is preferable to late or weekend meetings, when the therapist’s mind can be on family, his own crisis of the moment, or ice cream.
Employers hire folks to do jobs for them, not go to therapy, so they can be less than supportive. How do you do minimize time off work to see the therapist for a truly effective session? mHealth is an answer, using technology to minimize travel time and get the treatment you need to do your best at that job and life in general.
Mobile clinical health will reach $4.6 Billion annually by 2014 according to The Medical News . A good portion of that may be mental health services offered over the phone and internet…I hope you’re getting some of that by reading this over the internet right now, free.
Currently the physical health market is way ahead of mental health and addictions, as is usually the case with technology. Health monitoring with remote devices for diabetes, cardiac conditions and other chronic illness has been around long enough to make mHealth a $1.5 Billion industry today. Sessions over the phone and via webcam on the internet are being funded by the government in rural areas like upstate New York. This is a new way of doing business for us.
Clients like mHealth because they can get in a session without losing work…employers like it for that reason, too. Therapists like mHealth because they don’t really need to go to the office…they can connect with the client anywhere. Insurance companies like mHealth because they can pay less for a session (trust me, they’ll figure out how).
Mental Health folks like assessments. These tools can measure improvement over a period of time. For example, if you answer ten or twelve questions rated on a scale of 1-5 for each question, you have statistics to measure whether all those co-pays, direct payments, and insurance payments are doing any good. If treatment’s not doing any good for you, it’s only reasonable to fix the problem, the focus of discussions, and the tools employed by the client to get better.
Doing that assessment over the phone, or logging into you personal-health website with the therapist takes a few minutes and pays off in recovery.
Read more →My chest was getting tight. I had a weird feeling. It felt like I couldn’t breathe.
Then I woke up.
Why I had this anxiety event (no, not a heart attack) was irrelevant. I’m sure it was some manifestation of fear, and I’ll get around to that pervasive subject soon enough. The primary thing a person with an episode like this wants to do is get past those quite uncomfortable feelings….FAST!
Millions of people acquire tools to deal with symptoms like this, and once they tire of the misery, begin to use the tools.
And, here’s what I’ve learned:
I know, it sounds absurd for a breath to make it to a spot below the navel…the lungs aren’t that big.
Yes, yes, we breathe out through our nose or mouth, not the heart.
There are a ton of objections for which I have no answer. All I can say is that this works. Breathing out, look out, focus on everything in the vicinity, as far as you can see, hear, feel or smell. It’s a general sort of awareness with no focus.
Many sufferers of anxiety or depression relieve symptoms with medication, and people with these problems who I talk with confirm that medications work fine, once you settle on the right one. For some this is temporary, for others it’s a lifelong affair to rectify brain chemistry that’s out of whack.
One route to take is to focus on doing something…anything. That works for a while, and anxiety returns later. For many people it gets worse.
Breathing is an effective catch-all tool to get past uncomfortable feelings. Breathing is more than air moving in-and-out, it’s a technique that some say simply refocuses the mind, others say it’s a spiritual exercise. Breathing is also the first step in most meditative techniques and yoga.
Seeking the help of a pro is always the best route if you don’t know what’s going on with feelings that are somehow…damaged. I wasn’t kidding about trouble breathing being a sign of a heart attack. Consulting a mental health professional is always the best bet for a long-term solution.
Read more →It costs more out of your pocket to get well from problems of the mind or addiction, right? Insurance companies avoid paying for or charge higher co-pays or cut short programs for treatment, right? That’s the way it used to be, and could be again.
From stage left entered our hero, “Mental Health Parity”. Put simply, this law forces insurance companies to deliver coverage for mental health services on par with physical health coverage. It’s old news because this is a 2008 law, an attempt from our legislative system to take positive action that helps people.
On May 9, 2010 a New York Times headline declared “Fight Erupts Over Rules Issued for ‘Mental Health Parity’ Insurance Law”. Insurance companies are picking holes in the law in order to avoid paying for adequate treatment for problems of the mind. I suppose we can’t blame the insurance companies for trying to keep our premiums in their pockets, but it seems reasonable that they should pay for treatment that works, and what they don’t pay, we pay.
The tragic outcome for some people is that without parity, they won’t get treatment because they can’t afford the co-pays or to go “out of network” to see a specialist who can help them. Not getting treatment can lead to physical problems in addition to their condition of the mind getting worse, or at least not getting better.
These days, most of the people who are recovering from addiction and alcoholism “went to rebab.” Every day, people are overcoming depression, anxiety and mayhem in their lives through therapy and medication. Studies are showing they are less likely candidates for heart disease, obesity, chronic pain and other physical conditions because they’re taking care of their mind. Body, mind spirit, it’s all connected.
In the long haul doesn’t it make sense to treat my anxiety now to avoid paying for my next heart attack?
In this matter, I have two heroes. Representative Patrick Kennedy from Rhode Island and Wendell Potter from Washington DC (I forgive him for that). Kennedy supports Mental Health Parity and making the recent healthcare laws as beneficial for mental health and addiction treatment professionals. Wendell Potter is an advocate with the Center for Media and Democracy. If you’re personally affected by this issue, you can take a tiny bit of action by connecting with either of these fellas.
Read more →The Internet’s down!
What will we do? A question for which one of those wise old people I grew up with who always had an answer (usually right) comes to mind: “What did people do before we had the Internet?”
Hmmmm. I have to think about that. I think we waited. So, that’s what I did this morning. At other times in my life, I might have felt anxiety over that, but not this morning. I appreciate the old adage, “when the going gets tough – the tough go to lunch”.
In this particular vocation, I read a modicum of rather dull government documents. I get those documents off the web, so my planning consists of walking into my office in the morning, hitting a few sites on the web, and finding something I think is necessary or interesting in our business, and opening a blank document. I get a number of my quotes and topic information off the web, but not this morning…the Internet’s down!
I cannot imagine sending off to a government agency for a mailing, or going to some office to retrieve a document I may or may not be able to make sense out of and turn into something interesting or relevant.
I’d planned to write a piece about SAD, Seasonal Affective Disorder: Is it Real? Since it didn’t, I’m laying feelings and opinions out there. We all have those, and as we all do, I find mine most interesting and valid. Perhaps they are not so interesting or relevant to your life, tough cookies, the Internet was down!
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 →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 →On March 11, 2010, BlueCross BlueShield of Western New York (BCBSWNY), BlueShield of Northeastern New York (BSNENY) and American Well™ Inc agreed to provide on line care in upstate NY. This is good news for rural folks reported by Medical News.
I immediately suspect less than altruistic motives and question whether this will degrade outcomes since it’s headed up by insurance companies, leaders in the evil empire with a primary concern of quarterly numbers. I’ll wonder for a while, unless on line treatment is instituted immediately in enough places with rapid-cycle testing that can produce measurable data in three to six weeks. I’ve been a proponent of this sort of program implementation for treatment and software since the early 90’s. I’ve tried it, it works. It turns a situation whereby people must live with the final product into one that encourages fine tuning of the tools to produce the best outcome. Will rapid-cycle testing be used? It’s hard to say with huge companies, and could depend on who’s in charge of the project and current policy. Perhaps this is a newsworthy item for all you cub reporters out there…
Improving outcomes depends on a relentless search for the best way to treat people with problems. If on line treatment helps people get better, it will grow. Issues of saving both agencies and insurance companies money while producing acceptable outcomes in projects like this will determine on line treatment’s role in the future.
With over 1,000 clients, eGetgoing has been using on line treatment successfully a number of years, and it’s covered by insurance. Since it’s backed by CRC Healthcare, which is a pretty large company in the addiction treatment world, and headed up by their CTO, Jay Raimondi, I’d assume they have outcomes data to not only support continuing the business, but also proving outcomes to the insurance companies they do business with. But this is another story for another day.
It looks like on line treatment, telemedicine, gadgets and gizmos are in the treatment world to stay.
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