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 →In today’s world, $500,000 isn’t a lot of money. It was, however enough to drastically change Ron Hunsicker’s life.
The National Association of Addiction Treatment Providers (NAATP) disclosed Hunsicker’s 5-year misappropriation of funds to members at their annual conference in June. He was the CEO of that organization for many years, and quite effective and well respected in the industry…until this revelation. Behavioral Health Online shared the answer to the root question, “What did Ron do?”
It sounds like Hunsicker fell into a very human pattern of racking up expenses on the company credit card that were later deemed “personal” by the Pennsylvania DA’s office. After five years, it looks like a significant contribution to the executive’s paycheck. It’s a picture of human frailty aggravated by a lack of controls. Nobody was auditing expenses, like any corporation or even small companies I have worked for.
My friends in recovery would say one of Ron’s defects of character came out to play. And who knows, Ron may have felt perfectly justified in using the credit card after the first decision to use the card for a questionable purchase.
That decision and all the following decisions lost him his job and regular paycheck.
It’s a testimony for honesty in expense reporting when spending other people’s money.
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 →The mental health and substance abuse treatment industry has a great advantage over other businesses.
Many years ago when I worked in radio, production/creative and administration/sales departments seemed to have a low-simmering, seldom acknowledged cold-war going on, similar to what can be found under the covers in some mental health and substance abuse treatment organizations’ business and clinical departments.
The tension is partly a matter of record-keeping in order to stay in business. An advantage in our field is that record-keeping is vital to both financial and treatment outcomes. If we examine the emotional payoffs, practitioners can get a charge out of seeing somebody get better, watching ongoing assessment scores improve and identifying the improvement as a result of treatment. On the business end, the payoff is displayed in the sigh of relief when the Office of the Medicaid Inspector General’s review doesn’t result in too many “Takeback” dollars due to inadequate documentation.
Which brings me to my point.
In the 1980’s radio stations hit the top of the bell curve for implementing computer systems to keep records that increased efficiency integrated magically successful programming and in some cases moved a person from an eliminated position to another, more valuable spot in the organization. Accounting became more efficient, proof of meeting FCC requirements was more easily producible, and a ton of other technologically inspired changes revolutionized the industry (they needed it with the decline of market share and advertising dollars for radio).
In the 1990’s mental health and substance abuse treatment organizations discovered the benefits of computers in a bigger way with the advent of the Electronic Medical Record (EMR). Nowadays people are upgrading or replacing their EMR. The new technology isn’t just about keeping notes and treatment plans and pushing records of service to billing programs. It’s easy to see the advantages of computerized billing. Just run a management report in a few minutes and remember how long it took to get that data before the report was available. The EMR adds an entirely different dimension: people in clinical and business departments are working together to succeed.
The new technology delivers business improvements that are sensitive to advancing both clinical and billing processes. The EMR can analyze a client’s ongoing outcomes assessments and deliver the information that OMIG wants simultaneously. The EMR can help identify suicidal tendencies during intake and record the requirement of investigation while alerting a specialist to see a client before he gets out the door that day. The EMR can make mergers and acquisitions more effective with less work by integrating data from two different computer systems…which used to be a major problem due to lack of data standardization.
Few will argue about the effectiveness of implementing new technology. The most significant issues are budgeting the upgrade or purchase and allocating the human energy to do that.
Let me know if you need help, info@ehrsio.com.
Read more →Not for profit Community Mental Health Centers (CMHCs) must become entrepreneurs in order to make it through the bumps in the financial road most have experienced lately.
Adopting a CMHC entrepreneurial mind set is to provide the public with more, better and different services…more help available is good for everybody. As an exercise, let’s turn an entrepreneurial effort into a new, profitable, ongoing business – even if it’s non-profit. It’s a fun exercise, and every management team I’ve been involved in does this.
I ran across a couple problems today that need attention, and finding a problem to address is important to our project. • Annual suicides (33,000) almost double the number of annual homicides (18,000) • People with mental illness are three times more likely to be in the criminal justice system than hospitals Thomas Insel, Director of the National Institute of Mental Health advises these are little known facts requiring attention.
Prevention comes to mind for suicide, and that’s been done and is being done. It’s a requirement for agencies to ask about suicidal thoughts, plans, etc; most agencies have an assessment either in the Electronic Medical Record or on paper that’s completed as required. Anybody who’s even thinking about suicide immediately catches a mental health practitioner’s attention.
What can be done about the sorry state of America’s population with mental illness in jail? Perhaps prevention is again the answer.
My mind jumps: “OK, how can we treat these folks efficiently and effectively, showing outcomes that give us a true picture of whether we are really providing value to the public and helping an individual recover?” That’s well and good, but a bit premature. I don’t even have a consumer for this new, profitable, ongoing business.
Marketing is the first step leading to our inevitable success. CMHCs who will survive are improving marketing now, but non-consumers are slipping through the cracks, living in their illness, and winding up in jail. How do we reach these folks when they seem to see crime as a solution to all their problems?
A number of programs are in play today to reach mentally ill prisoners. Common sense tells me that since a high percentage of people needing treatment are in jail today, and most prisoners have been in jail before with a high likelihood of coming back to jail, the problem may be a distancing from treatment after folks are released and rejoin us.
Crime is exciting. Life can be a drag. Problems come up, and treatment tools go out the window, and Poof! Crime is the answer!
Here are ways to reach the person at that point that a provider should be able to get paid for: • Peer interventions: NY Medicaid, for one, pays for peer services…build an army of peer advocates. AA says that there’s no treatment like one alcoholic talking to another. Perhaps this approach will be effective with disorders other than addictions. • Outreach: Assign professional staff or peer advocates to go to jail, talk with people who will be released soon and set up an appointment the day of release. • Hold hands. Release is the critical point, so be there. Meet the family; invest a few minutes confirming your prospect will come to the appointment.
Where do prisoners go after they rejoin us? Find out. Talk with them face-to-face, it’s better than the phone. Discover that spark of willingness. Your ratio of success may only be one in a hundred, but don’t worry about that. Most jails are overcrowded, so you’ll have plenty of prospects for this new business we just built.
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 →