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 →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 →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 →Ron Hunsicker has been terminated from his position as president and CEO of the National Association of Addiction Treatment Providers (NAATP).
Apparently, the termination was prompted by confirmation of some sort of financial impropriety. Gary A Enos, a contributing editor for Behavioral Healthcare’s on-line magazine reported that the press release was issued to members on May 10, 2010 and advised NAATP’s due diligence included use of an outside accounting firm and conversations with the Pennsylvania Attorney General’s office.
This is big doin’s in River City, and it’s a shame to see a fall like this, under these circumstances. A number of years ago I attended a NAATP conference, and thought it was a fine, if small, affair. Hunsicker grew the organization since then, and is well respected in the field. I expect people will simply shake their heads and move on.
I wonder about the nature of the improprieties. Were there simply accounting problems that indicated incompetence (Hunsicker was not CFO)? Did money disappear to an unknown destination? Hunsicker may not be guilty of more than poor oversight of business matters, or it could be an indication of crime. We don’t know.
I’ll keep an eye out for the details and update you when I find them.
Read more →Either counselors produce or we’re all out of work. And it’s best if they help some consumers along the way.
Mary Ann Vassallo, CFO of Family & Children’s Agency on Long Island advised me of a different focus on a big question of the moment: “What is best for the client?…All we talk about now (is) how many units of service should be required for each fte. Is 1100 a year right, not enough, 1500 too many?”
I quested for data.
We used the hot dog cart approach in one of my past lives: If you’re going to make a profit on hot dogs, you need to know how much it costs to deliver a hot dog that people will like enough to bring friends back for more. Cost of treatment analysis in a big agency can get pretty granular:
There’s more, but enough already. We’re busy people who want the short, easy answer so we can get to work on solutions. From what I’ve seen, there is no easy, short answer, so I went in search of an expert in the matter. What should I find on The National Council’s website, but David Lloyd’s MTM Services’ productivity calculator. Eureka, I thought!
David Lloyd’s thought is that the EHR is key to enhancing productivity and measurable outcomes, which has been EHR software manufacturers claim for many years. I’m a fan. His organizations’ recent work in Ohio, Massachusetts and New York has been influential and exemplary.
Then I saw CEO Michael Flora’s accompanying presentation. It’s 76 slides of very exacting description of the revision and implementation of best practices throughout his Ben Gordon Institute.
As I suspected, still, there’s no easy, short answer.
The approach is nothing new, an extension of discovering how much it costs to put a hot dog out the window to a happy customer. The actions Michael Flora explained to NCCBH were basic, proven business principles, and they can be replicated at other agencies to show dramatic business improvements…answering important questions like Ms Vassallo’s.
One business improvement is the ability to measure treatment outcomes by analyzing services rendered and continuous results of various treatment instruments. Creating your own agency benchmarks for treatment outcomes seems to be the answer to what’s best for the client.
Start a project. You could ask how treatments and their associated instruments used in your agency are working to improve depression outcomes. If you have an EHR in use, existing data can measure improvements for different conditions. What are the key variables?
An EHR will usually have these elements recorded for as long as you’ve been effectively using it. Writing a report should be a simple matter.
If you don’t have an EHR, you may want to make that a priority for the agency.
In either case, studies like this have a lot to say about improving agency efficiency and improving treatment quality. A key reason studies like this don’t get done is that qualified people are usually busy people, so the reasonable and sensible approach may be to hire somebody for the project.
Contact me any time.
Read more →Starting in 2011, healthcare providers can collect an additional $18 for every service performed for Medicare patients in incentive payments. I was also able to find two grants, one from Health & Human Services for IT, and one offered by the NIH for job creation & economic development.
Similar Medicaid payments are in the works. Medicaid/Medicare incentives will continue through 2016 according to an ever decreasing grid, and there’s a catch.
Eligible Professionals and hospitals must be using a certified Electronic Health Record (EHR). Certification is relatively new to behavioral health and substance abuse treatment, and the Medicare/Medicaid incentives are designed to enable providers to pay for a certified record. Most providers haven’t approached their vendors yet about certification, and it’s almost 2011. Once again, incentive amounts begin to drop in 2012.
Factors conspire against the EHR vendors in this matter: 1. It could cost them up to $2 Million (that will change the competitive landscape) 2. Behavioral Health isn’t specifically included in the incentives and special rules apply to qualify as an eligible professional 3. Behavioral Health standards haven’t been completed by CCHIT to certify EHRs
I’ve shared on all these hindrances in the past, and all are being resolved in one way or another by the sectors of healthcare that are affected. If there’s a problem, it will be in missing deadlines. Your involvement with NCCBH’s political efforts, your software vendors’ SATVA organization work, and pushing along the CCHIT team with the Behavioral Health standards could only help our sector get a bigger piece of the pie.
The HHS IT grant I mentioned is being awarded to RHIOs, CHITTAs and nonprofits in the interest of securely sharing patient information to improve communication among treatment providers and outcomes of their work with the patient.
You can investigate the NIH grant on the web, too.
These grants affect the extension of EHR and the ability for it to deliver maximum value to the community.
An Electronic Health Record has come to be defined as an extended version of the Electronic Medical Record (EMR). While the EMR is the patient record for the agency, the EHR is that patient’s record for the healthcare community, making it possible to share medication lists, treatment plans, and outcomes of treatment when a patient is served by multiple healthcare providers. Imagine how much better it will be to really know what’s going on with a patient’s past and current treatment.
Changes in healthcare enable creative solutions that can do more than just help you “get along”. Look at the large, successful agencies in your area. How did they achieve such success? Likely somebody recognized an opportunity others didn’t in a time of great change, and they took a risk or two, making some creative business moves. It’s a good time to be in business.
If you’d like more information now, Email me at info@ehrsio.com.
Read more →