Prevention and Pain: A major way to save money

This morning I read an editorial (An ounce of prevention could heal a pound of pain) by Dina Overland of the FierceHealthPayer newsletter. She decided to use her platform as the editor of a newsletter that is aimed at insurance payers to directly address those payers about prevention of healthcare problems and diminishing future costs. She focused on an area that behavioral health and substance abuse professionals work in often . . . pain.

Ms. Overland’s review of the Institute of Medicine’s (IOM) report on pain and prevention cited some facts I had not heard.

Chronic pain affects 116 million Americans–that’s more people than affected by heart disease, cancer, and diabetes combined–and costs the United States
$635 billion each year. That’s what the Institute of Medicine (IOM) found in its report, Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education and Research.

If that’s not jarring enough, here are some more staggering facts: The United States spends $2 trillion on healthcare, but only 4 cents of every dollar goes to prevention and public health, despite being among the best tools to reduce spending. For every $1 invested in prevention, we save $6 in projected healthcare costs, says Sen. Tom Harkin (D-Iowa), who participated in the Department of Health and Human Services (HHS)’s announcement
of its guidelines to incorporating prevention throughout the healthcare industry.

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I could not help but think about the number of people who would never have become substance abusers if their chronic pain had been addressed and treated at an early stage. How many behavioral health clients have you treated for depression after years of experiencing intractable pain?

The IOM and HHS see the coordination of care among primary care providers and specialists as the best way to address early intervention and prevention of pain. What role should mental health and substance abuse providers play in this coordination? How many of your patients also experience chronic pain? Where do behavioral health providers fit in?

Please share your thoughts and comments below. What role do you want to play in diminishing healthcare costs? Who should we see when it hurts?

 

Data Safety, Consent to Release, and EMRs

According to a June 14, 2011 report by Government Health IT News, consumers’ confidence in the safety of their data in electronic health records (EHRs) is a prerequisite to the successful adoption of electronic means of recording and sharing health records. So says Dixie Baker, chair of advisory Health IT Standards Committee’s privacy and security workgroup and senior vice president and chief technology officer for health solutions for SAIC. Feeling assured that their information is safe and secure and going only where it is supposed to go will allow the public to support their health care providers in moving to electronic medical records (EMRs).

In fact, Government Health IT News reported on June 24 that the Office of the National Coordinator for Health IT (ONC) plans to contract with a vendor “to explore and evaluate methods to electronically obtain and record from patients their informed consent about sharing their health data.” The solicitation focuses heavily on the matter of educating patients about disclosure and consent for release of information.

In substance abuse and behavioral health settings, requirements beyond those encoded by HIPAA and HITECH are mandated in federal and state laws. 42 CFR Part 2 applies to any provider or provider organization holding itself out as a provider of alcohol or drug abuse treatment and to federally assisted alcohol or drug abuse programs. Special “handling” of the record is required, especially when it comes to re-release of the information obtained. It is not acceptable for a provider to receive information from an alcohol abuse program, incorporate it into their EMR and then release it on to other providers of the patient, without the specific consent of the patient.

The legal complexities are immense. Members of the Software and Technology Vendors Association (SATVA) who work with these issues all the time, have been wrestling with the kind of consent that could be used to disclose records and appropriately specify the degree to which such disclosure is authorized by the patient. Anasazi Software has shared a memorandum of understanding about privacy and security issues related to health information exchange (HIE) in California drafted at their expense. California and some other states have even more restrictive laws than 42 CFR Part 2.

The conclusions in this document lead SATVA members Anasazi Software, Valley Hope Association, and Sequest Technologies to work together to develop and demonstrate to SAMHSA a solution for managing automated electronic health information disclosure. The standardized consent for health information disclosure that they developed could go a long way toward assuring consumer control of their record, at least as that record is represented by the Continuity of Care Document (CCD).

This kind of cooperative effort is one of many reasons of why we at Synergistic Office Solutions are proud to be members of SATVA.

APA and Public Education in Behavioral Health

In a previous life, when I was actively involved in the American Psychological Association (APA), I was for three years a member of and one year the chair of the Public Information Committee of the APA. Prior to that, I hosted a live, call-in television show for two years. Frankly Speaking with Dr. Kathy Peres was entirely focused on educating the public about psychological matters. I believe that public education about how mental health issues affect our day-to-day lives is a significant responsibility of all professionals and organizations that provide services in the behavioral health arena.

Given that belief, I was very pleased today to receive an email from the APA announcing a new series of videos and podcasts by APA CEO, Norman B. Anderson, Ph.D. You can view the introduction and the first two installations in the series This is Psychology, one on bullying and another on children’s mental health.

APA invites you to place these links on your own professional web sites and to share them and the information they contain as broadly as possible.

Last week, I wrote about potential problems with use of social media in your organization. Public education of this sort. . .including sharing of the information created on Twitter and FaceBook is one arena in which I think social media has the potential for more power than in any other area of our professional lives.

How does your organization participate in education of the public about behavioral health issues? Please share your initiatives and activities here so others can communicate them more broadly for you.

Social Media, Data Breaches and Behavioral Health PHI

I am not sure why I continue to attend free webinars about data breaches. They mostly serve to make me extremely anxious for our customers. . . especially for those who have not created a data security plan or have thought minimally about their responsibilities for protecting the privacy of their patients’ Protected Health Information (PHI).

You all certainly know about the requirements that HIPAA and the HITECH portion of ARRA placed upon healthcare providers. You must protect the privacy and security of PHI. You must have assessed the risks to the security of your data and have a plan in place for mitigating any potential consequences of security breach.

The problem is that new potential complications arise all the time. This morning’s webinar was about social media and the potential security risks added by use of those media. It was presented by ID Experts, a company that specializes in an online tool that guides you through handling a data breach when it occurs. They believe that one must assume that such breaches will occur. . . and be ready to react at a moment’s notice.

Do you have a social media policy at work? Are you allowed to use Facebook or Twitter from your work computer? What about from your smart phone paid for by your employer? Are you allowed to access your personal email account from the same computer on which PHI are stored? Today’s presenters talked about all the potential downfalls of such capabilities since most social media sites are not encrypted and have marginally protected security.

I left the webinar feeling anxious for our customers who do not pay attention to these matters. What will they do when they have a data breach? What will you do?

Please share your comments…

Self-Awareness and Personal Responsibility

The holiday last Monday made it difficult to get to my blog. As each new item that I needed to handle came up, I found myself thinking about what I had hoped to write. Thinking about it was all I managed. No matter how much I thought, I did not discipline myself to leave all the other items aside and write.

Self-discipline is not one of the things I have been short on in my life. I was raised and educated in a setting that strongly taught the need for and benefits of taking responsibility for my own thoughts and actions and shaping them to the way I wanted and needed them to be. The last ten years have included many times when it was harder than ever before to focus myself and move forward, but because I have long known the methods that are most effective for me to achieve self-discipline, I have been able to do so. Taking personal responsibility is second nature for me (except, of course, in the areas where I have complete blind spots!).

For me, this self-discipline has resulted in a strong tendency to take action. . . in pretty much any situation in which I deem action to be necessary. If I have allowed a few extra pounds to creep on, I act to reduce my caloric intake and increase my activity. If I am driving or walking somewhere and have become lost (and don’t happen to have a GPS with me), I ask for directions. If a cause in which I believe is being threatened, I make contributions and write emails. I have always seen it as my responsibility to take action when I could and when it was necessary.

I am currently reading Jon Kabat-Zinn’s book Wherever You Go There You Are. . . one small section at a time. This week, the following paragraph struck me:

What is required to participate more fully in our own health and well-being is simply to listen more carefully and to trust what we hear, to trust the messages from our own life, from our own body and mind and feelings. This sense of participation and trust is all too frequently a missing ingredient in medicine. We call it “mobilizing the inner resources of the patient” for healing, or for just coping better, for seeing a little more clearly, for being a little more assertive, for asking more questions, for getting by more skillfully. It’s not a replacement for expert medical care, but it is a necessary complement to it if you hope to live a truly healthy life—especially in the face of disease, disability, health challenges, and a frequently alienating, intimidating, insensitive, and sometimes iatrogenic healthcare system.

Developing such an attitude means authoring one’s own life and, therefore, assuming some measure of authority oneself. It requires believing in oneself. (My italics)

Most individuals who work in behavioral healthcare are expert at helping others to mobilize their inner resources. This is a large part of what psychotherapy is about. For the seriously mentally ill, helping them see that they have inner resources is significant. . . and a major contributor to the process of recovery.

I have a great deal of difficulty with the large number of people who see the things in their lives going wrong and who feel they can do nothing or who choose to take a passive rather than an active posture. . . but gladly complain about all that is wrong. Listen to talk radio, stand around the metaphorical office ‘water cooler’, shake their heads saying ‘what is this world coming to?’. . . and then go on with their own little lives as if nothing else matters.

I am currently watching this budget debacle unfold in state legislatures (I live in Florida) and Congress. As we all know, the recession and unemployment have resulted in significantly lower tax revenues at every level of government. We have allowed those who represent us to pass laws virtually exempting the wealthy and large corporations from taxation while they rake in the profits. The rest of us continue to pay our sales and property and income taxes, but the working and middle classes just do not earn enough or pay enough in taxes to support the level of government spending that we have all demanded.

The decisions that are being made will most likely result in the deconstruction of the ‘safety net’ that has for the past twenty years provided some minimal care for the chronically mentally ill. As usual, those least able to speak up for themselves will pay the price. . . for the mortgage crisis, unfunded wars, and irresponsible tax cuts.

What is the responsibility of each one of us for the upcoming deconstruction of Medicaid, and possibly Social Security and Medicare? How do you feel about sitting around and complaining vs taking action? Who’s job is it, anyway? Please share your comments below.