Tag: behavioral health services

Bits of News for Behavioral Health Providers

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I have recently noticed several pieces of news that I thought would be of interest to providers of behavioral health services and others.

1. The National Council Public Policy Update of April 8, 2010 pointed out an important change in timely filing requirements for Medicare claims:

Requirements of the Patient Protection and Affordable Care Act makes (sic) several changes to the Medicare timely filing requirements. Under the new law, all claims from before Jan. 1, 2010 must be filed by Dec. 31, 2010. Beginning on Jan. 1, 2010, all claims must be filed within one year after the date of service in order to be considered timely.

Sec. 6404 of the law details the requirements. This is a change from the former allowance of 3 calendar years to file a claim. Be clear about this: you now have 1 calendar year after the date of service to file a timely claim for payment for those services.  Now might be a good time to use your billing software to learn which old Medicare claims have not been paid (the claims may have been lost) and if there are any Medicare services that have not been billed. If these are not already three years old, you have only until the end of 2010 to file them, and with services that are new in 2010, you have one calendar year to file a claim for the services.

2. Seth recently posted a message on our User Group about the potential privacy and security problems that can be caused by data left on newer copiers and multifunction machines. NJAMHAA Newswire of May 3, 2010 also commented on the possibility of HIPAA violations that can result from careless use of these machines. Seth’s comments follow:

Now that you finally got all your computer hard drives encrypted and you are feeling pretty smug, here comes another headache — thousands of images containing PHI stored on a hard drive hidden inside other office machines. Take a peek at this investigative report by CBS news:

http://www.youtube.com/watch?v=6pIFUOav2xE

This is a pretty big vulnerability. If you have one of these higher end digital copiers, printers, or multifunction machines and it is stolen — or you neglect to remove or wipe the hard drive before selling or trading it in, you have a reportable security breach. Nobody would be likely to have a list of the patient documents that had been copied over the years, so you
would have to assume that EVERYONE’s protected information was at risk. That means reporting to the Feds, taking out the newspaper ad announcing your negligence, and the rest of the breach notification nightmare!

Apparently all major manufacturers offer security add-ons of some sort. Now would be a good time to inventory your document devices to determine if they contain hard drives and whether you can retrofit appropriate security add-ons to avoid a potentially disastrous situation in the future.

3. The National Council on April 23 published a review of Parity Act implementation that will allow you to determine whether your insurer or the payer with which you are dealing is in compliance with the Parity Act. Is your insurer in compliance with the Parity Act? will help you ask the right questions and provides resources to help you answer the question.

4. On April 22, FierceEMR and other sources reported that hospital-based doctors are now eligible for ARRA incentive payments for meaningful use of certified EHR technology, and that a bill has been introduced by Rep. Patrick Kennedy (D-RI) and Rep. Tim Murphy (R-PA) seeking to include mental health professionals, Community Behavioral Health Organizations (CBHOs), psychiatric hospitals and chemical dependency programs in the ARRA incentives. Time will tell what will fly.

5. And finally, the Mercom Capital HIT Report of May 3 indicated that HHS is seeking comment on the anticipated impact the stricter disclosure reporting requirements included in the HITECH Act will have on providers.

To help guide the Health and Human Services Department in tightening rules for health information privacy, HHS has asked providers, payers and consumers to comment on the benefits and burdens of accounting for the disclosure of protected health information, even if the data is intended for treatment and billing purposes. The HITECH Act called for HHS to strengthen the privacy rule of the Health Insurance Portability and Accountability Act (HIPAA). With the changes, providers, plans and their business partners will have to account for disclosures of patient information contained in an electronic health record, even if the data is for healthcare provision and payment. 

HHS’ Office of Civil Rights (OCR), which oversees health information privacy, published a request for comments in the May 3 Federal Register 
“to inform our regulations under the HITECH Act,” according to the announcement. Under HIPAA, providers and plans currently do not have to report releases of protected data when the disclosures are related to patient treatment, payment and healthcare operations. HHS said in the notice that it will remove the exemption for those disclosures when it involves an electronic health record (EHR).

Needless to say, there is a great deal going on in the world of behavioral health care and health care in general. Please feel free to share news items you discover that might be useful to other readers.

Don’t forget, your comments are always welcome. Please share them below.

Health Care Reform and Behavioral Health

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On March 21, 2010, the U.S. House of Representatives passed the Patient Protection and Affordable Care Act. Subsequently, they passed the Reconciliation Act  (H.R. 4872) making changes in the original bill. After some maneuvering, all the necessary legislation was passed by both houses of congress and on Tuesday, March 30, 2010, President Obama signed the Healthcare and Education Affordability Reconciliation Act of 2010 into law.

In the past week or two I have seen many questions about what the effects of this legislation will be. Behavioral health provider organizations are especially concerned about what the effects will be on mental health and addiction service funding.

One of the most useful resources I have come across was forwarded to the Florida Psychological Association member listserv by Dr. Bob Porter. The Bazelon Center for Mental Health Law has done an excellent job of summarizing the law and its impact on coverage for mental health services. While it will take years for all of the provisions of the new law to be implemented, a Congressional document summarizes some of the immediate effects.

In the private insurance sector, generic requirements of the law have particular impact for those with mental illnesses. In the past, such diagnoses have routinely triggered pre-existing condition clauses in policies. Within the first 6 months, the new law prohibits this discrimination.

  1. No discrimination against children with pre-existing conditions.
  2. No rescissions based on developing an illness.
  3. No lifetime limits on coverage.
  4. Tightly regulated annual limits on coverage.

In addition, for those who are currently uninsured, the law mandates:

  1. Immediate help for those with pre-existing conditions (an interim high-risk pool).
  2. Extending coverage for young people up to their 26th birthday through parents’ insurance.

Since so many who have been diagnosed with mental illnesses or with substance abuse issues have been denied coverage or have had coverage revoked or have reached the limits of their benefits, we should see immediate increased access to behavioral health and addiction services. The ability for parents to keep young adults on their insurance plans until they are 26 years old will assist some of the young people who experience late adolescent onset of serious mental illness or substance abuse conditions. This will allow a period during which their parents will be more able to facilitate transition to some other form of insurance coverage.

The National Council for Community Behavioral Healthcare, the trade association of behavioral health community service providers, hosted a webinar on healthcare reform and its impacts, Healthcare Reform: What Happens Next? Additionally, their Public Policy Update for April 1 gives links to resources as well as information about moving forward from here.

I attended the Council’s webinar this week and was struck by a couple of things. Because the Council primarily represents organizations that provide services in the public sector, their information is generally focused in this direction. For me, there were three take-aways from this session, and they were not all for public sector providers:

  1. The Council believes Fee for Service will probably go away in the long run, to be replaced by Case Rates with a Bonus for improvement of the consumer.
  2. Behavioral health providers need to position themselves for the long term. Integrated care is likely to be the way of the future and it is best to start to get positioned for that now.
  3. Private practices can be competitors in the new system; however, those with deep pockets who can manage the whole range of healthcare services will be better positioned to compete.

Community Behavioral Health Organizations (CHBOs) have been working on these steps for the past couple of years and there will be pilot programs using CBHOs together with Federally Qualified Health Programs to start to provide integrated care. Unless private behavioral health practitioners also start to position themselves to play in the Integrated Care setting, they are likely to get left behind.

Even the American Psychological Association’s advocacy efforts focus on the assurance that mental health services will be part of integrated care. This sounds very much like an integration of mental health services into such settings to me.

What do you think about how the new health care reform law will affect behavioral health services? Do you foresee changes in how care is provided? What changes are you willing to make in your organization in order to assure participation in a reformed health care system? Please enter your comment below. If you don’t see the comment box, just click on the title of the article and then enter you comment at the bottom.

Evidence Based Treatment and Psychology

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As a psychologist trained 30 years ago in a Boulder-model scientist practitioner training program in clinical psychology, the ability to critically evaluate research and to determine its application to the treatment of my patients was an essential part of my practice and of my outlook on clinical psychology. That initial training fed my early interest in Cognitive Behavioral Therapy. I still have vivid recollection of attendance at my first two-day workshop conducted by Jeff Young (Jeffrey E. Young, Ph.D.) on Beck-style Cognitive Therapy of Depression, a workshop that had profound impact on the treatment I provided. Even my later identification as a Feminist Therapist and my questioning of programmed, patriarchal methods that elevated the therapist above the patient was always tempered by the need to use the scientific method in my practice and in my life. (I’ll credit George Kelly’s ‘man, the scientist’ and Franz Epting, Ph.D. for that.)

As I have mentioned previously, I have been retired from active practice since 1993. Imagine my surprise to learn this past November that clinical psychologists value their own experience and the guidance of their colleagues more than they do the dictates of science. In fact, according to the authors of Current Status and Future Prospects of Clinical Psychology: Toward a Scientifically Principled Approach to Mental and Behavioral Health Care by Timothy B. Baker, Richard M. McFall, and Varda Shoham, some clinical psychology training programs are downright anti-scientific. They believe the solution to this ‘problem’ is a new system of accreditation for training programs. NPR’s Science Friday aired an episode on this topic on December 4, 2009. The show, entitled The Science of Clinical Psychology, is a quick way to get a sense of the much longer paper.

This paper and the PR blitz surrounding it including an article in The Washington Post by the authors, has received strong reaction from practicing psychologists, directors of training programs in clinical psychology and divisions of the American Psychological Association (APA).

While some would describe the Baker, McFall, Shoham article as politically motivated and an attempt to wrest accreditation away from the APA, it seems to me that focusing in a defensive fashion on political motivations accomplishes little. Perpetuation of the ad hominem arguments used in the paper will not get us very far. Perhaps we should focus instead on the notion of scientific support for mental health and behavioral treatments, how clinical research might be encouraged, how evidence-based treatments (EBTs) might be most effectively promulgated, and whether psychologists are alone in their hesitance to adopt EBTs.

In his December editorial in Current Psychiatry Online, Henry A. Nasrallah, M.D. suggests that psychiatrists also could benefit from self-evaluation regarding their use of EBTs. Below is an excerpt from Dr. Nasrallah’s article:

PSYCHIATRISTS’ TRACK RECORD

 The Schizophrenia Patient Outcomes Research Team5 assessed how the treatment of 719 patients with schizophrenia conformed to 12 evidence-based treatment recommendations. Overall, <50% of treatments conformed to the recommendations, with higher conformance rates seen for rural than urban patients and for Caucasian patients than minorities.

A study using data from the National Comorbidity Survey6 found that only 40% of respondents with serious psychiatric disorders had received treatment in the previous 12 months, and only 15% received care considered at least minimally adequate. Four predictors of not receiving minimally adequate treatment included being a young adult or African-American, living in the South, suffering from a psychotic disorder, and being treated by physicians other than psychiatrists.

Finally, a recent survey of psychiatrists’ adherence to evidence-based antipsychotic treatment in schizophrenia7 showed: 1) mid-career psychiatrists more adherent than early or late-career counterparts; 2) male psychiatrists more adherent than female; 3) those carrying a large workload of schizophrenia patients more likely to adhere to scientific literature.

It would appear that psychologists and psychiatrists all need a stronger push toward use of EBTs.

In the world of community behavioral health, Medicaid and Medicare are pushing providers of care to the chronically mentally ill toward use of EBTs. SAMHSA has an entire section of its web site dedicated to EBTs. SAMHSA’s National Registry of Evidence-based Programs and Practices (NREPP) contains a searchable database of interventions for the prevention and treatment of mental and substance use disorders. The database currently contains 150 entries along with a method for submitting programs for review and inclusion in the database. The NREPP has the potential for becoming a clearinghouse for effective behavioral health treatment interventions.

How does your organization approach the issue of evidence-based treatments? What is your take on the current controversy in the field of clinical psychology? How do you imagine we ought to move forward in advancing scientifically-tested approaches to mental health treatment? Given the costs of health care, this seems like an extremely important issue for all providers of behavioral health services to address.

Please enter your comment by clicking on the title of the article and typing in the box at the bottom of the page.

Healthcare Reform: Where does mental health fit in?

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I was all set to write an article on various health disorders and their cost. Then I got frustrated. You see, I started reading the original articles upon which the news/opinion articles I was using as reference were based. I found very rapidly that the figures being used in the articles were comparing different things…some of the totals included reporting by consumers of care; some of the totals included services under multiple diagnoses; adding the totals together summed to much more than we spend on all health care all told. I wonder  how much of this misuse of data is occurring during our ongoing national discussion of health care reform. Apples and oranges are not the same and mixing data can result in sloppy conclusions.

On September 10, 2009, the New York Times published an Op-Ed piece by Michael Pollan in which he discusses the costs of health care in the U.S. Big Food vs. Big Insurance discusses the report of the Centers for Disease Control that chronic illnesses account for 70% of all U.S. deaths. The medical bills of those with chronic diseases result in 75% of the health care spending in the U.S. Pollan argues that some of those chronic diseases…obesity, diabetes, cardiovascular disease…are at least partially the result of America’s terrible diet and overeating. Just helping U.S. residents eat better could result in a dramatic reduction in the costs of health care.

Pollan’s position received some confirmation from a podcast of Science Friday on August 28, 2009. How Cooking Made Us Human focused on the hypothesis that humans evolved effectively and developed larger brains because we started cooking our food. Cooking begins breaking food down before it is eaten, so it is easier to digest. Raw food is harder for the body to digest, so one does not get as much nutritional benefit from the food eaten. The result for human evolution was that we were able to take better advantage of the food we ate by cooking it.

The corollary of this hyothesis is that highly processed foods are a big contributor to obesity because they are too easy to digest. The more processed the food, the easier it is for our bodies to use the caloric content of the food. The result is that those whose diets consist largely of processed foods are also heavier. Raw foods are likely good for some who want to lose weight because the body has to work harder to digest them and does not get all the caloric benefit from the food. One can eat more, feel more full, but consume fewer calories.

Pollan’s point that a change in one aspect of our lives could have huge impact on health care spending got me to wondering…is there a mental health issue that is analogous to food/eating related disorders like obesity, diabetes and heart disease?

According to Open Minds On-Line News for September 14, 2009, mental disorders jumped from fifth place among health expenditures in 1996 to third place in 2006 increasing from $35.2 billion to $57.5 billion. The number of people who sought treatment for mental conditions went from 19.3 billion in 1996 to 36.2 billion people in 2006. While the dollars expended per person for behavioral health care are many fewer than for heart conditions ($1591 vs. $3964), perhaps there is a way for behavioral health providers to dramatically reduce costs of care by addressing a single problem.

According to the U.S. Surgeon General, approximately 20% of the U.S. population experience some sort of mental health disorder in any given year. The best estimate is that 16.4% of the population experience some sort of anxiety disorder ranging from Simple Phobia to Post Traumatic Stress Disorder. A full 82% of those who experience a behavioral health disorder suffer from some sort of anxiety disorder.

Is it possible that education on stress reduction, prevention programs aimed at inoculating the U.S. population against anxiety and early treatment of anxiety disorders might decrease the cost of treating the disorders that do emerge? I have heard public health specialists argue that public education and prevention are the only way we will ever get our health care spending under control. I also have read that there is not yet compelling data to demonstrate that preventive care reduces costs at all.  Perhaps we should just focus our attention on the behavioral aspects of the chronic physical diseases? Or maybe behavioral health providers can work in both arenas and assist in dramatically diminishing the costs of health care across the board.

What do you think about this issue? Where should psychologists, psychiatrists, social workers, mental health counselors, community mental health centers and community behavioral organizations focus their energy? Where will our energies be most effectively spent?

Please enter your comments by clicking on the title of this article and typing your comment into the box below.

Yoga: Physical and Mental Health

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Those of you who read this blog regularly might remember that in July I decided to take a more active role in addressing the neck and back pain that is a regular part of my life. I started taking a yoga class. In August, I added a second one. I was all set last week to write my blog article on yoga; then Seth offered to write the week’s entry. I’m glad I waited. You see, I have just learned that September is the first official National Yoga Month, so designated by the U.S. Department of Health and Human Services. Now, I can even make a contribution to the observance by a timely blog entry.

Yoga means union. When we think and talk of the postures that are part of the practice of yoga, we are talking about asana, one of the eight limbs of yoga.  While most of the limbs relate to moral and spiritual development, asana and pranayama are very much physical.

Prana means life/breath. Pranayama is one of the eight limbs of yoga focused on the use of breath control to cause relaxation and alteration of mental state. Those of us who have utilized the teaching of progressive relaxation methods as an adjunct to psychotherapy know that the effect of cleansing breath on mental state is real. Diminishing anxiety and depression so a client can take action on life problems is one of the observed benefits of deep breathing, but the effect of breathing deeply is not just on mental state. Fully oxygenating the blood and relaxing the muscles adequately for the blood to circulate properly speeds healing, reduces stress, and increases the acuity of thinking. 

Recently published researchdemonstrates significant emotional and physical benefit from the practice of Iyengar yoga among a group with chronic lower back pain. www.MedicalNewsToday.com quotes the researchers as saying that “low-back pain is the largest category for medical reimbursements in the US, accounting for 34 billion dollars of medical costs every year.” Diminishing the cost of this care could have significant impact on our health care expenditures. This is one case where the use of complementary/alternative medicine can save all of us some bucks while simultaneously increasing the sense of personal responsibility and mastery for the patient.

Iyengar yoga is one of many schools or styles of yoga practice. It focuses on alignment of the body and balance, two crucial requirements for symptom relief. Practitioners utilize props to facilitate the various yoga postures. The use of chairs and blocks and straps to assist getting into and maintaining the positions makes it possible for just about anyone to practice the Iyengar style of yoga. The study found that those who practiced Iyengar yoga had less pain, less disability and less depression than those who did not. Over the longer term, they also used less medication than those who used traditional medical treatment.

My personal experience is that even minimal (twice a week) practice of yoga has had significant effects on my experience. I have chronic lower back pain, neck and shoulder pain. Practice of yoga has resulted in much improved physical and mental well-being.

  1. The focus on posture and lengthening of the spine has resulted in a day-to-day, minute-to-minute awareness of how I am holding my body. The  positions in which I put myself in my chair at my desk, standing talking to a colleague, having a telephone conversation all result in muscle tightening. Using proper posture allows the muscles and bones to work as they were designed.
  2. My twice a week classes have resulted in considerable strengthening of my muscles. While I bicycle each weekend, my upper body and core muscles get very little workout. The yoga classes take care of that. The core muscles that are crucial to proper alignment of the spine are getting strong enough to do the job adequately.
  3. The focus totally on the physical gets me out of my head for two hours a week. The workout tires the muscles getting me into the ideal state to benefit from the deep relaxation at the end of the class.
  4. I am gaining control over my physical comfort. I had come to a feeling of helplessness to control my pain. That is gone. I now have a much better sense of what I must do and how I must feel to minimize my pain.

While yoga may not be the ideal method of exercise for everyone, it is a wonderful tool that can be used by many. Why not consider exploring some of the benefits for yourself?

Talk with us about your experience with yoga. Your comments are always welcome.