Tag: Behavioral healthcare

Psychiatry CPT Codes for 2013

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A few weeks ago I wrote about the upcoming changes in the CPT codes for psychiatric services. Lots of people have been looking for detail on those changes, but the American Medical Association has not yet released all of the specifics. They are planning major changes to the general illness codes as well.

The AMA invites the health care community to learn more about the significant changes to the 2013 CPT codes and descriptors by attending the CPT/RBRVS Symposium in Chicago from Nov. 14-16, 2012. For additional information, please visit the AMA website at:http://www.ama-assn.org/go/symposium

If you are not going to be in Chicago in November for the symposium, there will likely be some other venues through which you can obtain more detail. The American Psychiatric Association (aPa) has created some documents that should be helpful, but they too cannot release the codes to the general public until the AMA gives them the go ahead. aPa members can obtain more specific information at their website.

The National Council announced their own upcoming workshop in today’s Public Policy Update. The challenge is that the codes are changing for everyone who provides mental health services. While some changes happen every year, this is a pretty involved set requiring the use of evaluation and management codes. The Council has already put together a fact sheet that you might find helpful. You might consider attending the webinar they are planning in November.

This is a topic for all of us to get informed about and stay on top of. Please share any information or links that you become aware of. Just enter them in the Comments below.

Energy at Work: What recharges you?

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Last night I saw a great horned owl sitting at the top of a tall pine tree silhouetted against the sky.

We had been hearing the hoots of the owls for the past several weeks. Sometimes we would hear him near bedtime when we walked outside briefly to say good night to departing guests or to pet our front porch cat. A few times I heard him calling early in the morning.

I had looked for him before, but seeing a bird in the dark is a real challenge, especially not really knowing where to look. It can be a challenge to localize the source of a bird call, especially one as loud and deep as that of an owl. The sound bounces off nearby houses and trees.

Last night, I walked out into an open part of my front yard and looked up toward the tops of very tall pine trees a couple of properties away from mine. I saw movement at the top of a tree, then saw a very large bird fly off. As I kept watching, I saw a second bird fly from the same location to the top of a nearby pine tree. It sat on the very top of the tree so I could see its 2+ foot height dark against the lighter sky. I ran inside to get my binoculars and he waited in the same spot. I had no camera with the power to photograph it, so my brain will need to store the image. And it will!

I am not a serious birder. I do not have a life list that I seek to fill. I do get significant pleasure from sighting birds that share my locale. It is a major recharge event for me.

You see, I have long found that I require a great deal of self-care and stress management to function well. When I worked as a psychologist, I used a variety of methods, mostly focused on professional involvement and time spent with other people. After 15 years of practice, I had burned out. I had not done enough to take care of myself.

I believe this is a major problem among behavioral healthcare workers. The job of assisting other people in being mentally healthy is a very difficult one. The chronically and seriously mentally ill can be a very satisfying but very draining population with which to work. Finding ways to recharge and re-energize is crucial to doing this work well.

Now that I work with providers of behavioral healthcare services instead of with patients themselves, I still need to do lots of self-care. Bicycling, gardening, watching the birds in my garden and near my home . . . these have become the ways I energize myself.

How do you take care of yourself? What recharges your batteries? Does your practice or organization have tools to help you with your self-care? When did you last see a great horned owl?

Please share your thoughts and experiences. When you offer your insights, you give other readers additional ideas to explore. Please do so!

New IOM Report: Best care at lower cost

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In early September, the Institute of Medicine published its most recent report on the state of healthcare in the U.S. Best Care at Lower Cost: The Path to Continuously Learning Health Care in America, identifies three major “imperatives for change: the rising complexity of modern health care, unsustainable cost increases, and outcomes below the system’s potential. You can download a free, prepublication .pdf version of this 450 page report before it is out in print.

The committee explored in detail some of the pressing needs of the system. They are convinced that we must move toward a healthcare system that learns from itself as rapidly as possible or the system is likely to self-destruct. We must learn how to incorporate research results more quickly, we must learn to change delivery systems that cost too much, we must move the system closer to its highest potential. In short, we must develop a culture of “continuous improvement to produce the best care at lower cost.”

FierceHealthFinance focused on the reported waste of $750 Billion a year (about 30% of the cost of healthcare in the U.S.) as one of the most important things to change. While that number is appalling, the fact that the figure reported was from 2009 is the most striking thing about it to me. Our system has become so complex that it takes three years before we know what it costs. We are constantly behind the curve, and must find ways to speed up the process of information assessment, dissemination, and implementation for change.

The behavioral healthcare system is often far behind the curve in implementing change that might be more productive. The public health and public behavioral health systems are deep in conversation and pilot programs related to integrating physical and behavioral healthcare. Suzanne Bennett Johnson, Ph.D., current President of the American Psychological Association (APA) identified the need to increase psychology’s role in integrated care as a primary thrust of her presidency; her presidential address also focused on this issue. I wonder how many mental health providers in the private sector are even willing to consider what changes to their work such an integrated system might bring.

Take a look at the very brief summary of the IOM report to see if you would like to read the whole thing. What do you think we need to do in behavioral healthcare to begin to address some of these issues?

CMS: Are you familiar with their newsletters and eLists?

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Since I was once a Medicare provider, I have long received newsletters from the Center for Medicare and Medicaid Services (CMS). Several years ago, they started to make major improvements to their websites offering large quantities of information for both providers and consumers of services. I am not sure how I wound up on an email list, but I now received regular information about a variety of topics related to healthcare and CMS.

While all healthcare providers need this information, we have found that behavioral health providers are often out of the information loop. Unfortunately, under most laws, HIPAA included, ignorance of a law and its requirements offers you no protection from the law. If you have not already done so, it might be time to begin to inform yourself about various subjects related to Medicare.

The number of topics available is outstanding.

I subscribe to both the CMS Industry ICD-10 Update and to the Caregiver eNewsletter. I find both resources quite useful.

 

 

If you would like to stay informed on any topics for which CMS is responsible just sign up for one of their eLists. Once you start receiving information on one topic, you can determine if it is useful and manage your preferences for the updates you receive.

Which of these lists are among those to which you subscribe? Please share your preferences!

 

 

 

Caring for the Caregiver: 5 Self-care Tips

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When I worked as a psychotherapist, I constantly struggled with the issue of self-care. I was always much better at taking care of others than I was at taking care of myself. I attended workshops and became involved in my professional associations because those activities felt good and were part of my self-nurturing, but they also ate up energy, so they were not as restorative as necessary.

When I had the opportunity to move out of the practice of psychology and into business, I jumped at the chance. Mental health care can be very demanding and eighteen years of other-focus seemed like my limit.

Then Katrina flooded my Mother’s home. Since September of 2005, she has lived with us and is now 92. I have become her primary caregiver. Although she is able to take care of many of her own needs, as she has aged and become more frail, the time and energy required of me has increased.

Last week I attended a webinar offered by my health insurance carrier. United Healthcare seems pretty intent on offering services that might prevent or mitigate illness. When I got their newsletter announcing the workshop, Take Care of the Caregiver, I signed right up. The information and suggestions they offered will undoubtedly prove valuable for me. My guess is that other insurers offer similar resources.

After attending their seminar, I got to thinking a bit about their ideas and others I have heard. These are a few I have gleaned over time.

  1. Practice mindfulness. Being really ‘present’ in whatever you are doing diminishes the frittering away of time and energy. This can be quite difficult to do when you feel great pressure and the demands of caring for others, but it is very much worth the effort to practice some activity that will assist you in focusing on the things and people for which you are responsible. For some of us, meditation can be helpful. For others, exercise does the job. Whatever method you prefer for increasing your ability to attend well to the persons in your care, use it. Get rid of the excuses and move forward.
  2. Set limits on what you can and will do.You cannot possibly be responsible for everything. Most psychotherapists know this, but it is often difficult not to feel responsible for the entire well-being of clients. Once you have learned to set boundaries as a therapist, it is easier to maintain your energy.The same is true when doing other sorts of caregiving. Know what you are able and willing to do and only do that. This will mean that you may need to find others to provide what you cannot, but that is OK. Just make sure that you know where your abilities and willingness end, that it is perfectly OK to have those end points, and that and your charges will be happier and better off for that clarity.
  3. Let others help you. It is much easier to set limits on what you will do if you let others help you. If you are taking care of children, that means letting their grandparents, aunts and uncles pitch in. If you are taking care of an elder, it may mean involving your siblings or finding programs and assistance in your community. If you are taking care of clients with behavioral health disorders, it may mean delegating tasks to others i1 your organization as well as finding a network of resources in your community that your clients can use.
  4. Take some time for yourself. Give yourself a moment whenever you can. Even brief times can have major impact. Just sit still and breathe for a minute or two. Go for a walk alone. Sit and watch the sun set. Schedule a manicure or a facial or a mini-spa day…or give yourself one. Indulge in a massage. If possible, schedule regular time away from those to whom your provide care. Utilize some of the others in your life so you can schedule an afternoon, a weekend, or a week away. You need vacation time. Take it.
  5. Schedule rest. Do your best to get enough sleep. If adequate continuous sleep is not a possibility, schedule mini-rest breaks into your day. If you always feel exhausted, you are less likely to be the kind of caregiver you would prefer to be. If you are permanently tired, you are more likely to experience suppression of your immune system and susceptibility to illness. Letting others help you may give you the time you need to rest.

I wish I could say I am good at these five things. I am working to be better at them. I’ll let you know when I get there.

I am sure many of you have found ways to take care of yourselves so you can do a better job of taking care of others. Please share some of your secrets. Inquiring minds want to know!