Tag: Behavioral healthcare

Self-Awareness and Personal Responsibility

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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.

Behavioral Health Administrative Workers: What are your employees worth?

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A discussion with my coworkers recently reminded me of the wide variability in the size and nature of the organizations that utilize our software products. Behavioral Health organizations range from solo, part-time psychologists, psychiatrists, social workers and professional counselors in private practice to large community-based organizations that provide inpatient, outpatient, intensive outpatient, and home-based care to those requiring mental health and substance abuse treatment.

As a result of this wide variability, the individuals with whom we deal in our provision of technical support services range from highly-trained medical and mental health billing/coding specialists and practice business managers to the teenage child or neighbor of the doctor who happened to be in need of a summer job. We are often amazed by the differences…by how much some billing specialists know and how little information others have.

One of the biggest surprises for me is how often highly trained mental health professionals are willing to entrust their businesses to individuals who have no training to do such a job. We are sometimes asked why our software does not do “x” for them. We explain that the software is a tool to be used by someone who knows mental health/medical billing to accomplish the needed tasks. It will not magically do billing for someone who has no idea how to do that job.

My niece works in a medical practice and is studying for the American Health Information Management Association’s (AHIMA) Certified Coding Specialist – Physician Based exam. I went to AHIMA’s site to see what the content is for this certification and was amazed at the breadth of the knowledge required to achieve the certification. The AAPC is a different organization. . . of professional coders. . . that also offers training, certification, support and networking. Both of these are aimed at individuals who work in medical coding and billing.

Some people who work in behavioral health assume that the billing job must be much simpler for mental health because it contains a much narrower range of services than a general medical practice. Just ask any experienced behavioral health billing specialist, and you will find out that it is not simple at all. Just because the range of services provided in behavioral health is much smaller does not mean that the person doing the billing requires less knowledge about billing and collections and dealing with insurance carriers.

Mental health services were “managed” by insurance carriers much earlier than most other specialties. As a result, there are rules and requirements for obtaining authorization for treatment that have a 30 year history. While “parity” was legislated in 2008 and the final rule for implementation promulgated in 2010, implementation has been slow and many consumers are not even aware that their plan might cover mental health services at the same rate they cover general medical care.

To expect someone who has never worked in a health care setting and has not previously done medical or mental health billing to have any idea about parity or treatment authorizations or copays or coordination of benefits or take-backs is just not reasonable. Medical billing is complicated and behavioral health billing has its own subtleties and complexities that are different.

So what is an employer to do? Here are some quick suggestions:

  1. Recognize that the person who is doing your billing is running a crucial part of your business. You should expect them to be a business professional.
  2. Do NOT expect someone who earns minimum wage to know how to do behavioral health billing. If you find a qualified biller who is willing to work for such a wage, they are selling themselves short.
  3. If your staff is struggling with how to bill, get them information. The Center for Medicare Services (CMS) is an outstanding resource. If a claim will pass Medicare muster, it will also pass the requirements of most other insurers.
  4. Invest in training for your staff. Having your staff thoroughly learn the software product you are using will earn money for your organization.

This is an arena in which I am sure many of you have experience and opinions. Please share your comments below. If you have additional recommendations for employers, please let us know.

Happiness and Optimism: Enhancing mental and physical health

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Wednesday, May 18, 2011 is American Psychological Association’s Mental Health Month Blog Party. This post is dedicated to Mental Health and Mental Health Awareness.

This past weekend, we rode 104 miles in the BikeMS Citrus Tour 2011. One of the fun parts of the weekend was getting to spend a few hours with our friend Wayne, one of the people for whom we ride. Wayne and his wife are two of the most positive, forward-looking people I know. While they struggle through the difficult patches that MS dishes out, they maintain a positive, happy focus on life.

As a person who tends more in the pessimistic direction sometimes struggling with depressive emotions, I am always inspired by those who are naturally optimistic and happy or who have set out to become so. Last summer, I read The Happiness Project by Gretchen Rubin and in September, started my own project. While I have not completed the formal project, I learned a great deal in the process.

One of the most important things I learned is that I need to focus on happiness in order to become happier. Unless I make my own happiness and well-being a priority, it will never just happen because of events outside myself. Because of my tendency toward negative thinking and pessimism, I have accepted Gretchen’s offer of a ‘happiness’ quote in my inbox each weekday. The ‘Moment of Happiness‘ daily quotation helps me focus, however briefly, on a thought aimed at Happiness. I have collected a few of my favorites and placed them in a notepad on the desktop of my computer. I love to be reminded each time I turn on my computer of Lao Tse’s statement…one of my favorites since my teen years:

Kindness in words creates confidence.
Kindness in thinking creates profoundness.
Kindness in giving creates love.
—Lao Tse

A new favorite is a quotation from Henry James:

Three things in human life are important:
The first is to be kind.
The second is to be kind.
And the third is to be kind.
—Henry James

Reminding myself of these things daily helps correct my own natural tendency. Giving myself the structure within which to work at happiness helps me to move in that direction.

One of the most important things about this process is that it has effects on both mental health and physical health. Dr. Andrew Weil is a well known integrative medicine expert who has written widely. His blog on Monday focused on the physical health benefits of being happy. Dr. Weil reported on a study in the March 2011 issue of Applied Psychology, Health and Well-Being. The happier and more positive you are, the healthier you are likely to be and the longer you are likely to live. Positive expectations about health events seem also to be correlated with better progress after the events. It appears that working to be happier ourselves can have a significant impact on our physical and mental health.

To go a step further, Dr. Weil suggests that having happy friends is one of the best ways to increase our own happiness. Surrounding ourselves with people who have a positive focus on life and who tend toward cheerfulness can significantly increase our own experience of happiness.

None of these comments are intended to minimize the serious impact that clinical depression has on the lives of those who are so afflicted, but our own thoughts and behavior can reinforce that depression or help improve it. Working to be a happier person and to surround ourselves with other people who are happy can be an invaluable contribution to our own physical and mental health.

We strongly hope that Wayne’s positive attitude will help him stay healthy and even recover some of what he has lost.

Please share your comments below.

Mental Health Blog Party Badge

Medicaid Shrinkage: Innovation or reaction?

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Just one year ago, after passage of the Affordable Care Act (ACA), The National Council highlighted the expansion of Medicaid that would occur as a result of the ACA. To meet the law’s requirements to provide insurance coverage to the working poor who are generally not insured through their employment, do not have access to insurance groups, and cannot afford individual coverage, the Medicaid program would need to expand to provide the legally required coverage.

In November, the American electorate hired new Congressional representatives who are dead set on rolling back what they call “entitlement” programs (Social Security, Medicare and Medicaid) and returning the Federal government to what they see as its proper role: funder of national security and protector of free markets (code words for defense and corporations). In this new/old world view, individual rights consist of the right to pursue happiness and to bear arms; communal responsibility for one another appears to be non-existent.

Where does that leave those with serious behavioral health issues and the people who treat them?

The National Council works to represent community behavioral health organizations and the people they serve. They view Medicare and Medicaid as crucial to the treatment and therefore to the survival of the seriously mentally ill since “Medicaid is the single largest source of funding for America’s public mental health system.” Since early March, The Council has reported regularly on the threatened slashing of the Medicaid and Medicare systems.

In early March, The Council reported that a group of governors testified about their need for greater “flexibility” in their Medicaid programs. This group especially wanted to be exempted from the maintenance of effort (MOE) requirement under ACA that prohibits the states from rolling back Medicaid eligibility. President Obama said he would support allowing states to opt out of the law’s requirements if they could guarantee an alternative method of providing universal coverage.

On April 4, Representative Paul Ryan (R-WI) released his committee’s plan for the 2012 budget that includes a dramatic restructuring and slashing of both Medicaid and Medicare. On April 7, the National Council released a fact sheet on the potential impact of the funding decreases promised by the budget blueprint. Under Congressman Ryan’s proposal, Medicaid would be converted to a block grant program beginning in 2013 and Medicare would be converted to a privatized voucher system starting in 2022. The House of Representatives voted to adopt this framework. While it is highly unlikely the Senate will accept the blueprint, they will need to come up with one of their own and then work to reconcile it with the House’s plan.

In a Health IT newsletter by Mercom Capital Group, it was reported that on April 14, 2011, The U.S. Department of Health and Human Services (HHS) “announced four initiatives to give states more flexibility to adopt innovative new practices and provide better, more coordinated care for people with Medicaid and Medicare while helping reduce costs for states and families.” In Florida which has been providing some Medicaid services through managed care contracts, the legislature is close to mandating managed care for the entire program in spite of poor reviews for the pilot programs. “At the workshop in Hollywood, a succession of doctors, care providers, advocates and Medicaid patients all had the same message: Managed care has been a disaster.”

As a small business owner who buys health insurance in the private marketplace for a very small group of employees, these proposals are extremely frightening. My health insurance premium at age 60 is already more than the proposed Medicare plan would pay once I become eligible at age 65, and my premiums will certainly not get any lower if I need to buy insurance in the private marketplace. If I, as a pretty healthy 60 year old, am so concerned about these changes to Medicare, I can only imagine the panicky reactions being experienced by those persons represented by the National Alliance on Mental Illness (NAMI) who are dependent upon Medicaid and Medicare to pay for their treatment.

How do you see these proposed changes impacting you and your organization? Do you agree with this method of limiting spending? What ideas do you have for controlling the growth of costs of Medicaid and Medicare? How do you propose that we proceed?

Please share your comments below.

Sleep Deprivation: The cost

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Two nights ago I woke up at 1:30 a.m. and did not fall back to sleep until 3:30 a.m. The room was too hot to sleep comfortably and I was awakened by a night sweat. I got up and cooled the room, but before I could fall back to sleep I was experiencing painful flushing caused by the niacin I take. Yikes! Today I am struggling with staying awake and trying to be productive.

According to surveys done between 1999 and 2004 by the National Sleep Foundation, 60% of adults report having difficulties sleeping a few nights a week. According to WebMD, some of the consequences of sleep deprivation can be:

  • Decreased performance and alertness
  • Memory and cognitive impairment
  • Stress on relationships
  • Poor quality of life
  • Occupational injury
  • Automobile injury

For many of us, irritability, poor decision making and decreased performance are the main problems. Yep, I have now started this article for the second time…my first try did not save properly.

According to sleep researchers, cognitive behavioral therapy can be as or more effective than the use of popular medications to solve sleep issues. Some of the recommendations for improved sleep include this list from the APA web site:

  • Keep a regular sleep/wake schedule
  • Don’t drink or eat caffeine four to six hours before bed and minimize daytime use
  • Don’t smoke, especially near bedtime or if you awake in the night
  • Avoid alcohol and heavy meals before sleep
  • Get regular exercise
  • Minimize noise, light and excessive hot and cold temperatures where you sleep
  • Develop a regular bed time and go to bed at the same time each night
  • Try and wake up without an alarm clock
  • Attempt to go to bed earlier every night for certain period; this will ensure that you’re getting enough sleep

I will definitely be heading to bed early tonight. I already do many of the other recommendations and usually sleep pretty well. Maybe that is why I am so discombobulated when my sleep is disturbed.

How often is sleep deprivation a problem for you? Has it become chronic insomnia? What do you do about it? How can we prevent this epidemic of sleep deprivation from undermining our lives?

Please share your experiences, your comments, your yawns 😉 below.