Healthcare Reform: What part will you play?

One of the largest challenges for the small employer (like us) is providing health insurance coverage for our employees. While wages are our largest single expense, we spend an additional 11% of that amount to purchase health insurance for our employees. The costs of that coverage have increased every year that we have offered it. As a basis of comparison, we have increased our product prices at something closer to five year intervals (2001 and 2006). Those of you who work in the private sector may have implemented price increases in your organizations more frequently than our once in five years, but those in the public sector have found your “fees” (dollars earned per unit of service provided) diminish significantly. No matter where you are in this equation, you have seen the cost of healthcare—physical and mental health—skyrocket in the course of your working life.

President Obama is working to pass Healthcare Reform that will diminish the ongoing increases in the cost of healthcare. On Monday, he announced and the NY Times reported that the major players in the healthcare arena, doctors (American Medical Association), hospitals (American Hospital Association), drug makers (Pharmaceutical Research and Manufacturers Association) and insurance companies (America’s Health Insurance Plans), along with the  Service Employees International Union, had voluntarily agreed to reduce costs of health care by 1.5% per year over the next 10 years. The dollar amount of this reduction is a whopping $2 trillion…a figure so large that it is almost meaningless to us lesser mortals.

While no one gave any details, it is clear that this huge public relations event was intended to place these players in a good and cooperative light. It is also clear that they offered voluntary reductions hoping to avoid mandates. They did not offer to remove opposition to a public health insurance plan modeled after Medicare from which Americans could buy insurance rather than from a private insurer.

In all of the articles I read on this announcement, mental health / behavioral health was not mentioned at all. While the National Council reports  that Americans with serious mental illnesses die an average of 25 years sooner than other Americans with three-fifths of those individuals dying from preventable, chronic diseases like asthma, diabetes, and heart disease, the seriously mentally ill appear to be nonexistent in the Obama administration’s world. It would seem that people who utilize such a significant quantity of healthcare resources might be an important group to consider.

Paul Krugman, the Nobel prize winning economist who writes for the NY Times, sees Monday’s announcements as unlikely to guarantee anything…but as an extremely hopeful event. It is the first time these major industry groups have said that they are willing to participate in cooperative endeavors to reform our healthcare system. Maybe something positive will come out of the efforts this time.

How do you imagine your organization will be impacted by healthcare reform? What kind of transformation would be most likely to help your provider organization? What variety of restructuring will help your clients? And what changes will help you as a consumer of healthcare services? What kind of reform would you like to see?

Please add your comments to this discussion by clicking on the title of this article and entering your thoughts in the box at the bottom of the article.

Measuring the Quality of Mental Health Treatment

This week’s entry is a guest article by Dr. Vince Bellwoar, a psychologist user of our software whose practice is located in Pennsylvania. Vince posted a question on our SOS user group about how other users measure quality of care. This spurred significant discussion on that group. I am hopeful that it will also stir up some discussion here. -Kathy

 

Our practice has always aspired to provide excellent quality. What business hasn’t? This article is meant to stimulate discussion as how to address and improve the quality of clinical practice.

We emphasize two points in hiring: 5 years of solid clinical work and very good people skills. If we can’t imagine a range of patients connecting with you, we are not hiring you. The next step is to monitor how well the therapist holds patients. Billing software with decent reporting capabilities can be an invaluable resource here.

Patients who stay in treatment tend to get better, and as they improve, they’ll refer others. In contrast, therapists who lose 40% of new referrals by the 3rd session usually are doing so out of errors of omission or commission. Our billing software allows us to mine the data that tells us what percent of new referrals continue with each therapist after the 3rd session. Granted, this is a blunt assessment tool; and so we have searched for other means of assessment.

After my car is in the shop for service, I get a call asking, “How did we do?” We tried something similar with a patient satisfaction survey sent to patients whose last treatment session was more than six weeks ago. (This assumes that a six week break from treatment meant the client was done with treatment for now). Unfortunately, the return rate was only 10% even though we provided stamped return envelopes or used email. Our next attempt will be to put the survey in waiting rooms with large signs encouraging completion. We want to keep the surveys out of the treatment session as many believe this could change the nature of the treatment session.

There are numerous satisfaction surveys out there. I find the ones constructed by insurance companies are particularly bad, not to mention self-serving. They see success as getting patients out of treatment ASAP. We constructed our own survey, yet it doesn’t seem to get at the heart of the matter: what was specifically helpful or not helpful in the therapy session. What did the therapist do (commit) or not do (omit) that made the treatment better or worse?

Our next survey version will pose these open-ended questions. I hope that this will generate the type of quantitative and hearty data that can complement the qualitative data from our billing software—and ultimately be beneficial to therapists.

Our goal is to identify what happens in a therapy session that makes a therapist “good”. Then we can give the therapist concrete, usable feedback that encourages improvement. We want people who are interested in this type of feedback, whether they are a therapist, secretary, psychiatrist, and, yes, even the owner!

I welcome your feedback.

Vince Bellwoar, Ph.D.
http://www.springfieldpsychological.com

Mental Health and e-Health News Bits

Running a mental health practice or community organization is a demanding endeavor and probably gets in the way of reading some of the huge volumes of info out there. I just thought I would share some quick bits and pieces of information you might find useful.

1.   ICD-10 Update: Last October 31, I posted information about an October 2011 deadline for implementing the ICD-10. HHS has relented and set a new deadline of October 1, 2013 for adoption of the diagnosis and procedure system.  The code sets are complete and available for your information at the HHS web site. An informational document will give you the scoop.

(Reported in Healthcare Informatics on January 16, 2009.)

2. Community Partnership of Southern Arizona has links on their website that many will find useful. They have collected state-by-state information on the following 19 items for all 50 states: Mental Health Authority, NAMI (National Alliance on Mental Illness), Mental Health America, Protection and Advocacy,  2-1-1 Human and Emergency Services, Employment Services, Vocational Rehabilitation Services, Medicaid Authority, Housing Authority, Homeless Information, Food Bank Locator, Food Stamp Program, Resources for Individuals with Disabilities, Psychiatric Advance Directives, Suicide Prevention, Civil Commitment Statutes, National Council: Providers, National Council: State Association, Child Welfare Information, and Department of Education.

3.  Evidence Based Practice Toolkits are available from SAMHSA. Six toolkits are currently available for public use. If you have been considering implementation of EBP in your organization, these toolkits are a good place to begin.

(Reported in the January 15, NJAMHA Newswire.)

4. HIPAA: I have come upon a wonderful way to keep up with and understand all things HIPAA-related. Hipaa.com is a web site devoted to education about HIPAA and has some outstanding articles. You can subscribe to their blog and follow them on Twitter.

What would you like us to discuss in this space? Are there kinds of information that are more useful than others? Let us know which topics you find most important.

To leave your comments, click on the title of this article and enter your message in the box at the bottom of the page.

Mental health practice and the financial crisis

I have been thinking a great deal lately about the current financial crisis and how it is affecting our customers and their clients/patients/consumers. Every day, the top news stories are about some aspect of this recession. American Psychological Association (APA) reports in the Monitor on Psychology article Money is the top stressor for Americans that money and the economy are the primary stressors reported by 8 out of 10 people surveyed.

When I practiced psychology, there was a belief that the mental health business was somewhat recession resistant. The thought was that people who are worried about money do everything possible to stay in therapy. But how long can that last? Now that this recession has been with us for a year, it has had the opportunity to spread further than many would have predicted. My colleagues at the Software and Technology Vendor Association (SATVA) meeting I attended in November described the impact that state budget crunches would have on Medicaid and community mental health centers that rely upon that source of funding. Florida is seeing a significant number of foreclosures and layoffs, as are most states. While a client has a job, they may have insurance to cover psychotherapy; after layoff, insurance disappears and the help a client needs can go right along with it.

One of the truly remarkable things about this ongoing crisis is how it emphasizes the personality style of each person in our lives. Those who see the glass as half empty do their best each day, however successfully, to continue to move forward in a positive way without becoming depressed. They may avoid negative information, or they may become obsessed with it. Those who see the glass as half full see opportunity to prosper. They are ever hopeful that the upturn will begin tomorrow; and even if it does not, they will find creative ways to benefit during difficult times.

APA will report in the January issue of the Monitor about the impact of the new economic realities on the field. But I am impatient. I wonder how you are being affected now. Is your organization going on with business as usual or are you seeing cutbacks? Is hiring frozen or does money to fill positions continue to be available? Are your clients feeling the crunch? What do you see for the short and the long term? What is your personality style and how does it affect the way you do business? Are you stopping all spending or buying new computers with 2008 profits? Where do you expect to be financially in the next month? in the next six months? in the next year?

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The big toe is in…

For the past couple of months we here at SOS Software have been toying with the idea of starting a blog. Stepping into the blogosphere is intimidating to me. As our customers know, Synergistic Office Solutions is a small company providing medical and mental health practice management software and mental health clinical records. Our staff range from highly technical geeks (developers) to extremely knowledgeable software gurus (tech support), all the way to what I fondly call competent end users (the rest of us). I am very much in the latter category although SOS President Seth Krieger would argue the competent part of that description as applied to me. Having my own in-house support team is very important to my successful functioning.

Even though I am not the most technical of our crew, I am connected into the events occurring in the general and behavioral healthcare community that affect the daily lives of SOS customers. I often come upon articles and topics that I am sure would benefit others, if only they had time to locate and read them. And I always want to know what our customers think about what is happening in the world of the behavioral health and medical provider.

And so, the SOS blog is born. Seth and I will use this space to talk about developments in the healthcare  Information Technology (IT) arena. We will discuss changes in the way providers must serve their clients and what is required of them to obtain payment. We expect to explore extensively the move toward electronic medical records (EMR) and e-prescribing. And we will sometimes invite others to write an article about their perspective on the world of practice management and healthcare technology. With every entry we invite your input. A blog is a conversation, so please talk to us! Got topics? Send them to us. Your comments, questions, and insights are all welcome. We’ll do our best to respond to them in a timely fashion when that is appropriate.

My first offering is a great article for those of us who fall into that competent end user category or who are novices to the computer world. David Pogue is a New York Times columnist and CBS News correspondent on the world of technology. On October 2, 2008, his column Tech Tips for the Basic Computer User was just what it says. If you fall into the geek category, his tidbits may be common knowledge for you. If you are like me, you will be delighted.

Thanks for reading SOS at-large. Please come back.
Kathy

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