[PC-BH-Integration] New to List

Fri Mar 13 11:36:30 EDT 2009

Hi, I've been following the list but haven't ever replied.  Great work
everyone's doing out there...
I have worked in primary care for about 3 years off and on and my
personal model is to stick to hour long visits as well as being
available for warm hand-offs even though it doesn't fit into the
prevailing culture in primary care.  What I find is by doing this I
provide a higher quality of care and am often able to give the providers
more feedback than if I was to do a briefer session.  Also, we use
community support workers to do case management and skills building
(goal oriented) type sessions to take care of the more behavioral type
interventions (collaborative model).  In addition the CSWs are available
for warm hand-offs when I'm not, which is often now that I'm booked.
Once my schedule is full I intend to hire another therapist to see the
patients that have to wait more than a week to see me.  The idea is that
I don't lessen quality and still keep up with the flow. 

Jon May, LISW
El Centro Family Health
Las Vegas, New Mexico, 87701
505-425-6788

-----Original Message-----
From: pc-bh-integration-bounces at lists101.his.com
[mailto:pc-bh-integration-bounces at lists101.his.com] On Behalf Of Trusa
Grosso
Sent: Thursday, March 12, 2009 2:37 PM
To: pc-bh-integration at lists101.his.com
Subject: Re: [PC-BH-Integration] New to List

Jody,
It sounds like you may have to step back and ask yourself if you are
trying to put a square peg into a round hole.  That is to say are you
trying to provide traditional mental health services in a primary care
setting?  Both you and the health center staff sound frustrated trying
to make this work.  I have found that primary care and mental health
have very disparate cultures and expectations.  Primary care is very
fast paced and not particularly amenable to hour-long assessments or
therapy sessions.  Primary care providers traditionally want immediate
consultation and a care plan that includes recommendations for what they
are to do next.  If we as mental health providers are to effectively
work within the primary care service delivery system, we have to adopt a
consultative practice pattern with brief, time-limited follow up.
Otherwise, you end up with a backlog of patients who can't get in to see
you.  
I suggest you sit down with the health center and address expectations
from culture right down to billing and work flow.  Certainly making use
of the medical codes will go a long way, but not every case fits in that
category. Then search the literature for the right integration model
that will meet the expectations of the health center as well as your
organization.  I have never had the pleasure of attending the training
at U Mass, but you may find it helpful in enhancing your practice
patterns to coincide with the needs of the primary care setting.  Good
luck!

Trusa Grosso, LCSW, DCSW
Director of Satellite Operations
The Center for Mental Health, Inc. 
Noblesville, IN
(317) 776-3730

-----Original Message-----
From: pc-bh-integration-bounces at lists101.his.com
[mailto:pc-bh-integration-bounces at lists101.his.com] On Behalf Of Mary
Jean MORK
Sent: Thursday, March 12, 2009 12:09 PM
To: pc-bh-integration at lists101.his.com
Subject: Re: [PC-BH-Integration] New to List

Hello, Have you considered using the Health and Behavior codes if you
are offering behavioral support for a medical diagnosis? These are
specifically intended for medical concerns, and not mental health
diagnoses - when there is an underlying physical illness or injury where
a biopsychosocial factor may be affecting the medical treatment. The
Medicare rules are fairly clear about the intention and documentation
required. Medicare in some regions (like ours in New England) limits
this to PhD's only, but the states can decide if Medicaid will allow
LCSW's to also deliver this. Our state (Maine) does. Because kids
generally have Medicaid (or Commercial) and not Medicare, this is worth
looking into. Let me know if you want any more specifics. Thanks, Mary
Jean

Mary Jean Mork
Program Manager
SHH/MMC/ Maine Health
39 Forest Ave
Portland, Maine
662-2490

>>> Jody Rowell <jrowell at cliffordbeers.org> 2/14/2009 10:55 AM >>>
Hi, our primary care integration with a FQHC is failing.  As an LCSW I
am
there for 4 hours a week.  I have been providing consultation to the
medical
clinicians, seeing kids and their parents briefly, and hooking them up
with
other MH external services as indicated.  Because I am the only child
therapist there it doesn't seem particularly helpful to do a full hour
assessment (90801) to provide a few sessions, especially since there is
an
enormous amount of backlog.  In addition, I would need a translator with
me
for a large majority of the assessments and treatment.  Currently there
are
over a 100 kids on the shared list.  Our MH clinic is billing the FQHC
for
my time.  The FQHC is struggling financially and is feeling that they
cannot
continue to pay for my presence even though they find it valuable.  I am
not
billing enough to cover my time there.  Upcoding through FQHC codes is
nearly impossible because most of the peds are reluctant to do the 10
min
warm transfer because of their own insane schedules.

If I sound a little desparate it is because I am worried that all the
work
we have done combined with the incredible need means we will loose this
project.

Any ideas would be very much appreciate.  Jody

On Fri, Feb 13, 2009 at 3:24 PM, Jaffy Phillips <jaffy at pobox.com> wrote:

> Hi,
>
> I've just recently signed up to join this list-serve. My impression is
that
> I am to send an email to this address by way of introduction? If so,
here
> goes:
>
> I've been practicing as a psychotherapist for several years, and am
> currently back in school for a Master's in Public Health, focussing on
> health policy. I have a strong interest in collaborative care, and I
am
> currently working on a research paper for the Massachusetts Health
Data
> Consortium, exploring the barriers to and possibilities for
implementation
> of shared electronic medical records between behavioral and
non-behavioral
> providers in Massachusetts.
>
> Thanks for letting me join in the conversation.
>
> Jaffy
>
>
> Jaffy Phillips, MA
> Psychotherapist in private practice
> Health Policy Intern: Massachusetts Health Data Consortium
> MPH student: Boston University School of Public Health
>
>
>
> _______________________________________________
> Reply to this message to send to the group
> Help can be found at
> http://lists101.his.com/mailman/listinfo/pc-bh-integration 
> or call Bob Beckwith at (301) 984-6200
>

-- 
Jody L. Rowell, MSSW, LCSW, Advocate
Clifford W. Beers Guidance Clinic
93 Edwards Street
New Haven, CT 06511
(203)772-1270 x-238 (203)772-0051 (F)
jrowell at cliffordbeers.org 

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_______________________________________________
Reply to this message to send to the group
Help can be found at
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_______________________________________________
Reply to this message to send to the group
Help can be found at
http://lists101.his.com/mailman/listinfo/pc-bh-integration
or call Bob Beckwith at (301) 984-6200

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