[PC-BH-Integration] New to List

Fri Mar 13 10:12:20 EDT 2009

I am absolutely sure that the standard mental health treatment is not what
can be done at this point and personally have found the consultation focus,
as you mentioned, is where I feel the best work is being done.  The problem
is the clinic is having difficulty financing that kind of intervention.  I
think we agree that that model is the one that is indicated here.  So to
some degree, I feel caught between a rock and a hard place.  The Clinic
is underfunded in many areas and has a large percentage of clients who are
unisured.  The MDs and APRNs I think would agree that brief consultations
and connecting the patients to mental health outside of the clinic, and
recc. for other services.  The problem is how best to bill or show the value
of the consultation model when money is the driving force in this economy
for this Clinic.  I would so appreciate your guidance as I believe you are
clearly getting the hurdles here and I am at a loss for how to resolve the
issues.

Thanks so much for your thoughts.  I look forward to hearing more.  Jody

On Thu, Mar 12, 2009 at 4:37 PM, Trusa Grosso <grossot at cfmh.org> wrote:

> 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
> http://lists101.his.com/mailman/listinfo/pc-bh-integration
> or call Bob Beckwith at (301) 984-6200
> _______________________________________________
> 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

This email and any files transmitted with it may contain information that is
confidential under the Health Insurance Portability and Accountability Act
of 1996 (HIPAA) and is intended solely for the use of the individual or
entity to whom they are addressed.  Be advised that disclosure, saving,
printing, copying or taking any action in reliance on the contents of this
message are strictly prohibited.  If you have received this email in error,
please notify the original sender immediately and no one can make you feel
either by telephone No one can make you feel inferior without your consent.
ephone or by reply email and delete the message and any attachments from
your computer.
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