Psychotherapy Finances

The Veterans Administration Office of Inspector General has published a scathing report on veterans’ access to mental health care. The review was requested by members of the House and Senate who believed that veterans were not getting treatment in a timely manner.

They were correct in their suspicions, according to the report.

Veterans Health Administration policy requires that members are seen and assessed within 24 hours of a request. That’s to be followed up with a comprehensive treatment plan within 14 days.

But the report maintains that data used by the VA to support its conclusion that it meets that requirement are flawed.

“Using the same data VHA used to calculate the 95 percent success rate shown in the [Fiscal Year] 2011,” examiners wrote, “we selected a statistical sample of completed evaluations to determine the starting and ending points of the elapsed day calculation.

“Our analysis projected that VHA provided only 49 percent (approximately 184,000) of their evaluations within 14 days. On average, for the remaining patients, it took VHA about 50 days to provide them with their full evaluations.”

The process for follow-up appointments was equally sloppy, the report contends. “For established patients,” examiners said, “medical providers told us they frequently scheduled the return to clinic appointments based on their known availability rather than the patient’s clinical need. For example, providers may not have availability for 2–3 months, so they specify that as the return to clinic time frame.”

The report conceded that staffing has been inadequate, even though mental health services staff increased 46 percent from 2005 to 2010. They treated 39 percent more patients, but they “still did not believe they had enough staff to handle the increased workload….”

They recommended that the VA put better data collection practices in place, and review staffing levels to find out if vacancies are “a systemic issue” and if so, develop a plan to deal with it.

* * *

Most people have heard of the Occupy Wall Street movement, but a related protest last weekend in Philadelphia didn’t get much media attention. It was the “Occupy the American Psychiatric Association,” a group that marched outside the APA’s annual convention.

They were protesting the upcoming publication of the DSM-5, the new diagnostic manual for identifying and classifying mental illness. Some critics have argued that the proposed manual goes too far in creating new diagnoses when at least some of the issues are normal reactions to everyday stressors.

During the event on Saturday, May 5, Occupy protesters held “a label rip” — tearing up papers containing diagnoses named in the new manual.

“Don’t medicalize natural emotions,” one of the signs at the protest read. To see a 4-minute video recorded at the protest, click here.

For a professional analysis of the DSM-5, read this article published by the Philadelphia Inquirer on May 4.

Health care professionals aren’t the only ones complaining that the parity law hasn’t been implemented. Mental health treatment advocates Jimmy and Rosalynn Carter say the problem is a source of “huge frustration” for them, according to a new article in Medscape Medical News. (Free registration required.)

Speaking to the Association of Health Care Journalists in Atlanta, former President Carter was asked why equal coverage for mental illness hasn’t gone into effect despite the law being passed four years ago. In some states, such as Florida, the American Psychological Association has accused insurers of ignoring the requirement and slashing reimbursement rates for psychologists. Read the Oct. 5 APA letter to HHS Secretary Kathleen Sebelius on this issue by clicking here.

Carter said he thinks parity delays are “the political consequences of an election year. Excuse me for being so blunt.”

Rosalyn Carter said she blamed the hold up on insurance companies, and an administration that hasn’t been forceful enough on the issue. “You don’t know how many times I’ve called the White House to talk about this, but nothing seems to be done,” she said.

On a side note, Carter told journalists he’s “not confident” that the U.S. Supreme Court will “make the right decision” on the constitutionality of the Affordable Health Care Act. “If they strike it down we’ll have to start over, and more people in this country will end up suffering,” he said.

* * *

ValueOptions has landed a contract to provide EAP services to 60,000 members of the U.S. Coast Guard and family members, the company announced. It’s a one-year contract with an option to renew for four additional one-year terms.

Services will include substance abuse treatment and treatment monitoring, financial counseling, critical incident stress management, and deployment-related counseling.

* * *

The I-4 corridor in Central Florida will be awash in politicians and psychologists this August. First, the American Psychological Association will hold its annual meeting in Orlando at the Orange County Convention Center August 2-5.

The APA says on its convention home page that this year’s sessions will cover “immigration, racism, eating disorders, clinical practice, social networking and psychotherapy.”

Just up the road in Tampa, the Republican Party meets for its national convention three weeks later, from August 27-30.

Issues aside, both meetings are sure to benefit some of America’s most treasured institutions: Disney World, Sea World, Universal Studios and Bush Gardens.

- John Nelander, Contributing Editor

Therapists have a tough enough time marketing their practice, and managed care reimbursement rates have remained steady or fallen. But there may soon be more competition to contend with as a result of a computer game developed by researchers in New Zealand.

Called SPARX, the CD-ROM based game is available at sites around New Zealand to help young people deal with depression. In a study, the game was equally effective in treating depression as standard treatments comprised of mainly face-to-face therapy. Benefits include low cost and easy access.

According to the study, published in the British Medical Journal, SPARX was tested at 24 sites that included youth clinics, schools and general medical practices.

Half of the young people at the sites accessed standard treatment for depression through their physician, school counselor or other health care provider, and half used the SPARX game. SPARX was at least as good as the standard treatment, according to ScienceBlog.com.

“Using computer technology that young people are comfortable with is one way of making therapy more accessible, practical, and hopefully more fun,” says Sally Merry, associate professor of psychological medicine at the University of Auckland.

One in five New Zealanders experience depression before their 18th birthday, but 75% are never treated for it.

* * *

Fewer graduating U.S. med school students are going into psychiatry this year. In 2010, 670 graduates opted for psychiatry residency programs, a number that dropped to 640 last year. This year, 616 are headed into the program, according to Psychiatric News.

That’s 3.9% of graduating seniors, the lowest percentage in six years.

There were 1,118 positions offered this year and 1,096 of them were filled. Those not filled by U.S. seniors go to international students, graduates of osteopathic schools and medical school graduates from past years.

In a separate article, Sandra DeJong, chair of the recruitment committee for the American Association of Directors of Psychiatric Residency Training (AADPRT), blamed several factors for the drop including stigma about mental illness and psychiatry, uncertainty about health care reform and reimbursement issues.

- John Nelander, Contributing Editor

UnitedHealth Group earnings were up 3% in the first quarter on 7% revenue growth, impressing Wall Street investors, the company announced Thursday. A major reason for the good showing: people are putting off major medical procedures and going instead for a quick fix, which is saving insurers money, analysts told the Minneapolis Star Tribune. The company is based in nearby Minnetonka.

Also, patients are avoiding emergency rooms and heading to urgent care centers.

Sheryl Skolnick, an analyst who follows UnitedHealth for CRT Capital Group in Stamford, Conn., told the paper that people are “being very cautious about how they spend their health care dollars. If a doctor gives them the choice of a fix or a painkiller, they’re taking the painkiller.”

Financial analysts say investors are worried, though, about the U.S. Supreme Court decision due in June. If the Affordable Health Care Act is struck down, and the insurance mandate dissolves, it will probably mean less revenue for UnitedHealth and other insurers in the long run.

* * *

Social media websites are cracking down on material that promotes anorexia and other eating disorders, ABC News reported this week. Tumblr, Facebook and Pinterest said they would remove pro-eating disorder posts and links to websites that offer such information as how to cover up eating disorders.

A statement on Tumblr announced: “We aim to sustain Tumblr as a place that facilitates awareness, support and recovery, and to remove only those blogs that cross the line into active promotion or glorification of self-harm.”

Hospitalizations dropped 23% for eating disorders between 2007 and 2008, the first time they have decreased since tracking for the problem began in 1999. But skeptics say the real reason for the decline is a loss of health insurance coverage, not an actual drop in the number of people struggling with the condition.

* * *

WELLNESS ON THE WEB: Aetna has hooked up with the online Mindbloom Life Game, making its services available to members and employees. The “Life Game,” according to Aetna “blends the principles of behavioral science with social gaming to offer a fun, simple and effective way for Aetna to inspire people to live healthy, productive and balanced lives.”

It’s an interactive service that encourages the user to set behavioral goals and keep track of their progress. The company’s move was announced April 11.

The website Mashable Business describes the Life Game this way: “Mindbloom’s Life Game is based on the central concept of a tree as the metaphor for a user’s life. By choosing a series of areas to focus on maintaining and improving — for example, health, creativity, relationships and so on — users see those facets of their lives represented as different parts of the tree.

“They can then in put a series of smaller benchmarks — such as completing a set of push-ups, practicing guitar scales or spending time with family — that aim toward larger goals. If they achieve their smaller tasks, then different areas of their tree grow. If not, then that growth remains stunted.”

Aetna claims the game is also way for members to manage stress and boost creativity.

What’s better than being a psychologist? Well, being a medical secretary, according to a new Best and Worst Jobs of 2012 published by CareerCast.com. Based on factors that included physical demands, work environment, income, stress and hiring outlook, psychologists came in at No. 41 out of a list of 200 occupations.

Right behind them were psychiatrists at No. 42. Medical secretary came in at No. 39 and physicians in general practice were 38th on the list. The top-ranked health care occupation, according to CareerCast, was a dental hygienist, ranked at No. 4.

Other medical professions ranked in the top 50 were: occupational therapist (7); speech pathologist (11); optometrist (12); physical therapist (13); pharmacist (14); dietician (17); chiropractor (19); orthodontist (23); podiatrist (24); dentist (32); registered nurse (38); optician (44); surgeon (45); respiratory therapist (46); and medical records technician (50).

Social Workers came in at No. 51.Marriage and family therapists were not ranked, nor were professional counselors.

The most undesirable health care occupation was a dental laboratory technician, listed at No. 134. The worst occupation overall, according to CareerCast, was a lumberjack, right behind dairy farmer and enlisted military soldier.

The best job was software engineer, only slightly better than an insurance actuary, which came in at No. 2.

Much of the survey, not surprisingly, is based on job demand and pay. Software engineers are commanding a median income of $88,142 per year, according to The Wall Street Journal. Lumberjacks start at between $12 and $13 per hour, the paper said.

- John Nelander, Contributing Editor

The National Alliance of Professional Psychology Providers (NAPPP) has a long history of blasting the trend toward physicians prescribing patients pharmaceuticals as a first-line of treatment for mental disorders. Last December, the organization contracted with a producer to make a pro-psychotherapy video to be aired on PBS, Fox News and CNN.

This month, NAPPP put a rough edit of the video on its website. “Keep in mind that this is a first edit,” John Caccavale, a member of the organization’s executive board, says in the new issue of The Clinical Practitioner. “The final will be available in a few weeks and in HD quality for TV broadcasting.”

Caccavale and other board members hope the video will reach 60 million viewers over the next year in a bid to confront the shift of mental health care to primary care physicians “head on. Psychologists must become ‘the adults in the room’ before it’s too late,” he says.

The video begins by setting up the argument: “The brain is the most complex organ in the human body, and perhaps the most remarkable,” a narrator says. “But one in five Americans will suffer at least one form of mental illness in his or her lifetime.”

It goes on to talk about the “over-prescribing of psychotropic drugs as a first line of treatment by primary care physicians who may be unqualified to treat mental disorders… [which] has been a concern of many mental health professionals.”

Drugs treat only the symptoms of problems like depression and anxiety, Nicholas Cummings, another executive board member and a former president of the American Psychological Association, says in the film. “If you give aspirin for a headache,” he says, “the person may get temporary relief from pain, but then may also die.”

In an article accompanying the release, Caccavale concludes: “Medications have their place in some treatment plans but not without an appropriate role for doctoral level psychologists.”

The watch the video, click here.

* * *

Origins of the field of sports psychology were spotlighted–just in time for the opening of the 2012 baseball season–in the APA’s April issue of the Monitor on Psychology.

It tells the story of a Illinois psychologist Coleman Griffith, who was hired by Chicago Cubs owner Philip Wrigley to help bail out the 1938 season. The Cubs had tried everything that year, including bringing in a guy “in a checkered suit” to “put a whammy” on opposing teams.

But Griffith didn’t have any more success than the “unnamed voodoo expert,” according to the Monitor. In fact, manager Charlie Grimm was disgusted by the idea and ordered his players not to cooperate with the “headshrinkers.”

“Wrigley watched and did nothing,” says the Monitor. Griffith was kept on the payroll until 1940, after which he returned to the University of Illinois. Other managers looked at the experiment as a failure, but Griffith was declared “America’s first sport psychologist” in 1970.

- John Nelander, Contributing Editor

Delivering mental health services via Skype and other web-based videoconferencing has continued a slow climb to respectability. It is becoming particularly important in public health programs like Medicaid, and in rural areas where there’s a shortage of mental health professionals.

Arkansas is the latest site of expansion in this area.

People under 21 who are dealing with mental health issues will be able to get checkups via videconferencing under a new state Medicaid proposal in Arkansas.

Initial assessments would be face-to-face, but teens and young adults diagnosed with schizophrenia, depression and attention deficit disorder would receive follow-up treatment over the Internet.

“We have psychiatrists having to drive all over the state and children traveling outside their hometown,” department spokeswoman Amy Webb told the Associated Press. “This will allow (doctors) to interact without all the traveling and give them more time to be doctors.”

Telemedicine was approve for adults 21 and older in 2000. If the proposal is approved by the state’s House and Senate Interim Committee on Public Health, the program will expand to include youths in mid-May.

* * *

Facebook time can lead to depression in young girls, a psychologist says. The more Facebook friends she has, the more likely she is to become depressed.

The reason is that girls tend to post only positive events–and reading the posts offer a distorted view of reality, Leonard Sax, author of the book, Girls on the Edge, told Fox News.

He explained: “Girls post the happy things and they turn the camera on themselves so it’s ‘look here at what I’m doing. Then they look at all the other girls’ Facebook pages, look at them being happy and think, ‘my life sucks, look at all the things those girls are doing and how much fun they’re having.’”

They don’t understand that people are intentionally trying to make themselves look good. And the focus on Facebook activity comes at the expense of forming strong personal relationships with friends in reality, not just online.

More than two years after the incident occurred, Blue Cross Blue Shield of Tennessee has settled a HIPAA violation claim with the U.S. Department of Health and Human Services and the Office of Civil Rights. The security breach cost BCBST $1.5 million.

Details of the case and the agreement, reached March 13, were posted on the HHS website and can be found by clicking here.

The case dates back to Oct. 5, 2009, when BCBST employes found out that computer equipment had been stolen three days earlier from a “network data closet” in the company’s Chattanooga office. The theft included 57 hard drives with encoded electronic data pertaining to more than 300,000 video recordings and a million audio recordings.

Also stored on the disks were protected health information of over a million members such as diagnosis codes dates of birth and Social Security numbers.

The data had been left in the storage closet after a BCBST move earlier in the year. Security had been turned over to a property management company. It was secured via biometric and keycard scanners with a magnetic lock, plus an additional door with a keyed lock.

BCBST agreed to pay the fine, although the company does not admit liability in the agreement. The company did, however, agree to a corrective action plan.

On the website Legal Health information eXchange, attorney Helen Helen Oscislawski wrote a post on Monday (Peeling Back BCBS’s $1.5 Million HIPAA Settlement Onion) in which she said she found the agreement “instructive and frightening.” BCBST reported the security breach within the necessary legal time frame, she said, and the precautions taken could have, arguably, been enough to show that they were in compliance.

She noted that the breach was the result of a criminal act.

“However, at least for [BCBST], apparently the costs and burden of going through an investigation to prove that the Breach was not due to an underlying lapse its HIPAA compliance program was not worth it, at least not $1.5 Million,” she said.

It seemed as if HHS was more concerned about BCBST’s overall HIPAA compliance program than it was about the security breach itself, she added.

She suggests that covered entities review any contracts they may have with third parties that have access to protected health information and provide “clear language regarding allocation of responsibility for security ….”

- John Nelander, Contributing Editor

Several times over the past 10 years, We’ve talked about the marketing advantages of incorporating sports psychology into your practice. It’s virtually all cash and there are no insurance hassles to deal with.

But there’s the implied requirement that the therapist must be a participant in the sport the client is seeking help for. You should know how to speak the client’s language.

While that’s true to a great extent, some therapists have expanded the definition of sports psychology to include the broader category of performance psychology. This can apply to almost anything, but particularly to the business world, where the right frame of mind can make all the difference between success, mediocrity or even failure.

Now, the American Psychological Association has hopped onboard with its own recommendations in this area. In its new Psychology Help Center, the APA’s Robert Singer, former president of Division 47 (Exercise and Sports), discusses how sports psychology can help anyone on the job.

“Psychologists aren’t just sharing sport psychology ideas with patients; they’re also working with corporations eager to think of themselves as winning teams in an era of downsizing,” Singer says. “Although their employees aren’t facing Olympic competition, they are facing the stress of trying to increase productivity while lowering costs, the stress of working long hours on jobs that might take weeks or months, and the stress of fitting into a team where individual goals have to fit into group goals.”

Approaches to success include using visualization to reduce stress and build confidence — just as athletes do before a big game.

As a clinician, you may not be all that interested in golf, tennis or football or baseball. But you can still expand your practice by using many of these techniques and calling it performance psychology. People are looking for an edge in a very competitive job market these days, and they’d pay good money to fine one.

* * *

The idea of mobile mental health services pops up now and again. This time it’s happening in Salt Lake City, where Mayor Peter Corroon has gotten behind it in a big way.

Last week, he announced the creation of a mental health crisis unit for county residents. It’s a partnership between Salt Lake County, OptumHealth (United Behavioral Health) and the University of Utah. It operates 24/7 and will be dispatched when someone calls the county crisis line, or if requested by a law enforcement officer.

Each team has a licensed mental health and a professional and a Certified Peer Specialist.A psychiatrist is available by phone.

The team conducts a psychiatric assessment with the goal of stabilizing the individual. The person is then referred to community mental health resources and someone from the team later follow up to make sure the individual is keeping the appointments.

* * *

Psychiatrists, licensed clinical social workers and psychologists have been breathing sighs of relief now that the “Medicare Fix” is in place for the remainder of 2012. But as Psychiatric News points out in this week’s issue, each time a permanent solution is put off, a larger cut looms down the road.

The next cut on the horizon, in January of 2013, will be 32%, according to the magazine.

The American Psychiatric Association’s Medical Director, James Scully Jr., complained in a statement: “Every year that Congress puts off repealing the [Sustainable Growth Rate] just adds to the final cost. We are also deeply concerned that the ‘doc fix’ is paid for by cutting bad debt and disproportionate-share payments to those hospitals that are caring for the nation’s indigent patients.”

The Mental Health Parity and Addiction Equity Act went into effect in 2010. It’s been about a year since health care companies were required to incorporate the law’s provisions into their plans. Implementation has not been smooth.

Some managed care companies have put up additional obstacles in an effort to monitor and control the flow of mental health services, professional provider associations have alleged. According to the American Psychological Association, Blue Cross Blue Shield of Florida proposed a 33-54 percent cut in reimbursement rates for psychologists, which the APA says violates the parity law.

The cut was applied only to mental health services, and a letter sent to the company by the APA says the move “violates the Interim Final Rules” on parity, which were issued in February 2010. To read the letter, click here.

Now, the American Psychiatric Association complains that the federal government itself is putting parity at risk by giving states the opportunity to define minimum “essential health benefits” in their own way. Psychiatrists submitted a written objection to the feds’ approach at the end of January.

Under the proposal by the Department of Health and Human Services (HHS), states could choose one of four plans as a benchmark: one of three smallest plans in the state; one of three largest; one of three largest federal employee health plans; or the largest commercial HMO.

Psychiatrists believe that HHS should provide specific regulations aimed at parity and provide guidance for mental health components of state minimum plans. That’s the only way to make offerings are uniform throughout the country, they say.

To read the Jan. 31 letter from the American Psychiatric Association, click here.

*

Mental health professionals often complain about the way they’re portrayed in the media. The National Association of Social Workers is taking this problem more seriously by holding a “Media Awards 2012″ event, in which members vote for the documentary, feature film, or TV program that best captures promotes social work. Newspaper and magazine articles are included, too.

Social workers are being invited to vote online.

Among movie nominees, the NASW has chosen: Oranges and Sunshine, about British social worker Margaret Humphreys; Appropriate Adult, another movie based on the life of a British social worker; and Change of Plans, a TV film in which a social worker helps a couple adult children who lost their parents in an accident.

- John Nelander, Contributing Editor