Psychotherapy Finances

More than 12% of emergency department (ED) visits were due to a mental health disorder or substance abuse, according to new data released by the U.S. Department of Health and Human Services.

The Agency for Healthcare Research and Quality (AHRQ), an arm of HHS, says almost 12 million emergency room visits fell into one of these two categories, or both, in 2007, the most recent year statistics are available.

Depression and other mood disorders made up 43% within this group, 26% were for anxiety disorders, and 23% were alcohol related. Other mental health related disorders were: drug disorders (17.6 percent); schizophrenia and other psychoses (9.9 percent); and intentional self-harm (6.6 percent).

Also, patients were reported to the ED with these problems were 2-1/2 times more likely to be admitted to the hospital compared with the general ER population.

The most common payers involved were Medicare (30.1%); private insurance (25.7%); uninsured (20.6%) and Medicaid (19.8%).

AHRQ researchers conclude: “Not only is this of concern to members of the mental health community, but also to the members of the emergency medicine community who are concerned that ED overcrowding results in decreased quality of care and increased likelihood of medical error.”

For the full PDF of the report, released in July, click here.

Marriage and couples counseling is a cornerstone of many therapy practices. The real question is, how do you carve out your own particular niche within that specialty?

A new book discusses one possible alternative: Marriages that are being wrecked by adult Attention-Deficit Hyperactivity Disorder (ADHD).

Actually, adult ADHD has been getting lots of ink in the press—it’s no longer a term that leaves the public puzzled. At Psychotherapy Finances, we’ve spoken to several therapists who have worked this niche into their practice with good success.

A new book coming out in September, The A.D.H.D. Effect on Marriage, is getting some attention in the commercial media, with a post this week in The New York Times’ Wellness Blog.

The book was written by Ned Hallowell and Melissa Orlov, who offer “marriage consulting” with a focus on understanding how ADHD may be impacting a relationship.

“Typically people don’t realize the ADHD is impacting their marriage because there’s been no talk about this at all,” Orlov told The Times. She says the disorder had been ruining her marriage before she teamed up with Hallowell, a researcher on the subject.

She said her husband was “consistently inconsistent. I could never count on him. It goes from feeling responsible for everything to just chronic anger. I didn’t like the person I’d become either.”

But the couple worked things out and are now happily married, The Times is pleased to report.

By the way, Orlov and Hallowell also publish a blog on this topic if you’re interested in finding out more about what could be a new and trendy niche market.

The potential for violence often looms in a therapy office, particularly when a clinician is working with a patient who has a serious mental illness. Two horrific attacks over the past five years illustrate the threat.

A psychologist was hacked to death in her Upper East Side office in New York two years ago by a man with a meat clever. The killer, who was caught, had come into the office looking for the psychologist’s colleague, a psychiatrist.

In 2005, San Francisco area psychologist Ira Polonsky was shot to death in his office. The masked killer was never found despite a $50,000 reward offered by the governor’s office.

A July 9 Psychiatric Times piece, Safety in the Evaluation of Potentially Violent Patients, outlines a few of the steps clinicians can take to lessen the threat. They include: maintaining a personal “safety zone” of at least four to six feet around you; staying at least two steps away from a patient who looks to be on the offensive; and making sure you have access to an exit door.

In previous Psychotherapy Finances pieces on this topic, clinicians have also recommended making sure there is furniture – such as your desk – between you and the patient.

After the New York murder two years ago, there was renewed discussion of installing panic buttons in therapy offices. But in extreme cases you may want to conduct interviews with the door open or another staff person present.

Statistics from the Crime Victimization Survey conducted by the Department of Justice show that the annual rate of nonfatal crime against psychiatrists was 68.2 per 1,000 people. The rate for all occupations is just 12.6.

Clearly, this is a subject that should be front and center when you’re developing office policies in your private practice. Planning for “what if” scenarios can help you reduce risk.

Psychiatry is the hot medical specialty of the coming decade, according to a July 1 piece in USA Today.

Merritt Hawkins, a national physician recruiting firm, reported receiving 179 requests for psychiatrists, according to the paper. That’s a blowout 121% increase from the firm’s 2006-2007 survey.

Psychiatrists were the third most requested physician after family practice doctors and internists. And the U.S. Bureau of Health Professions is forecasting a 100% rise in demand for psychiatrists by 2020.

But there’s a downside for those who opt for psychiatry, according to those already in the profession: Less income potential. Apparently that’s largely due to the “move-’em-on-through” philosophy of much of the medical profession.

Psychiatry, on the other hand, normally requires more patient contact.

“I get paid more for treating a zit than I get for sitting down for a half an hour talking to a patient,” one psychiatrist grumbled.

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Is mental illness over-diagnosed? A July 6 piece in Psychiatric Times raises the question, and it’s getting attention on mental health web listervs.

One study found that half of the general population qualifies for an anxiety disorder by the age of 32. Forty percent have diagnosable depression, and 30% qualify for alcohol dependence.

In, Normality Is An Endangered Species: Psychiatric Fads and Overdiagnosis, physician author Allen Frances asks: “Imagine what the rates will be like by the time these people hit fifty, or sixty-five, or eighty. In this brave new world of psychiatric overdiagnosis, will anyone get through life without a mental disorder?”

The full article is available at the Psychiatric Times website (free registration required).

The Department of Health and Human Services (HHS) launched its new consumer focused health care website yesterday at www.healthcare.gov. It’s supposed to become a “powerful tool” that consumers will use to find health insurance at competitive prices, as well as clinical information on diseases and prevention.

Of interest to private practitioners is this line in the news release that was published yesterday with the launch of the site: “The website will connect consumers to quality rankings for local health care providers as well as preventive services.”

Does this mean the new Healthcare.gov site will have a data base of practitioners ranked by consumers that can be accessed by prospective patients? I called HHS but a spokesman said he was swamped and didn’t have the details yet.

Second day of the launch and all that, and the site already contains 500 pages of content. That’s a lot of material to wade through—and right on the brink of a holiday weekend. (And such nice weather in Washington, too.)

So stay tuned.

One thing the site will have – eventually – is comparison prices for health care plans. This, we’ve been told, has irritated health insurance officials since some of their plans are closed but they were required to provide information to the feds anyway.

Naturally, everyone is on Twitter these days and HealthCare.gov is no exception. In the wee hours after the open, www.twitter.com/@healthcare.gov had just 11 followers, 0 followers and no tweets.

By this morning, there were 840 following, the site was following 12, and they’d posted two tweets.

Related: Speaking of social media, if you’re a TRICARE provider you can now receive updates about the military health benefits programs from Facebook and Twitter.

Find them at: www.facebook.com/tricare and www.twitter.com/tricare.