Psychotherapy Finances

With a new legislative year stretching out before us, psychologists are back to the task of trying to expand their prescription privileges beyond the two states that already allow the practice – New Mexico and Louisiana.

Psychologists suffered the first defeat of 2011 earlier this month when the Utah Legislature’s House Committee on Business and Labor overwhelmingly (11-2) shot down a proposal that would have allowed specially trained psychologists to prescribe psychotropic medication if they were in “a cooperative care model” with a primary care supervision.

“The bill is therefore dead for 2011,” The American Psychiatric Association reported in its March 7 edition of the newsletter, Advocacy Notes.

And now physicians, who have bitterly opposed the scope of practice expansion, are turning their attention to six other states that have similar legislation on the drawing board. They include Arizona, Hawaii, Montana, New Jersey, Oregon and Tennessee.

The argument put forth by psychologists is that patients have to wait too long to see a psychiatrist, especially in rural areas.

In Hawaii, prescription privilege legislation passed both houses in 2007 but was vetoed by Gov. Linda Lingle. (A bill in Oregon last year suffered a similar fate, but the proposal has resurfaced this year.)

This year Hawaii’s SB 597 has already passed the Senate’s Commerce and Consumer Protection Committee. It would allow psychologists with a master’s degree in psychopharmacology to prescribe after a one-year practicum.

If this legislation is passed and signed by current Gov. Neil Abercrombie, it would launch a five-year pilot project to begin on July 1, 2012.

Here’s a heads-up for therapists who offer substance abuse services. A new study released by the federal Substance Abuse and Mental Health Services Administration (SAMHSA) reveals that inhalant abuse has become a multi-generational problem.

It’s been assumed for years that “huffing” — inhaling chemical vapors to get high — was an issue primarily for children and adolescents. But according to the SAMHSA study, 54% of treatment admissions for this problem were among adults 18 and older.

Even more surprising: 52% were age 18-29; 32% were age 30-44; and 16% were 45 and older. The statistics were based on data collected from treatment facilities around the country.

SAMHSA now estimates that 1.1 million adults have abused inhalants over the past year. That’s more than the number of adults who used crack (988,000); LSD (637,000); heroin (571,000) and PCP (75,000).

SAMHSA details one case involving a 42-year-old mother who spent four years hooked on a chemical used to clean computers.

“I actually passed out driving one time when I was using and came to a stop in the middle of the road,” the mother said. “As much as I don’t like dealing with probation and all the money I have to pay out, getting caught probably saved my life. I know I wouldn’t have stopped. I couldn’t.”

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State officials painted an increasingly bleak picture of community mental health services in a report this week, citing deep cuts in budgets that help fund treatment to an estimated 6.4 million Americans nationwide.

Forty-eight states have cut funding for mental health services since 2009 at the same time demand for services is on the increase due to the recession and home foreclosure crisis. For the complete report, click here.

Should therapists be able to ask their patients if they own a gun? Absolutely not, some lawmakers in Florida say.

The State Legislature is considering a bill that would make it a felony for psychiatrists, physicians or any other medical provider to ask about guns in the patient’s home. If they do, they would risk a five-year prison sentence and a $5 million fine.

The bill would also prevent providers from making notes about gun ownership and make it illegal to refuse treatment to anyone for declining to answer questions about gun ownership.

A full description of the proposed legislation was published in the March 4 issue of Psychiatric News.

Track the bill, which was authored by the National Rifle Association, in the Florida Senate at http://www.flsenate.gov/Session/Bill/2011/432.

A group called Florida Carry supports the bill and is asking members to lobby lawmakers in support.

On its Facebook page, the organization said: “The American Medical Association and American Academy of Pediatrics have embarked on a path of gun control activism. Long aligned with anti-gun proponents, they now encourage their members to ask about the presence and storage of firearms from both patients and their children and to record the responses. Refusal to provide such information by the patient may be met by refusal of service.

“Basing service on whether or not one practices of a constitutionally-protected right is discriminatory. Creating a ‘gun registry’ violates statute. Interrogating children is deplorable.”

Medical providers, of course, disagree.

“The feedback I’ve been seeing from our membership is that there’s a great deal of concern about how this law would interfere with the ability of the psychiatrist to properly assess a patient,” Asher Gorelik, president of the Florida Psychiatric Society, told Psychiatric News. “We need to consider the danger patients might pose to themselves and to the community, including evaluating if the patient has access to weapons.”

How common are health care data security breaches by health care entities? So common that the U.S. Department of Health and Human Services has set up a website to track them.

The cases go back to 2009 and there’s a brief description of each breach on the site. As of Friday, there were 241 cases of data breaches under the federal HIPAA law that affected 500 people or more.

Covered entities must report these breaches to HHS and they are investigated by the Office of Civil Rights. Types of breaches include theft, loss and unauthorized access.

Here’s one example of a case from Aetna: “On May 28, 2010 Aetna discovered that a file cabinet containing member protected health information (PHI) was not cleaned out before it was given to Aetna’s vendor for removal. The documents inside the file cabinet contained the PHI of approximately 6,372 individuals.”

The impacted individuals were given a year of free credit monitoring and the insurer updated its PHI policies and procedures.

In October 2009, Blue Cross Blue Shield of Tennessee reported a theft of computer hard drives that impacted 1,023,209 people.

Brooke Army Medical Center in San Antonio, TX, February 2010: “A binder with printed protected health information (PHI) was stolen from an employee’s vehicle. The covered entity was unable to determine the number of affected individuals, but the stolen binder contained the PHI of up to 1,272 patients.

“The PHI involved in the breach included names, telephone numbers, detailed notes regarding treatment, and possibly Social Security numbers.”

The employee was sanctioned and new policies were developed.

Other breaches involved lost or stolen laptops, backup tapes, and data from portable electronic devices (iPhones, for example).

It’s interesting to take a look to see what can happen and how data can be lost. Protect your practice accordingly.