Psychotherapy Finances

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.

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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.

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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.

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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.

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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

Consumers may soon be buying health care the same way they purchase a new cell phone — at a retail outlet.

A Blue Cross Blue Shield retail insurance shop has opened in Tampa, FL United Healthcare recently opened a 16,000-square-foot store in Queens, NY. Insurance analysts expect the trend to continue and say that it’s one unforeseen result of the health care reform law.

“The stores are big, bold and easy to see,” Marc Pierce, who helps insurers evaluate retail options as president of Stonegate Advisors in Chicago. “For insurers, the impetus is to provide a tangible touchpoint so they can provide more value for their customers.”

It’s also a way that insurers can generate some “positive buzz” in the community, according to Kaiser Health News. Matt Fidler, vice president of consumerism and retail marketing at Highmark, a BCBS plan, explained: “We don’t really drive a whole ton of word-of-mouth on the positive side.”

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U.S. Sen. Chuck Grassley of Iowa is asking states to provide evidence that Medicaid is not overpaying or underpaying managed care service providers.

“Recently, questions have arisen regarding the process states have utilized in determining the appropriate payment to managed care entities by the Medicaid program,” Grassley, a member of the Senate’s Judiciary Committee, wrote in a recent letter to David Godfrey, Minnesota’s Medicaid director. He noted that the Government Accountability Office (GAO) found inconsistencies in the way states set rates for Medicaid, a $300 billion program.

“In the 18 months since that report was issued, I have seen nothing to convince me CMS or the states have improved in their ability to confirm that managed care entities are appropriately and correctly reimbursing for the services provided,” Grassley said.

“If an entity is paid too little, the access to and quality of care provided to beneficiaries is jeopardized. If an entity is paid too much, scarce Medicaid resources are diverted away from providing services to beneficiaries.”

He has sent letters to all the states, in addition to Minnesota, asking how rates are set, and what guidance they have received from the Centers for Medicare and Medicaid Services (CMS).

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Psychologists and other mental health practitioners who engage in distance therapy through Skype are getting more attention from state regulators, According to the March issue of the Monitor on Psychology by the American Psychological Association.

State laws are inconsistent on use of email, Skype and videoconferencing but that’s beginning to change, the magazine reports.

The biggest issue is one of providing services across state lines. But now some states are developing “guest licensure provisions” that are good for up to 30 days. And the Association of State and Provicial Psychology Boards has come up with an “interjurisdictional practice certificate” that also OKs temporary work across state lines.

Even if you restrict Skyp or telehealth services to your own state of licensure, APA officials suggest researching telehealth state laws and watching for updates; checking with your state licensing board; and contacting your malpractice carrier to find out what’s covered and what’s not.