Saturday, June 07, 2008

My dinner with the Executive Board of NCPA

Dr (Christina) Mickiewicz: (; Alamance-Caswell MH/DD/SA)

You are a LME administrator associated with Almance-Caswell MH/DD/SA----is that correct?

I would like to know, as per your status as administrator (I assume), is there a limit to the number of sessions for state funded clients (yes, I understand that they are not 'entitled' as are Medicaid/ Medicare clients) and does your LME demand that everyone that provide therapy services for state funded clients go thru 20 + hrs of unpaid Community Support Services (CSS) training.

I am asking this at the level of trying to understand just how different the LME's are. This is no attempt to entrap you. I truly want to understand why the people from Raleigh had no idea about these kinds of issues. I can only assume that the problems are unique to western NC.

When I talked about these specific difficulties at the dinner meeting of the NCPA Executive Board last night, even the local psychologists looked alarmed. The president of NCPA stated he was alarmed.

And so I want to know are we just saddled with a couple of dudd LME's in western NC, in control of 25% of the states' counties?

I am not able to make a living as a clinical sychologist due to mental health reform issues. These are issues which, I believe and hope, NCPA could address.

My quandary has everything to do w/ NC mental health reform.

As associated w/ the dinner last night w/ the NCPA board, this is what I carried away:

1. NCPA is not able to carve out a 'scope of practice' as doctoral psychologists are represented by NCPA as well as are LPA's, or psychological associates---master's degree people. That means that comraderie (yes, I wish the world was a cooperative place but unfortunately I need to put dinner on the table) is necessarily created between NCPA/ LPC's/ Social Workers as pertaining to issues.

And that means that rather than hire a doctoral level psychologist, any sensible business will hire an LPC/ social worker/ or psychological associate.

When you speak of 'we' needing to fix the matter, I find myself trying to figure out how to look out for my own profession, that of Clinical Psychologist, as well as contribute to 'fixing' it.

And I am afraid that 'fixing it', for me, is the same as carving out a safe place so that I can stay afloat.

The other day I did not resist the impulse to open the mail of a colleague of mine in Atlanta; he temporarily lived in my house there while he was looking for a place to live. He is an old friend who would not have minded; the tax return information indicated that his VA psychologist pay for last year was over $105,000/ year.

I assume that your salary is comparable, is it not, Dr Mickiewicz?

I nevertheless welcome your ideas on how to 'fix it.'

The VA, just after WWII, carved out a 'scope of practice' for psychologists.

Contrarily, as re: NC Mental Health Reform, there has been a distinct effort by DMA and NC DHHS, to treat MH providers as all the same in terms of training/ status/ authorization/ payment-----and this has everything to do w/ my inability to practice within the confines of DHHS-----soon to be expanded to Medicaid, the only safe refuge for clinical psychologists as they can independently bill while as LPA's cannot.

2. NCPA board member, Dr. Rumer, who is on this listserv, verified last night at our dinner meeting in Asheville, just as an example of what I mean when I say that the creation of the LME's has fractured the entire mental health care system in terms of there being differing criteria for each of the LME's as associated with available therapy/ authorization associated w/ such/ payment of such--------that yes indeed Marsha Ring, the Utilization Manager of Western Highlands LME, in a convoluted manner indicated that for PD diagnoses there are indeed more than 8 therapy sessions/ year if DBT gp therapy is coupled to request for therapy sessions.

The barriers associated with working as a psychologist or indeed any of the mental health professions are accelerating----not diminishing. Until the barriers are addressed, there is no fixing of this mental health care reform fiasco.

As a clinical psychologist, I cannot even get to the Behavioral Health Codes (96152) which could pay me at the 'medical' rate, which is 80%. 96152, as passed to me by Dr. Rumer last night, and as verified by other psychologists in the room, is not on the list of NC DMA.

Contrarily, APsychological Association just can't stop tooting their horn about the ability of psychologists to use this behavioral health code. I can't use it or if I can, I haven't yet found the way to do this. If someone knows, please tell me.

I am thus railroaded into seeing clients for 45 minutes, 90806, rather than 90808, which is more productive in my professional opinion and as associated with my frequent home visits (I have a very low no-show rate).

'Pretend' Medicare e.g., Humana, will not pay for anything other than 90806. Medicare minimally pays more for that extra 45 min of therapy. For this clinical psychologist, direct billing CIGNA, for 90806, I get approx $55.

Moreover, as the Executive Director of NCPA stated last night, NCPA continues to try and follow-up on the lack of wrap around of dually eligible clients (those who have Medicare as a primary and Medicaid as a secondary). This would afford me some more pay for the 90806 but I am blocked from getting to it.

No, Dr Mickiewicz, this is not sibling rivalry. This is a matter of a well trained clinician simply trying to put food on the table.

Pass this to anyone you like. I believe that the profession of clinical psychologist is doomed in the state of NC.

What does this matter to NC mental health reform? Clinical Psychologists are the better trained of the mental health professionals and I believe I can argue with substantiation that we address issues from a research basis and we are very well trained.

I am not saying that LPA's do not have similar training. I have no stomach for an argument w/ the LPA;s and indeed that would be sibling rivalry.

I am saying that the combining of the LP's with the LPA's, so long ago (and I have no idea about this history and would welcome any comments from people) has assigned me to a place wherein I can barely make a living. NCPA has not carved out any 'scope of practice' for either one of the parties it represents.

This being said, this combining is probably negligible in terms of the assigning of authorizations and payment to any mental health provider of whatever ilk---as re: NC DMA and NC DHHS.

For them, we are all exactly the same. And the benefits all go to those 2 agencies while confusion and chaos is what I see all around me re: the disintegration or 'governmentalization' as one psychologist put it last night, of mental health care in NC.

I don't know what the answer here is and the more I find out and understand the more futile everything appears. I walked away from the meeting last night vowing to learn to live more cheaply---and trust me----I'm already pretty cheap.

Marsha V. Hammond, PhD
associated e mail: Dr (Christina) Mickiewicz: (; Alamance-Caswell MH/DD/SA)

When will these constant "sibling rivalry" issues finally end. We need to focus all our attention on our patients and keep coming up with more innovative and collaborative approaches and stop this finger pointing- its enough we have to deal with all the politics, etc, but this is enough . Everyone had/has done all they could to prevent this train wreck, to no avail. Now its time to HELP FIX IT! Dr Mickiewicz


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