Value Options, Medicaid authorizing agent for NC: continued Barriers to services re: constant changes in paperwork

I've documented this before. And its still a problem. And I do not anticipate any relief from this because it is not an important agenda, this diminishment of paperwork for the people working hands-on w/ the clients.

Value Options (VO) is the authorizing agency for Medicaid clients in NC. They have a contract w/ NC DHHS.

Endorsed Provider companies or private providers, such as myself, send them paperwork in order to ask for services beyond the basic services. For outpatient adult therapy, after 8 sessions in a calendar year, authorization must be obtained from VO in the form of a simple, appropriate, one page form. YOu fax it in or mail it in, and more or less, the authorization is forthcoming within a couple of weeks. No sweat.

HOWEVER, re: the constantly defunded Community Support Services (CSS), there has to be a very lengthy (we are talking 20 pages of very carefully written treatment plan) document entitled the PCP.

This appears to be the flow associated w/ VO re: the PCP's which allow the 8 hours/ week/ CSS/ client which is provided by CSS workers; now 25% of those face-to-face services must be provided by the supervisory QP rather than the CSS workers who undergo very frequent, non-paid, upgrading of their skills----like the vastly important----CPR (Cardiopulmonary Resuscitation) last week which took about 4 hours for an Endorsed Provider company which I know.

(I am demanded, as a private doctoral level psychologist to have associated with an Endorsed Provider company in order to be able----should I choose to----provide outpatient psychotherapy to state funded clients). This demanded association is, in itself, a Barrier re: all the paperwork that has to take place between ME and that company e.g., the assigning of passwords in order to submit the paperwork to the LME, etc.

You guessed it: its not worth it to me, the doctoral level psychologist, to provide outpatient therapy to the state funded clients. Too many barriers.

But I digress.

As associated with the PCP, the 20 something page document, is apparently scanned by VO. There are certain section that have to be filled out in an appropriate manner.

Recently, as re: PCP's associated w/ CSS, rom the time that the QP submits the PCP to VO, the requirements of the document keep changing and thus the PCP keeps getting kicked back and thus the client continues not to get services.

An example: VO has changed the dating of the PCP to be the 'last time that the document was changed' vs the usual 'the original submission date of the PCP.'

ONLY AFTER THE DOCUMENT HAS MOVED THRU THIS SCANNING MESS CAN IT FINALLY BE SEEN BY A HUMAN REVIEWER. Who knows how long that takes...

No company is ever advised about the changes. It simply happens and remember: no services are available UNTIL the CSS are approved.

I had a similar complaint re: Western Highlands Network LME document change last fall when I submitted the 10 pages of paperwork on a state funded client....waiting...waiting....and finally between the time it had been sent to WHN to the time it was disapproved, which was over a month, sure enough a section in the document had been upgraded by either NC DHHS or WHN LME and instead of grandfathering the change in the document, they simply rejected the submission of the paperwork.

Its a year later. I have yet to turn up the energy or time to send in more paperwork to WHN on this one state funded client that I have.

Its easier just to see him for free.

HEY! Maybe that is what NC DHHS was counting on!

Cherry Hospital: the problem is not that the workers do not care but that neither workers or patients are treated w/ DIGNITY

August 29, 2008

Dear NC Senator Martin Nesbitt:

I read w/ interest your statement to the Raleigh News & Observer for the 8.29.08 edition pertaining to the investigation of Cherry Hospital by the feds which may very well put their ability to have Medicare/ Medicaid patients----if not more than this----at risk.

And all of this means, once again, as took place at Broughton Hospital in western NC, as per its loss of fed funding for a year, something which just ended, and which was paid for by NC tax payers to the tune of $1.5 million/ month-----only to have its JCAHO accreditation removed a week ago---and so that the tax payers now pick that up again.

This is a never ending set of problems which require a bigger vision and stepping back.

You stated, Mr. Nesbitt:

"I'm not sure we had people involved who care about the patients," said Sen. Martin Nesbitt, an Asheville Democrat and committee co-chairman. "That is a systemic problem I don't know how to fix." Senator Nesbitt

http://www.newsobserver.com/2771/story/1195764.html

I am sure you have had your fill of advice from every psychiatrist, psychologist, mental health technician, hospital director, and newly created division in order to investigate problems like this. This is a systems issue and while as psychiatrist Harold Carmel maintains, ‘there must be accountability’, I would like to add that a step back----in order to overview the components of this system---- provides the answer. And the right answer is reflected when one asks the question, “Who maintains power here?”

It is, I think, a red herring to think that the people who work there do not care about the patients and those people should be fired, no questions asked. Certainly, in every worksite in the world, there is a range of people as associated with how they do their jobs. I am sure that you probably are familiar w/ this information:

“More than 1,000 workers are put out of work due to injuries each year. Since December 2000, at least 82 patients have died in ways that raise questions, including homicides and suicides. Workers are incredibly underpaid, with health care technicians, the bulk of the front-line workers, earning on average less than $24,000 per year and forced to work incredible amounts of overtime in unsafe and understaffed conditions to pay their bills......”




On May 29th, more than 200 workers attended the UE 150 Mental Health Workers Public Hearing. Before the hearing, workers held a public rally to expose the conditions at the state hospitals, demand Dix hospital stay open at least one year longer and demand a Mental Health Workers Bill of Rights.
WW photo: Dante Strobino (World Workers)

Many people might dismiss the above as associated with anarchists, commies, or unions-----all equivalent in the South. However, facts is facts.

Difficulties in working w/ the population w/ mental health challenges is evidenced also by March, 2008 NC DHHS Crisis Intervention Team training which advances the notion of ‘expertise training’ which should be part and parcel of the training of every person working in a psychiatric hospital. (see http://www.dhhs.state.nc.us/MHDDSAS/consumeradvocacy/
consumerempowermentteam/2008leadership/
overviewofcrisisinterventionstraining.pdf )

The people who work in public mental health hospitals are embedded in a social milieu which supports the very observeable fact, as per the staffing when the feds are not sniffing around, that no one cares about them and therefore why should they knock themselves out to care for the patients?

Let me explain. Have you ever been a patient in a mental hospital?

I imagine you have not; neither have I. However, I worked at Bryce Hospital, the state mental hospital in Tuscalossa, AL, as an intern, a person of no ‘power value’ and therefore was able to observe----as if a fly on the wall----the behaviors of both the staff and patients. Indeed, it was an assignment given to me by my supervisor.

What has been taking place at Cherry Hospital, Broughton Hospital, in Georgia at GMHI, and indeed, around the world is not unique. There is not something so terribly wrong and different about the NC mental health system. I believe that the media is all over this as associated with years now of mental health reform coverage and that every episode creates anew a sense of a system that is rapidly devolving. It may be worse than it was, but I am betting that if the records could be combed, that many episodes of mistreatment of patients would be turned up and I personally know of some of them myself.

Here is a statement randomly picked from google.com utilizing the descriptors “mental hospital patient what it’s like to be.”

The example is associated with a mental hospital in Finland. The Scandanavian countries, I maintain w/ some evidence, are more consistently progressive in terms of social issues:

“The closed institutional care used in mental treatment is suffering from extremely negative attitudes. The exercise of power in those wards is partially distorted, reminding of the abasement of mental illness compared with other diseases.”

http://www.schizophrenia-help.com/A_Day_in_Mental_Hospital/a_day_in_mental_hospital.htm


When I was an intern at that mental hospital, second only in size to the Pentagon in its heyday, this is what I witnessed and it is not different than what has taken place in any public, as well as many private, psychiatric hospitals in the US.

When a patient walked up to the nurse’s station, it was common for them to stand for a very long time without even being able to get the eye contact of the nurse or technician.

If you were to go to a store, and you needed something from the person on the other side of the counter, and they continued to stare down at their paperwork, ignoring you, how would you feel?

If you are like me, and like most fully functioning American adults, you would feel perturbed and righteously angry. You would ask for someone to help you; you would start to sigh and make loud noises in order to get someone’s attention.

The patients have no magical way of getting rid of how they feel in these situations. They may try to escape using the laundry hole, as at Cherry Hospital; they sit quietly in their chairs, hour after hour, like the man who recently died there.

People in mental hospitals would not demand that the nurse looking down at his or her work pay heed to their request. If they did this, they would find themselves labeled as ‘angry’ and in need of medication which would be watched as you swallowed it----to make sure you would not have another episode like this. For, you see, this is not a luxury hotel where the staff’s desire is to cater to your whims. This is a place where you have been sent because there is nothing else to do w/ you. This is a place where you take your medication and do what you’re told or there will be ramifications and punitive actions.

Your eye glasses will be with-held from you, as for one of my patients who was in a public psychiatric hospital. You will be buggered by the orderlies, late in the night, when no one watches-----as happened to another client of mine. Your husband will ask you what happened that you are so red in that area. Another client: the sheriff will run into your house in order to drag you off to the mental hospital, throwing you to the floor and dislocating your shoulder. Another client: you will pee in your pants if the deputies come to take you away. Another client: you will sleep on a bed w/ no sheets so you cannot hang yourself and threaten the psychiatrist that if she tries to commit you again, you will take everyone out with you. Thus, you will hide your psychotic depression rather than be humiliated again.

I do not believe that enough ‘accounting’ is available in order to monitor every egregious circumstance. This is the argument of ‘lets just have some more police.’

When you are a patient in NC public mental hospitals, when you take a shower, someone stands in the door in order to make sure you do not do something weird-----if you are on suicide watch----which is a common reason for admission to a psychiatric hospital. There is no privacy. People in mental hospitals, as much as they are able, keep their heads down and do not complain.

They are more like prisoners than patients.

You may say that this is necessary in order to protect them from themselves and this is partly so. However, the unwitting cost of that is the creation of a social setting associated with one set of people in control and the other set of people not in control.

Phil Zimbardo, a Stanford psychologist who did the Stanford Prison experiment in the early 1970’s, which, along w/ psychologist Stanley Milgram’s work, has indicated in his widely disseminated work, that in situations in which there is a distinct difference between the rights of one set of people and another, lack of caring and even violence WILL take place. The people who are the staff are not ‘bad’ people. The patients are not beserk loonies who will bite, scratch, kick and generally tear down the house.

Dr. Zimbardo has continued to work on this matter as pertaining to what has taken place in Guatanamo Bay as re: the behaviors of military personnel who acted in a manner which was in keeping with the social milieu of the prison but which was out of keeping with the (some of) the expectations of the military. In other words, Zimbardo is, best I understand, maintaining that people are social creatures who respond in a particular PREDICTABLE manner given social situations in which the distribution of power is vastly different for one group versus the other. People respond in predictable manners to social situations. It is the social situation which shapes communal behaviors.

I am advancing the notion that the mental health technicians, nurses, psychiatrists and psychologists are not people who do not care about the patients that they are assigned to.

Also, I am advancing the notion that the patients do not, without provocation in the form of dehumanizing treatment, kick, bite, and generally aggress against the mental hospital staff.

I am submitting that accountability MUST be coupled to a recognition of the demoralizing impact of understaffing, which seems to be the most distinct problem at the state mental hospitals. This means that the NC State Legislature has to make available MORE MONEY for funding. That is the first priority.

The second agenda item is that accountability include the concept of dignity and that the concept of dignity be enshrined throughout the mental health system.

Both staff and patients should be treated w/ the dignity that they need and deserve.

People are social creatures; they react to egregious circumstances by engaging in behaviors that reflect their core feelings about matters e.g., the staff sits and plays cards while the patient sends hour after hour in his chair, unattended.

If the powers that be understand that this is not an issue about ‘bad apples’ e.g., ‘there are no people who care about the patients’---the argument that Carmen Hooker Odom attempted to launch at the Endorsed Provider companies upon seeing her Service Definition of Community Support fully utilized-----that indeed the problems take place because of the social milieu in which the MH workers and patients find themselves embedded.

IMO, it is not a matter of there being no people who care about the patients but rather there being no underlying sense and demands that the staff and the patients be treated w/ dignity.

THIS is the leap that should have been taken rather than privatization back in 1999 and prior to the development of mental health reform which saw as a panacea the privatization of mental health care rather than a re-invention of attitude with which to shape efforts.

Thank you for reading this, Mr. Nesbitt. I know you are vastly overworked. Me too.

Marsha V. Hammond, PhD
NC mental health reform blogspot:

Cc: Janowsky; Insko; Stratus; Wainwright; Benton; Raleigh News & Observer; Harold Carmel; MH advocates throughout NC; madame defarge blogspot: http://madame-defarge.blogspot.com/

Carrboro Citizen's Sisk outlines new division 'Program Evaluation Division' report which indicates: NC DHHS DOES NOT USE OUR PAPERWORK

August 29, 2008

Dear Mr. Taylor Sisk, staff reporter at the Carrboro Citizen newspaper:

Thank you so much for your wonderful article. Great to hear Tom Smith and Nick Strattus's voice for they know an enormous amount.

As per your article, I would be interested in hearing/ you writing/ or someone writing about this important matter: "The legislative report cites delays in securing federal approval of new service, which led to a delay in the implementation of overight procedures."

I noticed that a person named John Turcotte is the Director of this new division which reports to a committee within the NC STate Legislature. I called that office and I understand that Mr. Turcotte has been a program evaluator in MS and FL for over 30 years.

I furthermore noted the recommendations from this newly formed division's director (the report...besides your aforementioned note on 'Pace of Implementation' and the other header as per the pdf report document associated with the report, specifically, 'Insufficient forecasting and monitoring'):

"....•• Information not organized for decision-making. Performance goals and measures were not established for the service array at the outset, and the department’s current external reports present excessively dense data that are neither synthesized nor interpreted. The lack of useful information limits decision-makers’ abilities to understand trends and determine how well the current system is working.

The Program Evaluation Division recommends the department: • manage data and information so that its executives can readily identify key issues and respond purposively; and • improve its internal data analysis and policy development processes by continuing to move from data collection and reporting to information synthesis and knowledge management...."

You may know, Mr. Sisk, that one of the primary complaints of mental health providers practicing within NC, is associated with the ever-changing paperwork demands created by NC DHHS and implemented by the various LME's.

How comforting to know that NC DHHS has been changing the paperwork for no good reason and have no well organized manner of utilizing the literally truckloads of information which is demanded to be given to them.

Here is the link. I am forwarding it to others. I am featuring a bit of it at my NC mental health reform blogspot: http://madame-defarge.blogspot.com/

Article link:

http://www.carrborocitizen.com/main/2008/08/28/lost-in-a-lost-system-a-new-report-confirms-fears/

I see that the copy of this legislative report is available here:

http://www.ncga.state.nc.us/PED/Reports/documents/MHI/MHI_Report.pdf

Excerpt from your article:

"The Report

Last week the newly formed legislative Program Evaluation Division released a long-awaited report titled “Compromised Controls and Pace of Change Hampered Implementation of Enhanced Mental Health Services.” The report is largely focused on the now well-documented excesses in the provisioning of community support services and chronicles the general mismanagement, overspending and lack of oversight in our mental health system since the passing of reform legislation in 2001, which called for privatizing services.

Community support services include, for example, assistance with grocery shopping or homework or chaperoning to movies or ballgames. The News & Observer reported that between March 2006 and January 2008, the cost of these services rose to nearly $1.4 billion, or 90 percent of all spending for community-based mental health care services. The cost of community support services was then nearly 20 times the state’s original estimate.

State officials now acknowledge that too much money has been wasted in the provisioning of community support services and – granting that these services are vital for many who are poised to reintegrate back into their communities – that too much money is being allocated to them at the expense of services that are more time- and cost-intensive to provide – local in-patient care, for example, or everyday counseling.

The legislative report cites delays in securing federal approval of new service, which led to a delay in the implementation of overight procedures, which in turn led to some new providers taking advantage of the system by “delivering an unchecked amount of services”; a failure to establish a baseline “against which to measure system performance and assess utilization and expenditures”; and reports to decision-makers that included “excessively dense data that are neither synthesized nor interpreted.”

In sum, the report is about mismanagement and abuses in the overhaul of our state’s pre-existing mental health care system – an initiative that most everyone now acknowledges is in serious need of some overhauling of its own.

What the report is not about is how mental health care reform is failing people – most particularly, those people most critically in need...."

Thanks again, Mr. Sisk

Cherry Hospital, NC: Zimbardo's "UNUSUAL CIRCUMSTANCES"?? : Beserk patients and the minimal, poorly paid & poorly trained staff

The mental hospitals in NC have very difficult populations with which to deal with AND it does not seem that they are learning lessons re: how to do this in the most appropriate manner which undoubtedly is associated with HIRING MORE PEOPLE so that incidents do not happen like this---and

THAT IS THE JURISDICTION OF NC DHHS AND THE NC STATE LEGISLATURE.

You can fire the individuals but until the 'stage' is altered, the incidents will simply repeat themselves, more subtly perhaps. And it cannot be dismissed that MH workers are injured during these altercations w/ patients:

Amidst crisis in North Carolina, mental health workers struggle for justice
June 16, 2008

"The mental health care system in North Carolina is in a state of crisis. More than 1,000 workers are put out of work due to injuries each year."

http://raleighfist.wordpress.com/2008/06/16/amidst-crisis-in-north-carolina-mental-health-workers-struggle-for-justice/

******************************

SO, WE'VE GOT VIDEO CAMS IN THE NC STATE MENTAL HOSPITALS......and what do they tell us?

As per Steven Sabock sitting in his chair, choking on his meds, and rolling out of his bed to hit his head, they paint a picture of a non-engaged staff, playing cards, ignoring patients, and documenting the patient as (per Raleigh News & Observer article cited below) as not hungry and needing no attention.

****************************

WE'VE GOT VIDEOS OF ZIMBARDO'S STANFORD PRISON EXPERIMENT INCLUSIVE OF THE DIRECTIONS HE, AS THE 'PRISON SUPERINTENDANT' GAVE THE STUDENT GUARDS:


Guards force prisoners to do push-ups, while another (standing) is made to sing.


"The Stanford Prison Study video, quoted in Haslam & Reicher, 2003, Zimbardo is seen telling the guards, "You can create in the prisoners feelings of boredom, a sense of fear to some degree, you can create a notion of arbitrariness that their life is totally controlled by us, by the system, you, me, and they'll have no privacy… We're going to take away their individuality in various ways. In general what all this leads to is a sense of powerlessness. That is, in this situation we'll have all the power and they'll have none."

http://en.wikipedia.org/wiki/Stanford_prison_experiment

In Zimbardo's 1971 prison experiment, students, assigned to the role of 'guards' (who were students at Stanford) began to beat up on, and humiliate, the 'prisoners' (who were also Stanford students).

Here is an outline of how the experiment was put together.

"....In August of 1971, Phillip Zimbardo headed up a simulation study of the psychology of imprisonment. The study took place at Stanford University, with volunteers from the University itself. Zimbardo had two specific questions in mind that he hoped to answer after the study was complete. The two questions were: What happens when you put good people in an evil place? Does humanity win over evil, or does evil triumph? (Zimbardo, 1999-2007). ...

After the prisoner’s and guards all arrived at the prison, the guards began their duties. The prisoners were dressed in muslim smocks and they were not allowed to wear underwear. They were given a pair of thong sandles and numbers were sewn into their uniforms which would be their new form of identity; they would no longer be called by their names. The prisoner’s were required to wear a stocking over their head to make it look as if their heads had been shaved. They also had to wear an ankle bracelet to constantly remind them of the imprisonment and oppression (Stanford, 2007).

On the second day of the experiment, trouble began. There was a lot of emotional and psychological distress amongst those participating. Before the study was even over, 2 prisoners had to be released due to extreme suffering that lead to potentially life-threatening effects. The study was intended to last for 2 weeks, but had to be stopped on the sixth day due to both the guards and prisoners suffering emotionally and psychologically. The results of the study tied into the study of electrical shock that was done by Stanley Milgram. From his study, Zimbardo was able to prove that “most evil is the product of rather ORDINARY PEOPLE CAUGHT UP IN UNUSUAL CIRCUMSTANCES THAT THEY ARE NOT EQUIPPED TO COPE WITH IN THE NORMAL WAYS” (Farmer, 2007)...."

http://www.freeonlineresearchpapers.com/stanford-prison-experiment

**********************

WHAT HAPPENED ON THAT SECOND DAY DURING THE STANFORD PRISON EXPERIMENT?

"....After a relatively uneventful first day, a riot broke out on the second day. The guards volunteered to work extra hours and worked together to break the prisoner revolt, attacking the prisoners with fire extinguishers without supervision from the research staff...."

http://en.wikipedia.org/wiki/Stanford_prison_experiment

************************

Over 50 people viewed the conditions of the 'prison.' One might assume that these were people who did not want to ruffle Zimbardo as the superintendant and as an already well-regarded Stanford University teacher. They were the 'good Germans':

"Zimbardo concluded the experiment early when Christina Maslach, a graduate student he was then dating (and later married), objected to the appalling conditions of the prison after she was introduced to the experiment to conduct interviews. Zimbardo noted that of more than fifty outside persons who had seen the prison, Maslach was the only one who questioned its morality. After only six days of a planned two weeks' duration, the Stanford Prison experiment was shut down."


http://en.wikipedia.org/wiki/Stanford_prison_experiment

****************************

Zimbardo's experiment was also very vividly recreated by German film makers. They ran their experiment to a chilling conclusion such as might have been part and parcel of Abu Gharaib or Guantanamo Bay:

Das Experiment
Das Experiment ("The Experiment" in the US) is a 2001 German movie directed by Oliver Hirschbiegel and inspired by the events of the Stanford prison experiment in the United States. It is based on the novel Black Box by Mario Giordano.

*************************

AND SO RETURNING TO THE MATTER OF CHERRY HOSPITAL, WHERE PATIENTS HAVE BEEN BEAT, BY BOTH THE MENTAL HEALTH TECHNICIANS AS WELL AS THE PSYCHIATRIST....

http://www.newsobserver.com/2771/story/1193980.html#MI_Comments_Link

"...Vickory (the county DA) said Monday that hospital police and administrators never told his office about the video footage of the assault."

("I didn't know about any of this", said the county DA.)
("I don't see anything morally repugnant about this Stanford experiment.")

****************************

"Vickory said the two mutually agreed to drop the charges against one other."

(so, the patient and the person that the patient might run into again in the future, agreed to drop charges on each other, and this was OK w/ the county DA).

(("One of the most abused prisoners, #416, and the guard known as "John Wayne", who was one of the most abusive guards, confront each other in an "encounter session" two months later.": see wikipedia, Stanford experiment)

********************************

"Jack St. Clair, the hospital director, has not returned calls requesting comment about Sabock's death or the arrest of two more employees on Friday for beating a patient last week. "

(Jack St. Clair is avoiding owning up to his responsibility as a leader of the hospital)

(Zimbardo, as the 'prison superintendant' lost his bearings until he was grilled by Christina Maslach, pertaining to the perverse conditions of the 'Stanford Prison')

*********************************

"Federal officials have cited Cherry for serious deficiencies in the care of both Sabock and Luciano, and have threatened to cut off millions in Medicaid and Medicare payments from the hospital. "


SBI probing patient's death
Local prosecutor invited its help
Michael Biesecker, Staff Writer

RALEIGH - The district attorney for Wayne County has asked the State Bureau of Investigation to review the inaction of Cherry Hospital employees who played cards and watched television as a dying patient sat unattended a few feet away.

Hospital administrators and internal police have not always provided all evidence against their employees, District Attorney C. Brandon Vickory III said Monday. Last week, he invited the SBI to investigate the death of Steven H. Sabock, 50. A patient at the Goldsboro state mental hospital, Sabock died after choking on his medication, hitting his head on the floor and then being left in a chair for 22 hours without food or water.

In the last two years, Vickory's office has dropped cases against at least six hospital workers arrested for assault. Vickory, prosecutor for Greene, Wayne and Lenoir counties, said Monday that the facts of what happens inside the state mental hospital are often murky. But on April 29, a security camera captured footage showing the hospital's staff ignoring Sabock sitting in a day room through parts of four shifts, according to a report issued by federal regulators last week.

********************************

NCPA: depending on APA to solve our problems in NC

August 25, 2008

Dear Sally Cameron, Executive Director of the NC Psychological Association ("Sally Cameron" ):

You stated, in an e mail dated 8.25.2008, as associated with meetings at APA in Boston, one week ago:

"It was particularly gratifying in various meetings with the Practice Directorate Staff and leadership to hear them acknowledge that reimbursement is the top issue for the practice profession. I think you will see actions to follow up this acknowledgement - including the APA President Task Force on the Future of Psychology Practice. "

I hope you are inferring by 'I think you will see actions' to mean that NCPA will be paying attention to the people who are psychologists LP's and LPA's in the state of NC.

I still have NO answer re: my questions that I have sent to you x2, which you indicated you sent to the NCPA Board, associated with (no 1, specifically):

1. persisten utilization review problems in western NC associated with Western Highlands Network LME (no more than 8 therapy sessions for state funded clients/ year) and as per Smoky Mountain Center LME (no outpatient therapy except under the Service Defintion 'Community Support Services', which, as you know, is constantly being defunded.

These are other pressing reimbusement concerns:

2. Health and Behavior code reimbursement; apparently the NPI of the referring physician has to be put on the medicare billing or you cannot be paid. There is an online NPI Data Base. That the NCPA board had no idea about any of this blows my mind. Here is the link for the NPI data base. Why is this important? Because it means that psychologists do not have to spend additional time calling up a physician for his/ her NPI: https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do

3. no wrap around to Medicaid vis a vis CIGNA government services.

4. Humana, a Medicare Advantage company, will not pay for anything other than 90806. They will not pay for Health and Behavior codes.

Please forward my e mail to the executive board. Maybe sometime I will hear something from one of them or perhaps the Public Sector psychologists who have never responded to any of these concerns associated w/ public sector reimbursement, in part, will someday respond.

Marsha V. Hammond, PhD

cc: Pedulla; Puente; members of WNCPA

Steven Sabock: an unimportant man who died at Cherry State Hospital, unfed and unattended to

From California poet/ existential psychologist, Tom Greening, PhD. He has a new book of poems.


Words Against the Void : Poems by an Existential Psychologist

By: Tom Greening
***************************************************************************

Steven Sabock

Steven Sabock,
age 50 and not a happy man,
sat in his chair unfed for 22 hours
at Cherry Hospital in Goldsboro, North Carolina,
choked on his medication
and died.
A few feet away
the staff watched TV and played cards.
It was not reported what programs they watched
or who won at cards,
but maybe that was not important,
and neither was Mr. Sabock.

Tom Greening
********************************************************
heads rolling.....I'm knitting....

Ward where mental patient died closes at Cherry Hospital


Posted: Aug. 22, 2008

RALEIGH, N.C. — The ward on which a patient died after he was left unattended for nearly a day is closed, and the 16 Cherry Hospital staff members on duty during that time have been disciplined, Department of Health and Human Services Secretary Dempsey Benton said Friday.

Closing the ward at the Goldsboro facility reduces adult admissions from 90 to 67 beds and reduces Cherry Hospital's overall bed capacity from 274 to 251, but allows the hospital to have two registered nurses on the remaining three wards for each shift, which is now standard, Benton said.

http://www.wral.com/news/local/story/3419482/

Baby, you can drive my truck......

Mental Health Outsourcing :



I was depressed last night, so I called Lifeline.

Got a call center in Pakistan .

I told them I was suicidal.

They got all excited and asked if I could drive a truck

Be They Democrats or Republicans, Privatization w/ no funding, Will Collapse Any State's MH Services

Atlanta Journal Constitution: http://www.ajc.com/services/content/metro
/stories/2008/08/21
/mental_health_privatize.html?cxtype=rss&cxsvc=7&cxcat=13

Mental health system may cut back, privatize
Amid budget pain, state weighs hospitals’ future

(My letter to the editor of the Atlanta Journal Constitution)

*************************


Be they Dems or Republicans, Mental Health Privatization Does Not Work

I read with dismay the information concerning a desire to privatize some of the mental health services in GA. I was formerly licensed as a psychologist in GA.

This privatization won't work. Funding is what works. Privatization is a red herring that, in the beginning, seems to be an inspiration.

NC has been undergoing MH Reform for the past 7 years under Democratic Governor Easley. The problem is the same as in GA: the state legislature refused to fund the matter.

All this talk about taking mental health services into the community also will not work and for the same reason: it won't be funded.

People magically believe that somehow privatization has some way of acting more efficiently. It doesn't----not as regards intensive, professionally driven services.

The providing of mental health services is not about making a better, cheaper burger.

Fund it, GA (right at the bottom of MH funding) or expect a decade of (more) collapsing MH services.

Marsha V. Hammond, PhD: Clinical Licensed Psychologist, NC