Tuesday, March 30, 2010

LME Data of Citizens Receiving MH Services: 2005-2009: lots of interesting & odd data

There is a 5 year study of the LME's by NC DHHS available here:


Note that the y-axis, associated w/ 'thousands served' varies across the LME's; thus, if you're simply perusing the data line, your eye will be deceived unless you look at the numbers associated w/ the y-axis.

Western Highlands Network LME data and Smoky Mountain Center LME, the two LME's in western NC, for 'numbers of all consumers served', are in increments of 4,000 citizens for each increment of the y-axis. Contrarily, for Centerpointe LME, over in the eastern part of the state (an LME which has a troubled history as associated w/ its administration), the 'numbers of all consumers served' is in increments of 2,000 citizens for each increment of the y-axis.

CenterPointe LME: approx 40% reduction in consumers served between 2005-2009

Western Highlands LME: approx 18% reduction in consumers served between 2005-2009

Smoky Mountain Center LME: approx 32% reduction in consumers served between 2005-2009

Mecklenberg LME: approx 8% reduction in consumers served between 2005-2009.

So, does this mean that SMC & CenterPointe are doing a poorer job of addressing the concerns of consumers than Western Highlands and, for instance, Meclenberg LME?

Sunday, March 21, 2010

25% Jump in Uninsured in CA Between 2007 and 2009: US News & World Report

Health Buzz: Nearly 1 in 4 Californians Lacks Health Insurance Coverage

By Megan Johnson
Posted: March 17, 2010

Nearly 1 out of 4 Californians Goes Without Health Insurance
A new study by researchers at the University of California–Los Angeles found that the number of people in California who went without health coverage jumped 25 percent between 2007 and 2009, Reuters reports. In 2009, 24.3 percent of Californians under age 65 lacked health insurance for at least part of the year, up from 19.5 percent in 2007. That's higher than the national average, which was 17 percent in 2008. High levels of unemployment most likely led to the spike in California's uninsured, according to the study.


Vague Writing Creates Opportunities for the Powers-that-Be: Naming Names re: NC Mental Health Reform Mess

Let’s Have the Specifics about Current Mental Health Treatment in NC

By Marsha V. Hammond, PhD

In an editorial by Community Mental Health co-director, Barbara B. Smith, about the need for efficient treatment of schizophrenia, a SPMI (Severe Persistent Mental Illness), she outlined some suggestions to improve the situation. She alluded to the following well-known problems: necessary completion of a ’13 page form’ prior to receiving treatment; adequately funding public mental health; and, the maintenance of long-term, flexible, community based services. So, let’s review and name names behind her potent and admirable suggestions.

The ’13 page form’ is what NC DHHS and as their agent, the LME’s (Local Management Entity; in western NC there are two, namely, Western Highlands Network and Smoky Mountain Center) demands. This is why I do not work with the LME’s but function in the shadows of private practice, billing directly to Medicare/ Medicaid. Until those systems figure out that creating paperwork is nothing but a barrier to care, then I will continue to do the same. This means that people with SPMI have one less doctoral level clinical psychologist to interface with when they walk into the door while having a psychotic episode.

Mental health care company after company is folding in western NC due to the complete dissolution of Community Support Services (CSS) which was the lynchpin piece of NC Mental Health Reform, which began first in western NC (funny how the changes start out so far from Raleigh). CSS is the long-term, flexible, community based services of which Ms. Smith appears to be speaking and as of January 1, 2010, it is kaput due to years of flogging by Governor Easley, poor organization by former NC DHHS Secretary Carmen Hooker Odom, and the acceleration of the need for services as jobs tank. The NC State Legislature put NC Mental Health Reform into play only to remove it 8 years later. We are now back to the place wherein the clinical psychologist must utilize therapy time----billed to NC Medicaid----in order to do basic social work jobs like get someone to a physician’s appointment or find some food for the table. There is no point in therapy when the patient is starving.

An important matter which Ms. Smith does not speak to is just how BCBSNC has been able----as supported by the NC State Legislature----to opt out of mental health reform. This company is the largest private insurer in NC but is kowtowed to by the state legislature that, don’t ya know, has a ‘special liason committee’ to oversee BCBSNC. When mental health parity was passed about a year and a half ago in NC, specifically House Bill 973, BCBSNC got special concessions from the state which limited mental health care. Even more maddening than this, is that the NC Psychological Association sat on its hands as BCBSNC worked the state legislature. And the icing on the cake was then to be elected Beverly Perdue’s contention that more ‘case management’ services were needed, rather than hands on CSS. Case management is paperwork and that’s it. Citizens with SPMI have gone from an abundance of CSS hours to less than one hour/ week and the elephant in the room is the fact that private insurance companies continue to get special amenities which allows them to suck in 50 cents on the dollar as related to administrative costs. As related to the health care brouhaha, there is no way that a public option could do worse.

Reference (Ms. Smith's Opinion piece: http://www.chapelhillnews.com/2010/03/21/55824/we-can-do-more-to-help-people.html

Monday, March 08, 2010

NJ Psych Assoc pins BCBS up against the wall in lawsuit: 50cents on the $$ spent on administrative costs/ case management

I just sent in an application to join the NJ Psychological Association. They seem to realize that 'case management'----which Community Support Services which WAS hands-on direct contact w/ citizens having mental health concerns-----is a silly way to spend money. Nevertheless, Community Support Services is now only case management.

There is no direct contact w/ people who have mental health challenges utilizing a case management strategy which was the PLATFORM that Governor Beverly Perdue ran on!

And now we have proof that case management consumes up to 50 cents/ on the $$ re: mental health treatment.

Contrarily, the NC Psychological Association has done nothing to address mental health reform issues and given that 2100 NJ psychologists have been willing to say something about the matter of diminished authorizations by BCBS and other private companies I'm perfectly willing to throw my weight behind them.

HURRAH for the NJ Psychological Association!

Here is the past president speaking on MSNBC about the matter: http://www.msnbc.msn.com/id/31510813/ns/msnbc_tv-the_dylan_ratigan_show#35768963

And here is the website associated w/ citizens speaking out about these matters: A Project of the New Jersey Psychological Association - © New Jersey Psychological Association

Mental illness is a significant clinical and economic burden.

Psychotherapy reduces utilization of medical care and saves money.

Case management of mental health services wastes money and threatens patient privacy.

"...Case management of mental health services wastes money and threatens patient privacy. • According to an independent audit, up to 50% of every dollar devoted to outpatient mental health care by behavioral management providers is spent on case management, administration and profits rather than on direct patient care. In contrast, a typical medical HMO requires only 13% for administration and profits, and Medicare manages to oversee its program for 5%.7 ..."


And you can register your complaints about the insurance industry here: http://www.psychologynj.org/displayemailforms.cfm?emailformnbr=97924

Thursday, March 04, 2010

NC Medicaid cuts do nothing but inefficiently cause emergency $$$ to be spent

A recent opinion piece of mine printed in The Mountaineer, Waynesivlle, NC, as associated w/ a client's adventure at the local jail after being drug off for throwing a salt shaker at her 17 yr old son:

Training, Medicaid cuts have overlapping consequences for mental health

Written by Marsha V. Hammond
Wednesday, 03 March 2010 13:44


In December, 2009, NC Medicaid began requiring an additional tier of pre-authorizations for many medications. This simply resulted in an increase in the use of emergency services and caused the police to be engaged for mental health events bought on by mental health care deficits.
Overlapping with this matter, within the past year, the Centers for Medicare and Medicaid Services have been approving the use of telemedicine (the psychiatrist is not local and a video cam is utilized). This is a good idea but loses significant effectiveness if the local provider cannot interface with the telemedicine end of things. Continuing cuts in public mental health causes loss of providers and since necessity is the mother of invention, telemedicine was certainly something to be considered. At this time, the Balsam Center, associated with Smoky Mountain Center LME, is considering bids for telemedicine contracts.
Recently, a client of mine with a well known (to the local police and hospital) mental health challenge was taken to the Hazelwood jail facility where she was left for five days without any of her medication; this endangered her life. Prior to this event, she had been taken to the local emergency room where she was dismissed as ‘drug seeking’ due to a chronic pain condition which could not be treated by her primary care provider efficiently due to the NC Medicaid prior authorization demand, causing her to be without her non-narcotic medication for weeks.
At the Hazelwood jail in Waynesville, collect calls are apparently very expensive (thus, family members cannot become involved); the heat is shut off come bed-time at the jail; drinking water comes from the top of the toilet. Such treatment is even worse than what occurred last winter at Haywood Regional Hospital when the mentally ill man was chained to the hospital gurney for days before a mental health hospital bed could be found. The jail nurse saw my client exactly five days after she was admitted there and she saw no medication until her sister-in-law bailed her out.
When the police were called due to she throwing a salt shaker at her 17 yr old son due to the ‘unfortunate’ delusional side effects of Thorazine which had been prescribed for sleep by the Balsam Center telemedicine psychiatrist (this psychologist advised that psychiatrist’s nurse of worrisome side-effects of the Thorazine four days prior to the police being called), the client was advised by the police not to take her purse or meds with her. She was rebuked by the police due to her slurred speech and ‘Thorazine shuffle. ’ DSS was engaged due to her son being a minor.
She has never been in jail before but her bond was held in place by the court without any apparent attempt to consider her history of mental illness and multiple admissions which are not unrelated to the medication boondoggle created by NC Medicaid’s attempt to curtail usage.
Each time an ambulance is called it costs Medicaid about $500. Emergency admissions cost a lot more. When the police are called, they necessarily are not able to respond to other demands. NC Medicaid would do well to consider the strain that additional paperwork is creating such that psychiatrists are lost and providers in the community have less time to work with patients due to being demanded to fill out more paperwork.
Paperwork is nothing other than an attempt to truncate services by burying the providers so that they will not render services — or simply quit or avoid working with certain populations of citizens needing health care. Additionally, a refresher course regarding how to best work with citizens with known mental health challenges seems to be in order as regards the local Haywood County police.
Preventive care, coupled to efficiency, is money saved; emergency events cost a lot of money, impact multiple agencies which cost money to operate, and create profound hardships for citizens with mental and physical health challenges.

Marsha V. Hammond is a licensed psychologist in North Carolina.