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How Behavioral Health Programs Should Respond to Requests for Resident Information

Residential treatment options, from independent living programs to intensive wilderness therapy experiences, can help many young people who struggle with substance misuse. Many of these programs fall under the National Association of Therapeutic Schools and Programs. Participants can improve their problem-solving and communication skills and develop healthier living habits, often after traditional therapy models have not been successful.

However, the sensitive nature of these programs can also lead to safety issues for residents. Even the best providers must be prepared to respond to inquiries and investigations.

Reasons for Behavioral Health Safety Investigations

Behavioral health organizations may receive safety inquiries and undergo investigations for numerous reasons.

Licensing agencies may launch a routine investigation as part of a licensing application or renewal.
Payers may request information if they suspect fraud associated with billing.
Former clients or their families may accuse resident programs of mismanagement or abuse.
Data breaches may prompt investigations and audits.

Inquiries may come from licensing agencies, state protection and advocacy systems, payers, attorneys on behalf of client families, or independent organizations. Here’s how to respond.

Receiving a Medical Record Request

Any inquiry is likely to involve a request for client medical records. Before responding, make sure your facility is allowed to disclose records under HIPAA and state laws.

A few rules to follow:

In general, protected health information (PHI) cannot be used or disclosed without consent, except to the individual client.
Additional protections may apply to a mental health professional’s notes recorded during conversation in a counseling session.
If a state law is even stricter than HIPAA, then state law prevails.

Sometimes, you may disclose PHI without consent. These cases are limited and allowed only if there is a “serious and imminent” threat. Always refer to HIPAA and other federal and state laws that apply to your organization.

Responding to a subpoena

Behavioral health organizations under HIPAA law may only release PHI in response to a subpoena if certain conditions are met. The subpoena is accompanied by a court or administrative tribunal order and signed by a judge. The investigator must also provide you with “satisfactory assurance” that it has made “reasonable efforts” to give notice to the individual whose PHI is involved, or to secure an appropriate qualified protective order from the court or tribunal.

If you are subpoenaed, you must address it in some way, no matter what. This may involve contacting the requestor, appearing before a judge, or moving to quash the subpoena.

Declining a Medical Information Request

Your facility may not be able to fulfill all requests for medical information you receive. Be sure you understand the possible consequences if your organization does not disclose requested records.

If you must decline a PHI request in order to comply with federal or state law, do not acknowledge that the client involved was treated at your facility. However, if the request involves an individual who is not, and never has been, a client of your facility, you may say so.

Be sure to maintain and keep records for an appropriate length of time. If your state does not have specific laws for maintaining behavioral health records, consider following the American Psychological Association’s recommendations.

Whether you’re dealing with a routine audit or an unexpected investigation, maintaining appropriate documentation is crucial for behavioral health. The BestNotes EHR solution offers a documentation app that follows to federal, state, and accreditation standards, updating changes automatically, so you can maintain compliant records without anxiety. Contact us today to learn more, or schedule a free demo.

date:  Jun 15, 2021
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Developing a Value Proposition for Your Behavioral Health Business

What do you offer your behavioral health clients? How do you contribute to your community and your field? What makes you different from other providers in your area?

The answers to these questions determine your value proposition. This is an essential part of defining your behavioral health business and guiding many of your decisions.

What’s in a behavioral health value proposition?

Your value proposition should focus on what is unique to your behavioral health business. Some possibilities include:

Newness: You address a particular set of needs that customers were unaware of, or offer something different from what is already available.
Performance: Your organization is results-oriented and focuses on improving existing services.
Customization: You tailor your services to specific needs of individual clients or a client segment.
Design: You can make your service stand out due to design elements, such as a great website or a beautiful, relaxing office space.
Brand/Status: The client finds value in simply using or displaying a specific brand due to the organization’s reputation.
Price: Offer similar value at a lower price to serve a more price-sensitive client base.
Cost Reduction: Your organization helps the customer reduce monetary and other costs.
Risk Reduction: This angle emphasizes how you help clients reduce risk, such as reducing the symptoms of depression that can otherwise put relationships and careers in jeopardy.
Accessibility: Offer services to clients who otherwise may not have access to them, such as operating in an underserved neighborhood.
Convenience/Usability: Make your services easier to use or more convenient for clients, such as virtual therapy options.

How do you determine your value proposition?

Your value proposition won’t include all of those factors. So how do you decide which ones apply to your organization? Start with a little research.

Conduct a stakeholder analysis to determine the audience of your value proposition. Who is affected by your work, has influence over it, or has an interest in your success? This includes clients and payers, but also policymakers and potential partner organizations.
Internally review your organization’s capabilities to determine what you do well, what you are best known for, and what advantages you have over others.
Look at your organization’s strategy and consider what success looks like and how to achieve it. Don’t forget to consider potential risks and weak spots, too.
Gather data that is most valuable to your stakeholders, and what will demonstrate positive outcomes and costs. Consider how your data compares state- or nationwide. This may include health outcomes, how quickly clients are seen, and client engagement.

Once you have the right information, you can begin to create your value proposition. You may want to create both a short “elevator pitch” and a longer value proposition document that incorporates your answers and the data you’ve collected. Write in language targeted toward all relevant audiences.

With an established value proposition, you can articulate the unique value your behavioral health business brings to your market. You can also use it to inform decisions, such as marketing, hiring, and partnerships, that will also contribute to your organization’s success.

BestNotes aims to help behavioral health organizations streamline their operations to help make providers, staff, and clients happier. Our hosted CRM solution saves you from the cost and hassle of developing and supporting your own CRM, so you can increase profits while saving time. Contact us to learn more.

date:  Jun 07, 2021
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How Providers Can Deal With the Behavioral Health “Pandemic”

As the novel coronavirus pandemic is on the decline, another crisis continues to threaten individual and public health. Behavioral health concerns, from depression to eating disorders to substance abuse, are on the rise, and many providers are unprepared to tackle the increased demand for treatment services.

Not Enough Mental Health Providers

The mental health effects of the COVID-19 pandemic response could linger for months or even years. Many individuals, such as frontline healthcare workers or those living in social isolation, have been suffering from anxiety and trauma.

A new report released by the U.S Government Accountability Office (GAO) describes how behavioral health concerns increased during the pandemic. At the same time, treatment access decreased.

The Centers for Disease Control Household Pulse conducted a survey from April 2020 to February 2021, finding that 38 percent of adults reported symptoms of anxiety or depression. This is an increase from 11 percent in 2019. Emergency room visits for overdoses and suicide attempts also increased by 36 percent and 26 percent, respectively.

The GAO report also noted that the Health Resources and Services Administration designated 5,700 mental health provider shortage areas. As of September 2020, one-third of Americans lived within these areas.

Public health experts have been warning about a shortage of mental health and addiction treatment services for years. During COVID-19, however, providers also experienced financial difficulties that led them to lay off staff and limit services. Because of social distancing requirements, many inpatient facilities reduced the amount of inpatient beds.

The ongoing behavioral health staffing shortage has become a vicious cycle. Existing behavioral health staff are experiencing burnout and fatigue, leading to higher turnover that can perpetuate staffing issues. Low pay has also hindered the ability to hire new staff members.

Options for Easing the Behavioral Health Burden

Although not the ultimate, catch-all solution, telehealth is one vital tool at providers’ disposal. The technology expanded rapidly during the early days of the pandemic, but even though more facilities are back to seeing in-person patients, many providers continue to expand telehealth to help meet demand.

Closer coordination between primary care and behavioral health could also help expand care. This could be the perfect time for hospitals, health systems, and others in the industry to try out different care integration models. Urvashi Patel, PhD, chief analytics officer at New York-based Brighton Health Plan Solutions, suggests that behavioral health specialists may work out of a primary care site, or work as part of a team managing individual patients.

In many states, non-physican clinicians, such as advanced practice nurses and physician assistants, can practice independently. Encouraging and advocating for these types of providers, even seeking legal changes to expand their practicing privileges, could also help meet behavioral health demand. Partnering with other behavioral health organizations, such as support groups and religious organizations, may also help get clients the support they need and ease providers’ workloads.

In Virginia, state-run psychiatric hospitals are considering several options to address overwhelming staffing shortages. Hiring additional security staff to help reduce risk for employees is one short-term solution. In the longer term, lawmakers are considering an increase for Medicaid reimbursement rates, particularly for private hospitals to encourage them to accept Medicaid patients.

Are you a behavioral health provider struggling with heavy workloads, high demand, and regulatory burdens? BestNotes offers a customizable EHR solution that helps you streamline your practice so you can save time, balance your life, and get your passion back. Contact us today to schedule a free demo and learn more.

date:  Jun 03, 2021
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Mental Health Awareness Month in the United States: How Are We Doing?

Did you know that May is Mental Health Awareness Month? This is an opportunity to look at the state of mental healthcare in the United States to identify trends and areas for improvement.

Despite Increased Demand, Behavioral Health Services Cut Back

Demand for behavioral health services has skyrocketed during the COVID-19 pandemic. A new report from the Government Accountability Office (GAO), however, has found that some provider groups laid off staff or cut back on programs.

The GAO report referred to a 2020 survey by the National Council for Behavioral Health that found that 27 percent of 343 behavioral healthcare organizations cut back employees. Forty-five percent of the organizations cut some of their programs. The majority (65 percent) of organizations reported having to cancel, reschedule, or turn away patients in the summer of 2020, even as 52 percent reported an increase in demand.

Some providers have had to reduce inpatient beds to follow social distancing requirements. Others have had difficulty getting insurers to cover inpatient stays for patients with both physical and behavioral health diagnoses. While providers have tried to address these issues through telehealth visits or partnering with digital health resources that provide self-directed mental health resources to clients, it has not completely offset demand, especially for those who need in-person care.

Time to Rethink Physical and Behavioral Health Integration

Integrating primary care with behavioral health has been a goal and a challenge in healthcare for years. However, Ed Jones, PhD, senior vice president for the Institute for Health and Productivity Management, notes that the movement so far has not met the high expectations. In many cases, “integration” has been interchangeable with “coordination,” which doesn’t lead to much change. The same goes for collaboration and the patient-centered health home.

Instead, Jones suggests a model that leads to fundamental, transformational changes in primary or behavioral care. That model should target the failure of primary care to address health behaviors that affect chronic medical conditions associated with a majority of healthcare costs, along with the continued stigma of seeking help for mental health concerns. A new type of provider, which Jones calls the “primary care therapist,” can help address both the issue of behavior change and stigma. Therapists may work within primary care settings to help screen, counsel, and refer patients. The full article can be found at Behavioral Health Executive.

How Has Telehealth Affected Therapy During the Pandemic?

During the COVID-19 pandemic, infection control measures and the increased demand for mental health services has led many behavioral health providers to move to telehealth. Clinicians are attempting to address a backlog of appointments, while patients deal with long waitlists to see a provider. At Aspirus Wausau Hospital, the waiting period to see a psychiatrist is 8-12 weeks, and referrals have doubled over the last year. As more providers resume in-person services, there is hope that the backlogs will decline.

Increased demand and complex client needs have created challenges for behavioral health providers. Make your practice more efficient and improve client outcomes with BestNotes’ EHR solutions, customized to your unique needs. Contact BestNotes today to learn more and schedule a free demo.

date:  May 25, 2021
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U.S Health Officials Lift Some Barriers to Opioid Addiction Treatment

New guidelines from the U.S. Health and Human Services Department (HHS) will make it easier for health providers to prescribe buprenorphine to treat opioid use disorder (OUD). As the U.S. faces an increase in drug overdose-related deaths during the COVID-19 pandemic, this change will help more patients gain access to necessary treatment, and expand the number of providers available to prescribe buprenorphine.

As of April 28, 2021, eligible healthcare providers will not need extra hours of training to prescribe buprenorphine, and they will no longer be required to refer patients to counseling services. The providers can also treat up to 30 patients at a time with buprenorphine. Prescribers who want to treat more than 30 patients at a time must continue to follow the stricter requirements.

Addiction treatment providers should be aware that the exemption applies only to the prescription of Schedule III, IV, and V drugs, and does not apply to Schedule II medications, such as methadone.
Before prescribing buprenorphine for OUD, providers must first obtain a waiver under the Controlled Substances Act and submit a Notice of Intent to the Substance Abuse and Mental Health Services Administration (SAMHSA), following current protocols. Providers must be state licensed and registered by the U.S. Drug Enforcement Administration to prescribe controlled substances. For the full list of eligible prescribers, see the official HHS notice.

Although the American Medical Association has praised the change, it has called for Congress to further loosen restrictions to buprenorphine prescriptions. Few providers have been willing to fulfill the requirements for prescribing the drug, restricting the number of prescribers available and limiting treatment access for patients struggling with OUD.

Buprenorphine (also known by the brand name Suboxone) has been approved by the FDA as a medication-assisted treatment (MAT). It is the first medication to treat OUD that can be prescribed or dispensed in physician offices, which can make it more available to those who need it most.

Buprenorphine is available as a pill or a sublingual film for about $100 a month. It helps reduce opioid withdrawal symptoms and cravings. As an opioid partial agonist, buprenorphine produces effects such as euphoria or respiratory depression. These effects are weaker compared to stronger drugs, such as methadone and heroin, making it less likely to be misused. This helps a patient taper from powerful drugs to lower doses of more mild opioids.

SAMHSA offers numerous resources for prescribers interested in MAT, and buprenorphine specifically. Recommendations for prescribing buprenorphine for OUD include:

Patient must abstain from opioid use 12-24 hours and be in the early stages of withdrawal.
The prescriber should adjust the buprenorphine dose once the patient is seeing fewer (or no) side effects or cravings, and has significantly reduced other opioid use.
Depending on the patient’s individual needs, OUD treatment with buprenorphine may go on indefinitely.
Besides buprenorphine, providers treating OUD should prescribe additional behavioral therapies, such as counseling, for the best treatment outcomes.

Do you treat patients for OUD and other substance misuse disorders? Your EHR should support every type of addiction treatment, from counseling to MAT. Learn how BestNotes can save you time and money with an EHR solution that offers eprescribing, medication monitoring, outcome tracking, and compliance with state and federal EPCS mandates. Contact BestNotes today to schedule a free demo.

date:  May 18, 2021
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