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Anorexia Could Have Genetic and Metabolic Components, According to a New Study

Anorexia nervosa, more commonly called simply anorexia, is an eating disorder characterized by restricted eating that can cause low body weight, usually combined with distorted body image and a strong fear of gaining weight. Many people with anorexia don’t recognize how underweight they become, or how harmful their condition can be to their overall health.

It is believed that anorexia affects between 1-2 percent of women and 0.2-0.4 percent of men. Since anorexia has one of the highest mortality rates of any psychiatric illness, treatment is essential.

No direct cause of anorexia has been established, although there are many potential risk factors:

Perfectionist personality
Obsessive-compulsive personality traits
Social, cultural, or peer pressure to maintain a certain weight
A first-degree relative who had anorexia
Severe emotional stress

Current treatment approaches for anorexia

Anorexia treatment usually includes several approaches, given the complexity of the disease. Hospitalization may be required for severe cases, followed by careful, supervised weight gain.
Like most other eating disorders, anorexia is largely considered a psychiatric issue. People with anorexia are believed to be struggling with emotional problems, and associate their weight with their self-worth. Therefore, individual and family-based counseling is also recommended to help establish healthy eating patterns and behaviors and change distorted beliefs and thoughts about eating and weight.

New anorexia research, however, suggests that there are also genetic factors involved in the disease. These factors may not only be mental, but metabolic, as well, and so treatment may need to account for these additional factors.

What does the new anorexia study show?

In a new study published in Nature Genetics, researchers at King’s College London and the University of North Carolina at Chapel Hill looked at data from 16,992 cases of anorexia nervosa and 55,525 controls. Data came from individuals in 17 countries.

This genome-wide association study identified eight significant genetic loci, or locations. The data showed significant genetic correlations between anorexia and metabolic traits, lipid traits, and body measurements. This overlap occurred independent of genetic effects that influence body-mass index.

These findings indicate that providers may want to avoid assuming that metabolic abnormalities are a direct result of the eating disorder that will go away once anorexia is treated and weight has been regained. Addressing both the metabolic and psychiatric symptoms in patients with anorexia may lead to better results.

Results also showed that the genetic basis of anorexia overlaps with other mental-health issues. These included obsessive-compulsive disorder, depression, anxiety, and schizophrenia. Some of the genetic factors associated with anorexia also were associated with physical activity, which may explain why people with anorexia tend to be more active.

Based on their findings, the researchers suggested that anorexia may need to be reconsidered a hybrid, “metabo-psychiatric disorder” rather than just a mental illness. The study authors noted that future, new treatments may need to incorporate both metabolic and psychological risk factors.

What does the new anorexia study show?

In a new study published in Nature Genetics, researchers at King’s College London and the University of North Carolina at Chapel Hill looked at data from 16,992 cases of anorexia nervosa and 55,525 controls. Data came from individuals in 17 countries.

This genome-wide association study identified eight significant genetic loci, or locations. The data showed significant genetic correlations between anorexia and metabolic traits, lipid traits, and body measurements. This overlap occurred independent of genetic effects that influence body-mass index.

These findings indicate that providers may want to avoid assuming that metabolic abnormalities are a direct result of the eating disorder that will go away once anorexia is treated and weight has been regained. Addressing both the metabolic and psychiatric symptoms in patients with anorexia may lead to better results.

Results also showed that the genetic basis of anorexia overlaps with other mental-health issues. These included obsessive-compulsive disorder, depression, anxiety, and schizophrenia. Some of the genetic factors associated with anorexia also were associated with physical activity, which may explain why people with anorexia tend to be more active.

Based on their findings, the researchers suggested that anorexia may need to be reconsidered a hybrid, “metabo-psychiatric disorder” rather than just a mental illness. The study authors noted that future, new treatments may need to incorporate both metabolic and psychological risk factors.

EHR for behavioral health providers

Eating disorders like anorexia can be complicated for behavioral health providers to treat. The right EHR solution can help you track patient progress and coordinate care with other specialists for optimal results.
BestNotes EHR software was designed with you in mind. Contact us today to learn more about how we can help strengthen your practice.

date:  Aug 07, 2019
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Five Things to Ask Before You Sign a New EHR Vendor

Choosing and adopting a new electronic health record (EHR) system is no small feat for any behavioral health or addiction treatment provider. Whether you’re choosing your first EHR or switching to a different solution, here are five questions to ask any EHR vendor you consider.

1. What is your implementation strategy?

How long should implementation take? Will the new EHR be rolled out gradually, or launched all at once? Does the vendor provide training, tutorials, demos, regular updates, and easily accessible support? Which staff members will need to use the EHR?

Each implementation is different, but your EHR vendor should help you create an implementation plan and schedule, understand what to expect, and minimize setbacks.

2. What additional fees do you charge?

Many behavioral health providers have been burned by hidden fees associated with a new EHR. For example, some EHR software companies add fees for certain tech support features. Make sure your budget isn’t being drained by examining the fine print of any agreements and cost estimates before you make a final decision.

3. How do you incorporate patient outcomes in your EHR?

The Joint Commission, a non-profit organization that accredits nearly 21,000 U.S. healthcare organizations and programs, requires its behavioral health members to use standardized methods to assess patient outcomes. This helps providers and patients create individual care plans and better evaluate patient outcomes.

The right EHR solution can help you track patient outcomes in different ways. This may include creating and managing patient progress notes, recording and sharing lab results, and managing intake assessments and discharge summaries.

4. What is your security strategy?

Data security and HIPAA compliance are important for your behavioral health practice, and should be equally important to your EHR vendor. Ask about how patient records are encrypted and saved, and how the vendor protects against data breaches.

Here are some things to look for:

Data transmission between user computer and the cloud should be encrypted
Vendors should provide a regular backup schedule; with BestNotes, for example, user notes are saved as they are made, with regular backups performed nightly
Whether the vendor uses penetration testing, which involves hiring experts to deliberately hack into their system to identify weak points

5. Do you belong to any national associations or follow specific industry standards?

An EHR vendor that joins a national association demonstrates a dedication to uphold standards within their industry. For example, BestNotes is a member of the HIMSS Electronic Health Record (EHR) Association, which aims to accelerate health information and technology, promote interoperability, and improve healthcare quality through EHR use.

BestNotes is also a member of the National Association of Addiction Treatment Providers, which is committed to providing advocacy, training, and other support to maintain the “highest quality of addiction treatment.”

Switch to an EHR made just for you

BestNotes EHR and CRM solutions are built specifically for behavioral health and addiction treatment professionals. Whether you are just launching your practice or looking to expand, we have the features you need to streamline your administrative tasks, boost your revenue, and improve your patient outcomes. Contact us today to learn more or schedule a free demo!

date:  Aug 05, 2019
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News Roundup: Medicaid Expansion Across the United States, July 2019

The Affordable Care Act (ACA), widely known as Obamacare, allows for expanded Medicaid coverage for low-income Americans. So far, 36 states and the District of Columbia have adopted Medicaid expansion. In other states, the debate continues in numerous forms. Here’s some of the latest news on Medicaid expansion across the nation.

Kentucky Plans to Expand School-Based Health Services Under Medicaid Plan

Kentucky’s Cabinet for Health and Family Services is partnering with the Kentucky Department of Education to work toward amending the state’s Medicaid plan. This would expand physical and mental healthcare access to students in schools by allowing for the payment of qualifying services.

Under the proposed amendment, Kentucky school districts would be able to use federal Medicaid funding to expand access to school-based healthcare for students enrolled in Medicaid. This includes mental health services and health screenings. Currently, students can only receive these services if they are covered by an Individual Education Plan under Medicaid.

North Carolina Still in a Budget Stalemate Due to Medicaid Expansion Conflict

North Carolina has not had a state budget for most of July, with Gov. Roy Cooper facing off against Republican lawmakers over including Medicaid expansion in the budget.
Cooper wants to expand Medicaid across the state, but has expressed a willingness to consider a compromise. He has already vetoed one budget proposal, while Republicans try to build up enough votes to override it.

Fewer Psychiatrists Accepting Medicaid Patients

Despite greater coverage of mental health services under Medicaid expansion across the country, research shows that fewer psychiatrists are accepting Medicaid patients. Writing in JAMA Psychiatry, researchers report that the percentage of psychiatrists accepting Medicaid as payment declined from nearly 48 percent in 2010-2011 to 35 percent in 2014-2015.
The findings demonstrate that expanded coverage does not always lead to expanded access. This may also increase demand for other clinicians besides psychiatrists who accept Medicaid for behavioral health services.

Study coauthor Adam Wilk of Emory University suggests that a shortage of behavioral health providers may affect how existing providers do business. They may accept more patients with private insurance, or opt out of insurance completely. Lower fees, reimbursement delays, and administrative burdens make Medicaid less appealing for behavioral health clinicians.

Small Florida Counties Worried About Medicaid Expansion

Florida is one of the 14 states that have not yet expanded Medicaid coverage under ACA. A political committee called Florida Decides Healthcare, however, is working to put a constitutional amendment before Florida voters in 2020. The amendment would require the state to expand Medicaid to include adults under age 65 who earn less than 138 percent of the federal poverty level. Currently, that amounts to $29,435 for a family of three, or $17,276 for an individual.
Some of the state’s smaller counties, however, are worried about how the state will cover the additional cost. Many residents in poorer Florida counties are concerned that they could see higher tax bills under proposed Medicaid expansion.

Behavioral Health and Addiction Treatment EHR for Providers Nation-Wide

Behavioral health and addiction treatment providers may see greater demand in states that expand Medicaid. A comprehensive EHR solution can help you keep up with demand.

BestNotes EHR and CRM solutions help behavioral health clinicians and staff save time, offer effective services, and grow their practice. Contact us today to find out more, or request to schedule a free demo!

date:  Aug 05, 2019
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How behavioral health providers can address workplace loneliness

As mental health and workplace wellness get more attention from the media and the general public, loneliness is emerging as a specific concern Loneliness not only affects quality of life, but creates problems at work, even among behavioral health staff.

What causes workplace loneliness?

In spite of open-office plans and increased connectivity, workers are lonelier than ever. This makes sense when you consider that technology has decreased the need for face-to-face interaction. Plus, more employees are working remotely, including in telehealth.

Behavioral health and addiction treatment professionals specifically face stress from helping individuals with complex, difficult needs. Privacy rules and other ethical boundaries limit clinicians’ ability to express concerns about patients or colleagues.

Staff also struggle with heavy administrative workloads and unique regulatory burdens, which may contribute to feelings of isolation. All this adds up to a strong potential for loneliness among behavioral health workers.

What are some effects of workplace loneliness?

CNN Business recently pointed out that workplace loneliness contributes to a variety of problems:

Reduced productivity, which can increase stress for individuals and hurt a bottom line
Lonely people may isolate themselves, potentially limiting workplace connections, communication, and teamwork
The spread of negative feelings and attitudes, reducing morale and increasing turnover

What are possible signs of workplace loneliness?

Loneliness can be difficult to recognize, especially if a person is trying to avoid appearing weak or feeling embarrassed. Signs to watch for among employees and coworkers include:

Falling productivity, including increased failure to meet deadlines
Lack of participation in meetings or social events without apparent reason
Limited or no response to group messages
Appearing tense or irritable with coworkers or clients
Taking more sick days than usual
Appearing to deliberately avoid interaction

What should behavioral health leaders do about workplace loneliness?

Loneliness has wide-reaching effects beyond the individual, so office managers and other behavioral health leaders should take steps to combat workplace loneliness.

Make sure new providers or administrative staff receive a personal onboarding experience, including thorough introductions and ongoing support.

Follow up with employees. Months after being hired, keep checking in periodically to make sure they feel connected and their needs are being addressed.

Show appreciation. Many employees feel lonely when they feel that they are not making a difference or their work is unnoticed. Gestures can be small, such as a short email or note to say thanks, or publicly acknowledging them for a job well done.

Encourage occasional outside gatherings, such as happy hours, employee lunches, holiday parties, or other casual get-togethers. Make sure everyone is explicitly invited.

Deliberately solicit employee input to keep them engaged. This is important for remote workers who may occasionally feel forgotten or isolated.

Communicate face-to-face when possible, rather than sending a message.

Make small efforts to get to know people, such as asking about their families or interests.

Encourage communication and teamwork with the right EHR

You don’t have to do without health IT to combat workplace loneliness. With the right EHR solution, behavioral health and addiction treatment providers can communicate more effectively, encourage teamwork, and boost productivity.

BestNotes EHR was developed specifically to help behavioral health practices stay streamlined and cost-effective without sacrificing employee well-being. Contact us today to learn more about how BestNotes can help you improve your care, track patient outcomes, and boost practice revenue.

date:  Jul 23, 2019
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Upcoming EPCS Mandates and Changes: What You Need to Know

Electronic prescribing for controlled substances (EPCS) has gained popularity in recent months as a way to better track opioid use and reduce fraud and misuse. Many states have already implemented their own EPCS mandates, but the federal government and even private companies also have gotten involved.

Federal Legislation and Requirements for EPCS

The U.S. Drug Enforcement Agency (DEA) gave providers permission to use EPCS in 2010, along with a set of standards for the EPCS systems that providers, pharmacies, and health IT vendors use. To be DEA compliant, an EPCS system must include:

Certification of the EHR/e-prescribing application
Identity proofing to confirm that a provider is authorized to prescribe controlled substances
Two-step logical access control to provide EPCS permissions to approved prescribers
Two-factor authentication for providers who sign an EPCS prescription
Comprehensive and detailed reporting to demonstrate compliance and to identify auditable events and security incidents

In October 2017, President Trump declared the opioid addiction epidemic a Nationwide Public Health Emergency. One year later, he signed the SUPPORT for Patients and Communities Act. This 250-page law includes multiple initiatives intended to address opioid misuse and addiction, and requires EPCS for all controlled substances under Medicare Part D by January 1, 2021.

Individual State EPCS Mandates

Due to the effectiveness of EPCS in curbing fraud, many individual states passed their own mandates. New York first mandated EPCS in 2016, with others quickly following.
Pennsylvania’s deadline for moving to EPCS is October 24, 2019. Arizona, Iowa, Massachusetts, North Carolina, Oklahoma, and Rhode Island all have mandates that will take effect January 1, 2020.

In September 2018, California passed a law that requires electronic prescribing for all medications—not just controlled substances. This law is scheduled to take effect January 1, 2022.

In many states, EPCS mandates are designed to work in conjunction with prescription drug monitoring programs (PDMPs). Under these programs, pharmacies submit information on the controlled prescriptions they dispense. These programs help identify patients who may exhibit drug-seeking behavior, and provide data on controlled medication use.

Pharmacy and Private Company EPCS Requirements

Pharmacies and other organizations also have implemented private mandates regarding EPCS. For example, Walmart pharmacies will no longer accept paper prescriptions for controlled substances after January 1, 2020. This is part of the company’s Opioid Stewardship Initiative to curb opioid misuse.

This year, the McKesson Corporation, a U.S. pharmaceutical distributor, will stop selling opioids to customers who cannot accept EPCS. To help with this change, the company has announced an intention to work with customers that have yet to make the transition to e-prescribing.

Health IT solutions developer DrFirst, which provides software used in BestNotes EHR, has updated its e-medication management platform. The company will discontinue its Rcopia3 software on January 1, 2020, and is requiring all users to move to Rcopia4. Available since 2016, Rcopia4 offers new features, including a unified integrated workflow experience for writing narcotic prescriptions and checking PDMPs.

Using EPCS with your EHR

Don’t get left behind in the changing regulatory environment. Make sure your EHR system allows for e-prescribing so you can continue to offer appropriate, high-quality care for your behavioral health patients while remaining compliant with state, federal, and private mandates.

BestNotes EHR and CRM solutions are tailored specifically for mental health and addiction treatment providers, with e-prescribing and other medication management options. Contact us today to learn more.

date:  Jul 09, 2019
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