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- Feb 26, 2013
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I work part time for one of those companies that provides psychologists and LCSWs to skilled nursing facilities and long term living facilities. Overall not bad work, company is generally fine to work with, and switching to FFS has made the workload much more flexible and enjoyable. I spend most of my time at these facilities doing initial brief evaluations.
Over time I learned that PHQ-9s are "very important" to these facilities as their results increase or decrease government money and reimbursement rates to these facilities. Naturally with private equity's hands all over these places, they want more and more.
My company comes in and includes these PHQ-9s in brief evaluations and such. They also tell facilities we'll do them as needed. As FFS usually we get paid a few bucks to do each one (if it's not included in the evaluation for whatever reason). But my company doesn't get anything from it, they can't bill for it. So I get informed recently they're no longer paying for them, but the facilities still need them and we should still be doing them. Apparently the finance department at my company noticed the company loses money on these when having to pay clinicians to complete them. The arrangement of this whole thing is my company charges $0 to these facilities , instead just billing for all the services we, the clinicians provide, then collecting revenue from insurance billables.
Obviously the private equity folks love this, they can offer "psychological services" as a benefit and feature to patients without spending a penny. So the burden is on my company to bill, baby, bill!.
Thus enters the clinical and ethical dilemma. My company can bill for brief individual therapy sessions as well as evaluations. They even have a therapy note in their EHR that includes the PHQ-9. So they say "well you can earn more AND keep doing PHQ-9s, just do them as individual session notes!"
The problem, as I see it, is most of these patients don't need therapy. And most during the evaluation will politely decline follow up sessions during their stay. Which is certainly within their rights as a patient. And the EHR documents this so if you do create an individual therapy session note , that shows in the note. Not to mention you need to identify a billable diagnosis, a treatment plan, and write up observable evidence of patient engaging in and benefitting from said session. You also need to state a reason for having the session (which could be as simple as facility requested patient be seen due to recent panic attacks or patient reported depression and sadness) but one of the billable reasons is not "to complete PHQ-9."
Fortunately I'm not beholden to productivity quotas (a big reason why I went from salaried to FFS to keep my sanity lol) , but there's increasing pressure to "do more PHQ-9s!" without them paying us to do them and instead suggesting we create billable events to add the PHQ-9s into. What's ironic here is the facilities actually have salaried staff that do PHQ-9s , but I was told a problem is the administration of these are haphazard and the facilities were unhappy with their own in house results ,so found outside results seem to be more beneficial.
Thoughts on how to navigate this because this seems a bit unethical to suggest? Basically what's a professional way to say, I guess there'll be less PHQ-9s being done if there's no compensation for doing them and creating therapy sessions with patients to do them isn't the way.
Over time I learned that PHQ-9s are "very important" to these facilities as their results increase or decrease government money and reimbursement rates to these facilities. Naturally with private equity's hands all over these places, they want more and more.
My company comes in and includes these PHQ-9s in brief evaluations and such. They also tell facilities we'll do them as needed. As FFS usually we get paid a few bucks to do each one (if it's not included in the evaluation for whatever reason). But my company doesn't get anything from it, they can't bill for it. So I get informed recently they're no longer paying for them, but the facilities still need them and we should still be doing them. Apparently the finance department at my company noticed the company loses money on these when having to pay clinicians to complete them. The arrangement of this whole thing is my company charges $0 to these facilities , instead just billing for all the services we, the clinicians provide, then collecting revenue from insurance billables.
Obviously the private equity folks love this, they can offer "psychological services" as a benefit and feature to patients without spending a penny. So the burden is on my company to bill, baby, bill!.
Thus enters the clinical and ethical dilemma. My company can bill for brief individual therapy sessions as well as evaluations. They even have a therapy note in their EHR that includes the PHQ-9. So they say "well you can earn more AND keep doing PHQ-9s, just do them as individual session notes!"
The problem, as I see it, is most of these patients don't need therapy. And most during the evaluation will politely decline follow up sessions during their stay. Which is certainly within their rights as a patient. And the EHR documents this so if you do create an individual therapy session note , that shows in the note. Not to mention you need to identify a billable diagnosis, a treatment plan, and write up observable evidence of patient engaging in and benefitting from said session. You also need to state a reason for having the session (which could be as simple as facility requested patient be seen due to recent panic attacks or patient reported depression and sadness) but one of the billable reasons is not "to complete PHQ-9."
Fortunately I'm not beholden to productivity quotas (a big reason why I went from salaried to FFS to keep my sanity lol) , but there's increasing pressure to "do more PHQ-9s!" without them paying us to do them and instead suggesting we create billable events to add the PHQ-9s into. What's ironic here is the facilities actually have salaried staff that do PHQ-9s , but I was told a problem is the administration of these are haphazard and the facilities were unhappy with their own in house results ,so found outside results seem to be more beneficial.
Thoughts on how to navigate this because this seems a bit unethical to suggest? Basically what's a professional way to say, I guess there'll be less PHQ-9s being done if there's no compensation for doing them and creating therapy sessions with patients to do them isn't the way.
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