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I currently moved into a new position with a large rural Federally Qualified Health Center. Most of the Federally Qualified Health Centers recently received funding to integrate Behavioral Health into their programs and administrators received training on implementing Behavioral Health into their Medical Health settings.
We are having a number of glitches with different expectations and some issues related to differences in training. The physicians and nurse practitioners are set up on a schedule of seeing patients every 20 minutes or roughly three patients per hour. When behavioral health issue are an area of focus, the Behavioral Health Team see the patient for a ten-minute screening that is non billable, but paid through the grant. We do a brief Mental Status and interview and then we either set them up for a diagnostic interview either the same day or when convenient for the patient.
Since I am the only Psychologist at my facility with psychological and neuropsychological testing approval, I am asked to rule out or rule in ADHD by the medical staff and it seems that they would like for me to do this when I do the BH Consults for ten-minutes. Rather than just do a brief consult for ADHD, I prefer to do a comprehensive evaluation and schedule it later on. However, the medical trained prescribers are wanting quicker information, so they will start the patient on a trial of stimulant-based medications pending evaluation by psychologist for ADHD.
We have had difficulty related to expectations of length of sessions. Coming from a mental health setting, we normally had one-hour sessions and three to four-hours for psychological and neuropsychological evaluations. Here they are wanting me to have 20-minute to 30-minute sessions, as we are reimbursed a set rate not based on length of time we see patients, since many are uninsured or have Medicaid-Medicare. We have agreed for psychological and neuropsychological evaluations that I have 30 to 60-minutes for the diagnostic interview and 120-minutes for psychological or neuropsychological testing.
Since this agency has traditionally provided only medical care, we seem to have problems associated with expectations. Apparently the medical providers see three-patient per hour and they may see up to 20-24 patient per day. In some of our staff meetings, it has been expressed by the medical providers that behavioral health in an integrated setting should be able to see at least two patients per hour, given they are booked solid throughout the day seeing 20 or more patients per day.
Per the training the administrators received, we are supposed to work as a team and meet briefly when needed in "huddling" about specific patient having behavioral health concerns. We are suppose to communicate back and forth electronically and in person about patients having behavioral health concerns. Anyway, to some extent medical providers have not been completely on board related to having behavioral health providers as it seems that expectations differ and the whole medical scheduling systems seems to endorse quantity of patients seen rather than quality of services provided.
I gather some on this board have worked in Integrated Behavioral Health Care longer than I have and I was curious if you have had similar issues, and if so, how these were resolved? We are having multidisciplinary meetings weekly and the first two went well, but now medical providers seem to express some hostilities related to wanting to have these brief BH consults to determine ADHD or other diagnosis quickly so they may make medication decisions quickly before the patient leaves from the appointment.
Apparently this agency being a FQHC has it mission to treat the whole person with emphasis on education, prevention, and intervention per the Health Home model where the patient can receive all of the treatment at one facility rather than go to multiple facilities. The local CMHC recently discontinued having medical providers and medications implementation for their patients and all of their patients are now referred to where I work for medication follow-up. The medical providers have been overloaded since this happened as has our whole system due to the influx of mental health patients we now serve. Being a FQHC we have to accept all patient regardless of ability to pay. So part of the issue could be that we are now expected to provide all of these services within the community whereas before it was primarily medical services with well child checkup and patient only having minor mental health concerns.
We are having a number of glitches with different expectations and some issues related to differences in training. The physicians and nurse practitioners are set up on a schedule of seeing patients every 20 minutes or roughly three patients per hour. When behavioral health issue are an area of focus, the Behavioral Health Team see the patient for a ten-minute screening that is non billable, but paid through the grant. We do a brief Mental Status and interview and then we either set them up for a diagnostic interview either the same day or when convenient for the patient.
Since I am the only Psychologist at my facility with psychological and neuropsychological testing approval, I am asked to rule out or rule in ADHD by the medical staff and it seems that they would like for me to do this when I do the BH Consults for ten-minutes. Rather than just do a brief consult for ADHD, I prefer to do a comprehensive evaluation and schedule it later on. However, the medical trained prescribers are wanting quicker information, so they will start the patient on a trial of stimulant-based medications pending evaluation by psychologist for ADHD.
We have had difficulty related to expectations of length of sessions. Coming from a mental health setting, we normally had one-hour sessions and three to four-hours for psychological and neuropsychological evaluations. Here they are wanting me to have 20-minute to 30-minute sessions, as we are reimbursed a set rate not based on length of time we see patients, since many are uninsured or have Medicaid-Medicare. We have agreed for psychological and neuropsychological evaluations that I have 30 to 60-minutes for the diagnostic interview and 120-minutes for psychological or neuropsychological testing.
Since this agency has traditionally provided only medical care, we seem to have problems associated with expectations. Apparently the medical providers see three-patient per hour and they may see up to 20-24 patient per day. In some of our staff meetings, it has been expressed by the medical providers that behavioral health in an integrated setting should be able to see at least two patients per hour, given they are booked solid throughout the day seeing 20 or more patients per day.
Per the training the administrators received, we are supposed to work as a team and meet briefly when needed in "huddling" about specific patient having behavioral health concerns. We are suppose to communicate back and forth electronically and in person about patients having behavioral health concerns. Anyway, to some extent medical providers have not been completely on board related to having behavioral health providers as it seems that expectations differ and the whole medical scheduling systems seems to endorse quantity of patients seen rather than quality of services provided.
I gather some on this board have worked in Integrated Behavioral Health Care longer than I have and I was curious if you have had similar issues, and if so, how these were resolved? We are having multidisciplinary meetings weekly and the first two went well, but now medical providers seem to express some hostilities related to wanting to have these brief BH consults to determine ADHD or other diagnosis quickly so they may make medication decisions quickly before the patient leaves from the appointment.
Apparently this agency being a FQHC has it mission to treat the whole person with emphasis on education, prevention, and intervention per the Health Home model where the patient can receive all of the treatment at one facility rather than go to multiple facilities. The local CMHC recently discontinued having medical providers and medications implementation for their patients and all of their patients are now referred to where I work for medication follow-up. The medical providers have been overloaded since this happened as has our whole system due to the influx of mental health patients we now serve. Being a FQHC we have to accept all patient regardless of ability to pay. So part of the issue could be that we are now expected to provide all of these services within the community whereas before it was primarily medical services with well child checkup and patient only having minor mental health concerns.
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