New Law in NY

[calvinhobbes]

Is this good or bad for psychiatrists?

New law expands access to mental health diagnosis, treatment

Senate Bill S9449 is designed to help alleviate what lawmakers are calling the verge of a crisis in New York.

www.rochesterfirst.com

---

Members don't see this ad.

 

[PikminOC]

There will be a lot of misdiagnosis with this.

 

[calvinhobbes]

Yeah, that’s what I feared :/

 

[birchswing]

<Not a doctor or medical student>

I've anecdotally heard of a couple of cases recently of people at PCP offices who have been given a very short questionnaire to fill out with the rest of their paperwork and as a result of it been given SSRIs for a new diagnosis of depression. And they were not there for mental health concerns.

At least mental health counselors don't have prescribing privileges. And if they did, at least it would be based on more than a questionnaire.

I didn't really follow the article, though. If they are able to get in to see the counselor, what difference does it now make that the counselor can now diagnose? How does that increase access? I also did not realize that counselors didn't already give diagnoses. I think I may have heard of some places where to see a psychiatrist you have to go through a screening with a counselor first? Is that what is about?

 

[WisNeuro]

<Not a doctor or medical student>

I've anecdotally heard of a couple of cases recently of people at PCP offices who have been given a very short questionnaire to fill out with the rest of their paperwork and as a result of it been given SSRIs for a new diagnosis of depression. And they were not there for mental health concerns.

At least mental health counselors don't have prescribing privileges. And if they did, at least it would be based on more than a questionnaire.

I didn't really follow the article, though. If they are able to get in to see the counselor, what difference does it now make that the counselor can now diagnose? How does that increase access? I also did not realize that counselors didn't already give diagnoses. I think I may have heard of some places where to see a psychiatrist you have to go through a screening with a counselor first? Is that what is about?

Depends on the payer source and the LCD where you practice. In many cases, patients need a DA to authorize certain services. If the waitlist to get a DA is 6+ months, they can be SOL for that time period. While I am generally opposed to midlevel scope creep, many of these issues are self-inflicted wounds.

 

[allantois]

I wasn’t aware counselors couldn’t diagnose patients; that’s certainly not the case in the two states I’ve practiced.

 

[WisNeuro]

I wasn’t aware counselors couldn’t diagnose patients; that’s certainly not the case in the two states I’ve practiced.

State law allows counselors here to provide diagnoses for Medicaid, but we're relatively progressive in our MH statutes. Aside from the whole conversion therapy issue.

 

[mistafab]

A textbook of forensic psychiatry I read had a wonderful line. Spmething like “…of all forms of medical mistakes, misdiagnosis is the most dangerous and costly to the healthcare system.”

New York is going to have a different kind of crisis down the road.

 

[PikminOC]

Depends on the payer source and the LCD where you practice. In many cases, patients need a DA to authorize certain services. If the waitlist to get a DA is 6+ months, they can be SOL for that time period. While I am generally opposed to midlevel scope creep, many of these issues are self-inflicted wounds.

What's lcd and da?

 

[WisNeuro]

What's lcd and da?

Local Coverage Determination and Diagnostic Assessment

 

[Stagg737]

Depends on the payer source and the LCD where you practice. In many cases, patients need a DA to authorize certain services. If the waitlist to get a DA is 6+ months, they can be SOL for that time period. While I am generally opposed to midlevel scope creep, many of these issues are self-inflicted wounds.

I still don't understand how this will increase access within those six months of waiting. I'm sure as heck not prescribing anything until I've seen the patient myself or a co-worker I trust has. Unless they're suggesting a counselor diagnose them and then a PCP prescribe, which as pointed out has a completely different set of problems.

 

[nexus73]

I know locally we still have issues where Medicare only contracts with masters level social workers for psychotherapy, many other masters level therapists (LMFTs, LCPCs, etc) can't bill Medicare which is limiting in hospital systems and for collaborative care to some extent. Though most in private practice eschew Medicare because reimbursement sucks. Word to the wise, if you know someone getting a masters level mental health degree, it should be in social work to have the most flexibility and job opportunities.

 

[deleted1100659]

I work at a large community behavioral health center as many of you know, and ill tell you why this is probably a terrible idea.

Before the patient sees a psychiatrist they do a one hour assessment from a lcsw or whatever their title is. Not even entirely sure some of them have those credentials. After the assessment, they give the patient a diagnosis. I have never once seen them to accurately diagnose the patient. About half of them diagnose based on the patient stating "I have paranoid schizoaffective bipolar disorder and I have ADHD and depression" and you can believe the patient will get "diagnosed" with most of these things and labeled with them.

Many midlevel providers are not really familiar with DSM criteria or diagnosing patients accurately so they often just go with what the labels say, and treat them based upon a clearly inaccurately clinical assessment. Some of mine have finally started taking off these dumb labels and attempting to diagnose and treat correctly but it has been a painful process.

1/4 of my patients come because they want to get on disability and want a "check at the end of the month". Unfortunate but its sadly true. These people come, often get ridiculous labels and get help with obtaining disability for mental health. it is a joke of a system. I have patients tell me "im just here so i can get a check at the end of the month". Though if im confident their diagnosis is BS I always delete it from the chart, but my facility helps people obtain benefits (which is good for a lot of people), but inevitably brings in the worst patients.

short version: we need less people giving out BS diagnosis, all that will do is cause the wrong treatment, and more people using it as a means to apply for benefits.