TPUs in the outpatient setting.

[DXM1]

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For those of you in outpatient private practices: Do you complete regular patient treatment plans (TPUs)?

From a brief google glance, it appears that this is a Medicaid requirement. Would it be correct to surmise that if a provider does not accept Medicaid, they do not have to complete TPUs?

Just trying to get a handle on the bureaucracy.

 

[Sushirolls]

My understanding is TPUs and and things like TPUs are bureaucratic nightmare created by the government, and seen in community mental health centers, probably FQHCs, and other such entities. I wouldn't be surprised if buried some where in a medicaid contract they expect private/commercial groups that take medicaid to also do such things, but I haven't in the past, and doubt many will. These TPU like things are complete waste of time and serve no real purpose. I would even say the same about the inpatient multidisciplinary treatment plan documents, too.

Tricare and its subsidiaries also require excess treatment plans and visit authorizations that are similar to the above.

Thus, the real summary is the government, and ever increasing laws will be the the death of us all by a 1000 paper cuts. So remember to say no to medicare for all and any other government health care expansions.

 

[dl2dp2]

General answer is no. Typically it’s not easy to enforce admin requirements and try to couple that to funding, since as you can imagine 1) they can’t find people to do a proper job already 2) reimbursement is by block grants not specific case 3) few admin review is actually staffed. So typically what happens in reality is there are admin requirements but nobody does them until charts get reviewed then you only do it for that one chart that gets reviewed. This is much more efficient.

In many contexts in public psychiatry if you don’t do what your non clinically trained boss wants you to do relating to non clinical duties, there’s nothing they can do. They can’t even fire you once they hired you. They can’t change your salary. They can’t change your schedule. Nobody cares. The same issues will continue to pop up for 30 years. So carry on do however much or little u feel Iike.

 

[DXM1]

I agree that TPUs serve no purpose and view them as detrimental to patient care, as time that should be spent with patients is spent on busy work that has zero patient benefit.

Thanks for answering, this makes it much clearer for me.

 

[TexasPhysician]

While I am sure you could do formal treatment plans at the expense of $, time, and benefiting other patients, I’ve only seen them to be detrimental.

Counselors I’ve worked with incorporate (briefly) a long-term plan in their notes. Each session whether q2 months or q3 days would have a different long-term plan. The result is that I never could understand the true goal/plan.