Treatment plan template for med management?

[mixolyd]

Does anyone have a treatment plan template that they use for med management? I never had to do one before but Optum/UBH requires them. Seems super annoying. Here's what they look for from their manual:

Treatment plan documentation needs to include the following elements:

• Specific symptoms and problems related to the identified diagnosis of the treatment
episode
• Critical problems that will be the focus of this episode of care are prioritized; any
additional problems that are deferred should be noted as such
• Relates the recommended level of care to the level of impairment
• Member (and, when indicated, family) involvement in treatment planning
• Treatment goals must be specific, behavioral, measurable, and realistic
• Treatment goals must include a time frame for goal attainment
• Progress or lack of progress towards treatment goals
• Rationale for the estimated length of the treatment episode
• Updates to the treatment plan whenever goals are achieved or new problems are
identified
• If the Member is not progressing towards specified goals, the treatment plan should be
re-evaluated to address the lack of progress and modify goals and interventions as
needed

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[Fan_of_Meehl]

Does anyone have a treatment plan template that they use for med management? I never had to do one before but Optum/UBH requires them. Seems super annoying. Here's what they look for from their manual:

Treatment plan documentation needs to include the following elements:

• Specific symptoms and problems related to the identified diagnosis of the treatment
episode
• Critical problems that will be the focus of this episode of care are prioritized; any
additional problems that are deferred should be noted as such
• Relates the recommended level of care to the level of impairment
• Member (and, when indicated, family) involvement in treatment planning
• Treatment goals must be specific, behavioral, measurable, and realistic
• Treatment goals must include a time frame for goal attainment
• Progress or lack of progress towards treatment goals
• Rationale for the estimated length of the treatment episode
• Updates to the treatment plan whenever goals are achieved or new problems are
identified
• If the Member is not progressing towards specified goals, the treatment plan should be
re-evaluated to address the lack of progress and modify goals and interventions as
needed

This seems to be the hottest trend in healthcare right now: let's over-engineer a system of checklists to eliminate individual clinician judgment and thereby 'improve quality' in healthcare.

 

[Fan_of_Meehl]

Does anyone have a treatment plan template that they use for med management? I never had to do one before but Optum/UBH requires them. Seems super annoying. Here's what they look for from their manual:

Treatment plan documentation needs to include the following elements:

• Specific symptoms and problems related to the identified diagnosis of the treatment
episode
• Critical problems that will be the focus of this episode of care are prioritized; any
additional problems that are deferred should be noted as such
• Relates the recommended level of care to the level of impairment
• Member (and, when indicated, family) involvement in treatment planning
• Treatment goals must be specific, behavioral, measurable, and realistic
• Treatment goals must include a time frame for goal attainment
• Progress or lack of progress towards treatment goals
• Rationale for the estimated length of the treatment episode
• Updates to the treatment plan whenever goals are achieved or new problems are
identified
• If the Member is not progressing towards specified goals, the treatment plan should be
re-evaluated to address the lack of progress and modify goals and interventions as
needed

The medical chart used to be a useful tool that WORKED FOR the provider as a place for the provider to write down info he/she deemed to be relevant and helpful to following the progress of the patient's response to intervention efforts. It has become CUDGEL for unlicensed and unsophisticated excellentologists and expertologists to use to bludgeon providers with in the name of 'quality improvement.' It's far past the time to wrench the reins away from the draft horse and put providers back in charge of medical practice.

 

[WisNeuro]

This seems to be the hottest trend in healthcare right now: let's over-engineer a system of checklists to eliminate individual clinician judgment and thereby 'improve quality' in healthcare.

Meh, we've needed a happy medium. In the olden days, I've seen notes that were extremely useless. Fro example, notes from the way back when in VISTA where someone was doing "therapy" with a patient for over a year. The notes essentially consisted of a sentence saying "Veteran attended a session of relational psychotherapy" and maybe one or two more sentences about the general topic that day. I honestly have no problem with actually having to document treatment progress and actually listing specific goals that the progress is documenting. If something is going to be paid for, there should be some kind of justification for it.

 

[st2205]

Meh, we've needed a happy medium. In the olden days, I've seen notes that were extremely useless. Fro example, notes from the way back when in VISTA where someone was doing "therapy" with a patient for over a year. The notes essentially consisted of a sentence saying "Veteran attended a session of relational psychotherapy" and maybe one or two more sentences about the general topic that day. I honestly have no problem with actually having to document treatment progress and actually listing specific goals that the progress is documenting. If something is going to be paid for, there should be some kind of justification for it.

So do you believe the quality of notes has increased or the amount of hoop-jumping fluff that gives the superficial appearance of a more quality note?

 

[WisNeuro]

So do you believe the quality of notes has increased or the amount of hoop-jumping fluff that gives the superficial appearance of a more quality note?

I don't believe that they are mutually exclusive.

 

[OldPsychDoc]

The medical chart used to be a useful tool that WORKED FOR the provider as a place for the provider to write down info he/she deemed to be relevant and helpful to following the progress of the patient's response to intervention efforts. It has become CUDGEL for unlicensed and unsophisticated excellentogists and expertologists to use to bludgeon providers with in the name of 'quality improvement.' It's far past the time to wrench the reins away from the draft horse and put providers back in charge of medical practice.

But how do you really feel?

 

[smalltownpsych]

But how do you really feel?

I'm not sure how fan of meehl feels about it, but I am thinking that if I posted how I really feel about United Healthcare, I might just get banned from the site. I am so tired of bureaucracies, whether it's medicaid, CMS, VA, or the 6th largest corporation in the country, making sure that I am doing something productive with their patients. I get that there have to be checks in place, but I don't have to like it.
"Thank you sir, may I have another" comes to mind.

 

[Fan_of_Meehl]

Meh, we've needed a happy medium. In the olden days, I've seen notes that were extremely useless. Fro example, notes from the way back when in VISTA where someone was doing "therapy" with a patient for over a year. The notes essentially consisted of a sentence saying "Veteran attended a session of relational psychotherapy" and maybe one or two more sentences about the general topic that day. I honestly have no problem with actually having to document treatment progress and actually listing specific goals that the progress is documenting. If something is going to be paid for, there should be some kind of justification for it.

I'm not sure how fan of meehl feels about it, but I am thinking that if I posted how I really feel about United Healthcare, I might just get banned from the site. I am so tired of bureaucracies, whether it's medicaid, CMS, VA, or the 6th largest corporation in the country, making sure that I am doing something productive with their patients. I get that there have to be checks in place, but I don't have to like it.
"Thank you sir, may I have another" comes to mind.

There's a great new book out by some of the top CBT researchers/clinicians in the field (edited by Hayes and Hofmann and endorsed heavily by all sorts of folks like Judith Beck and David Barlow) on Process Based CBT. They do a great job of summarizing what they believe should be a paradigm shift (renewal?) away from a 'protocol for syndrome/diagnosis' approach to 'evidence-based psychotherapy' and toward a more individualized case formulation, clinical hypothesis formulation/testing, and customized implementation of empirically-supported principles of behavior change approach. It will take some time (and, quite possibly, some bloodshed in the coming war between the administrative/bureaucratic authoritarian 'list checkers' and sophisticated clinicians), but I think that the better men/women will win out in the end. Think the equivalent of a 'Great (world) War' between the likes of Joint Commission Surveyors and the best and brightest that the field of psychology has to offer at the doctoral level. My money's on Beck, Barlow, Hayes et al.

 

[Shikima]

Easy fix, don't accept optum, UH or HCSC insurances. Problem solved!! Likely they're paying low too.

 

[FlowRate]

Joint Commission Surveyors

We're off topic enough at this point that I feel compelled to mention the $10,000 doorhandles our inpatient unit was required to install thanks to the ligature inquision, not to mention all of the doors and toilet paper holders.

No one has ever hanged themselves on our unit. People at high risk are on eyesight obs. Everyone else is on 5-15 minute checks. We have video monitoring. The $200,000+ spent is not going to have any impact on actual patient care or mortality. At least I get a mild grip strength workout trying to open the new indoor climbing doors.

I want to know which muckity-muck at the joint commission is married to an executive/shareholder of Sargent. 8200 Series Mortise Lock with BHW Trim Overview by SARGENT

• Specific symptoms and problems related to the identified diagnosis of the treatment
episode
• Critical problems that will be the focus of this episode of care are prioritized; any
additional problems that are deferred should be noted as such
• Relates the recommended level of care to the level of impairment
• Member (and, when indicated, family) involvement in treatment planning
• Treatment goals must be specific, behavioral, measurable, and realistic
• Treatment goals must include a time frame for goal attainment
• Progress or lack of progress towards treatment goals
• Rationale for the estimated length of the treatment episode
• Updates to the treatment plan whenever goals are achieved or new problems are
identified
• If the Member is not progressing towards specified goals, the treatment plan should be
re-evaluated to address the lack of progress and modify goals and interventions as
needed

This is something that wouldn't be too difficult to make as a smartphrase of smartlists, if you're in Epic or an EMR with similar functionality.

 

[mixolyd]

Easy fix, don't accept optum, UH or HCSC insurances. Problem solved!! Likely they're paying low too.

I was able to negotiate a pretty high rate with them, and I sort of have to take them because i'm in the state capital and all state employees have Optum.