VA Mental Health Provider Venting / Problem-solving / Peer Support Thread

[AcronymAllergy]

I've heard Mission Act pay isn't horrible, but that's second-hand information; I've not looked up the rates myself.

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[Fan_of_Meehl]

I've heard Mission Act pay isn't horrible, but that's second-hand information; I've not looked up the rates myself.

I tend to think that if I take the actual 'mission' to heart, then I'll be taken care of. But I've been pretty naive before. It ain't a virtue.

 

[PsyDr]

I've heard Mission Act pay isn't horrible, but that's second-hand information; I've not looked up the rates myself.

quick perusal shows, “...payment rates will not exceed the applicable Medicare fee schedule...”

 

[dkinca]

Hope someone can give some advice or info...

my spouse is a VA “graduate” psychologist at the GS-12 level and failed EPPP for the 2nd time. Sadly the 2 year timeline to obtain a license as a VA employee is now a couple weeks away. Her supervisor is already in the process with HR to get a term date set.

any thoughts or remedies? I wasn’t sure if the 2 year timeline (per 38 U.S.C. § 7405 [(c)(2)(B)]) pertains to the current job/position she is in or if she could reapply for some other VA psychologist position at another location at the GS-11 level.

 

[WisNeuro]

Hope someone can give some advice or info...

my spouse is a VA “graduate” psychologist at the GS-12 level and failed EPPP for the 2nd time. Sadly the 2 year timeline to obtain a license as a VA employee is now a couple weeks away. Her supervisor is already in the process with HR to get a term date set.

any thoughts or remedies? I wasn’t sure if the 2 year timeline (per 38 U.S.C. § 7405 [(c)(2)(B)]) pertains to the current job/position she is in or if she could reapply for some other VA psychologist position at another location at the GS-11 level.

It will very hard for her, if not impossible, for her to get another VA job without already having passed the EPPP at this point. Those records follow, so everyone will be able to see them in applications. At this point, maybe taking some time off and doing a functional analysis on what is keeping her from passing and working on that and passing before applying to another job is in order.

 

[psychRA]

my spouse is a VA “graduate” psychologist at the GS-12 level and failed EPPP for the 2nd time. Sadly the 2 year timeline to obtain a license as a VA employee is now a couple weeks away. Her supervisor is already in the process with HR to get a term date set.

Is there a possibility that they can be flexible about this and give her a bit more time? I've always heard that the 2-year timeline is firm, and yet I've also heard of people being able to extend that window.

 

[dkinca]

Per her supervisor they stated that their hands are tied and cannot extend the timeline. I’m not certain but I believe they can extend for providers who do not have patient contact. Ex: research position.

 

[LadyHalcyon]

I have been following this listserv (for mental health C&P folks at VA) for the past four years on a daily/weekly basis. There have always been 'rumors' and rumblings and the occasional minor downsizing. This time it's for real. Multiple posters chiming in that they have just gotten word recently that the plan is to shut it all down. Some completely shut down very soon. Some departments will (if I remember correctly) try to eliminate roughly 25% of staff and assessments per quarter while increasing community exams commensurate with that draw down until they reach zero in-house exams. D-Day for C&P is here.

I know the Lexington, KY VA shut theirs down not too long ago

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[cara susanna]

I'm not familiar with the 2 year timeline to get licensed--does that clock start ticking once you start as a psychologist?

 

[deleted343839]

I'm not familiar with the 2 year timeline to get licensed--does that clock start ticking once you start as a psychologist?

I believe so, yes. I know few people who've done this and became licensed within a year or so of their start date.

 

[AcronymAllergy]

I believe so, yes. I know few people who've done this and became licensed within a year or so of their start date.

I also believe so, and have generally heard that it's a pretty immutable deadline. I honestly don't know if someone would be eligible for a GS-11 position elsewhere. I wonder if they could keep her on LWOP (leave without pay) status until she passes...? I think that's capped at 3 or 4 months, though.

 

[Sanman]

I'm not familiar with the 2 year timeline to get licensed--does that clock start ticking once you start as a psychologist?

It's a requirement of gs-11 or gs-12 psychologists and is in their VA contract when they are highered for the position that is a full performance gs-13. No real wiggle room as it comes from HR. We just finished hiring a gs-12 and checked this with HR recently.

 

[psychRA]

It's a requirement of gs-11 or gs-12 psychologists and is in their VA contract when they are highered for the position that is a full performance gs-13. No real wiggle room as it comes from HR. We just finished hiring a gs-12 and checked this with HR recently.

I wonder if there's any variation by location? I always assumed that the two-year time frame was hard and fast, but a colleague and close friend of mine was able to push back that window within the past few years. I also heard, but can't confirm with certainty, that another colleague was able to do so as well within the past year.

Not that it necessarily helps in this case. I'm just curious.

 

[erg923]

I know the Lexington, KY VA shut theirs down not too long ago

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A determination of disability benefits by a psychologist working for and paid for by the same organization as the "defendant" has always seemed bizarre and somewhat a slippery slope to me? Yes, yes...they work for the VBA technically (I think?) etc. But I really don't know how much that really means in the grand scheme of things since they work in the same place/same building, know all of us, etc? I lunched with C&Ps and we talked very frequently about various issues. They provided some didactics and helped influence the way clinical staff do things (diagnostically especially).

That said, the quality of the contract stuff that I observed/read never even came close to our in-house exams.

Louisville has 8 in-house C&Pers...and has for years (maybe a decade now?). Seems heavy-handed for our VAMC catchment area (although Ft. Knox is also part of the catchment area).

 

[Fan_of_Meehl]

Per her supervisor they stated that their hands are tied and cannot extend the timeline. I’m not certain but I believe they can extend for providers who do not have patient contact. Ex: research position.

Is there not another position in mental health she may apply for? I work in VA mental health and we need all the help we can get.

 

[dkinca]

Is there not another position in mental health she may apply for? I work in VA mental health and we need all the help we can get.

She is already a licensed MFT for 10+ years and has a “possible” chance to maintain employment in RCS at the local Vet Center while continuing studying for the EPPP. Her supervisor said once she passes call her and she’d love to rehire her.

 

[cara susanna]

Hey all,

What amount of time do your division leaders give you for new patient intakes (e.g., how many min in your intake slot)? Just curious.

 

[AcronymAllergy]

From what I know, our psychologists typically get 60 mins.

I've heard of 90, but more commonly for psychiatrists than psychologists (I think).

 

[WisNeuro]

From what I know, our psychologists typically get 60 mins.

I've heard of 90, but more commonly for psychiatrists than psychologists (I think).

I still did(do) therapy when I was in the VA. 60 mins was usually plenty of time for an intake, generally because most people had a pretty extensive history in CPRS, with a lot of MH stuff already in the chart. Outside of the VA, I find I need more of the 90min intakes as I usually don't have as much to go on after a chart review.

 

[cara susanna]

60 just seems really short to me given all of the administrative requirements (e.g, the CSRE).

 

[erg923]

60 just seems really short to me given all of the administrative requirements (e.g, the CSRE).

Good Lord, what is that? More MH suite nonsense?

All MH clinic and I think specialty clinic intakes/new patients were a 60 minute slot when I was there. The PCMHI intake was bare bones (and we still fudged the 90791 code for it), but the MH clinic intake template (for psychology) was not much more comprehensive and a complete joke when I was there.

 

[cara susanna]

Good Lord, what is that? More MH suite nonsense?

All MH clinic and I think specialty clinic intakes/new patients were a 60 minute slot when I was there. The PCMHI intake was bare bones (and we still fudged the 90791 code for it), but the MH clinic intake template (for psychology) was not much more comprehensive and a complete joke when I was there.

Comprehensive Suicide Risk Evaluation. We have to do a suicide screener (the Columbia) for every mental health intake, even if it isn't due.

So, if you see a patient who screens positive and then you have to do a CSRE... then imagine you have to do a safety plan, and possibly a suicide behavior report. That just eats up time. Whenever I've tried to do 60 min intakes with complex patients I've run out of time. And, yeah, that doesn't include the admin stuff like Mental Health Suite or Mental Health Assistant.

 

[iliketohelppeople]

We get 90 minutes - but we are a specialty op clinic.

 

[cara susanna]

I used to be in a specialty clinic and got 90 min there as well.

 

[AcronymAllergy]

I agree, with the new CSRE on a complex patient, if you also have to complete a safety plan, 60 mins probably won't be enough to get to everything.

If it's something that happens frequently, I would start tracking numbers to see if you can make an argument for longer slots for pts who at least seem more complex. I rarely get a positive CSSRS, but I'm in specialty care, and most of my pts are being actively treated in MH before they come to me. The only alternative I can think is to hit the essentials in what's left of that initial appt, and schedule for f/u to complete the eval. If they're complex enough that 60 mins isn't long enough for an intake, they likely need to come back for f/u anyway.

 

[Fan_of_Meehl]

Comprehensive Suicide Risk Evaluation. We have to do a suicide screener (the Columbia) for every mental health intake, even if it isn't due.

So, if you see a patient who screens positive and then you have to do a CSRE... then imagine you have to do a safety plan, and possibly a suicide behavior report. That just eats up time. Whenever I've tried to do 60 min intakes with complex patients I've run out of time. And, yeah, that doesn't include the admin stuff like Mental Health Suite or Mental Health Assistant.

And...

Get ready for the Therametrics 'Behavioral Health Lab' software (I am one of a small handful of providers who have been voluntold to use this software).

An entirely separate software package that (sorta) integrates with CPRS where you get to enter all of your client's self-report questionnaire (PCL's, PHQ's) responses.

I think we passed ridiculous about five years ago.

'Behavioral Health Lab.' 'Lab.'

Yeah...pretty much just a glorified Excel spreadsheet of questionnaire responses with a clunky, buggy and slow Visual Basic front end interface tacked on.

'Lab.'

 

[iliketohelppeople]

And...

Get ready for the Therametrics 'Behavioral Health Lab' software (I am one of a small handful of providers who have been voluntold to use this software).

An entirely separate software package that (sorta) integrates with CPRS where you get to enter all of your client's self-report questionnaire (PCL's, PHQ's) responses.

I think we passed ridiculous about five years ago.

'Behavioral Health Lab.' 'Lab.'

Yeah...pretty much just a glorified Excel spreadsheet of questionnaire responses with a clunky, buggy and slow Visual Basic front end interface tacked on.

'Lab.'

How does this differ from MHA?

 

[AcronymAllergy]

How does this differ from MHA?

That was my exact question. Easier for data extraction or something? Allows the bean counters to more easily track compliance?

 

[Fan_of_Meehl]

That was my exact question. Easier for data extraction or something? Allows the bean counters to more easily track compliance?

It appears to be a replacement for Mental Health Assistant and they are 'piloting' it in my VISN...we're some of the lucky few who get to be required to use it (for all cases) first. But, don't worry, it'll make its way out into the entire organization to become yet another software requirement soon enough. The local social workers (who run mental health here) and administrators couldn't stop cooing and ranting how it heralds a 'new' era of 'evidence-based care' and how it is going to 'revolutionize' everything and bring in the mental health utopia.

 

[iliketohelppeople]

It appears to be a replacement for Mental Health Assistant and they are 'piloting' it in my VISN...we're some of the lucky few who get to be required to use it (for all cases) first. But, don't worry, it'll make its way out into the entire organization to become yet another software requirement soon enough. The local social workers (who run mental health here) and administrators couldn't stop cooing and ranting how it heralds a 'new' era of 'evidence-based care' and how it is going to 'revolutionize' everything and bring in the mental health utopia.

Stuff like this is one of the reasons I am strongly considering leaving the VA. Seems like a lot of focus on 'Gee Whiz Science', limitless paperwork, and attempting to disrupt quality patient care with many declarations that seem to be made with no thought of consequences. Ultimately, it makes it difficult to do really solid work. Fortunately, I have a good team that helps quite a bit.

 

[AcronymAllergy]

It appears to be a replacement for Mental Health Assistant and they are 'piloting' it in my VISN...we're some of the lucky few who get to be required to use it (for all cases) first. But, don't worry, it'll make its way out into the entire organization to become yet another software requirement soon enough. The local social workers (who run mental health here) and administrators couldn't stop cooing and ranting how it heralds a 'new' era of 'evidence-based care' and how it is going to 'revolutionize' everything and bring in the mental health utopia.

If it's actually an improvement over MHA (which can be a bit slow and cumbersome to use), I'd welcome it. Although I wonder if it was just an eventual necessity, given the move away from CPRS.

But yes, it's sad that "evidence-based care" has seemingly become synonymous with, "give as many checklists, questionnaires, and semi-structured 'interviews' to the patient as you can."

 

[Fan_of_Meehl]

If it's actually an improvement over MHA (which can be a bit slow and cumbersome to use), I'd welcome it. Although I wonder if it was just an eventual necessity, given the move away from CPRS.

But yes, it's sad that "evidence-based care" has seemingly become synonymous with, "give as many checklists, questionnaires, and semi-structured 'interviews' to the patient as you can."

To be fair, it is an improvement over MHA; in fact, it appears that clinicians may have actually had some input into its development (which is astonishing). However, I often wonder how my mentors from grad school (who write books about how to do cognitive therapy) or the likes of Judith Beck, David Barlow, or Marsha Linehan would try to make it practicing in the current VA environment. I'm all for 'evidence-based care' and quality therapy. However, the VA is currently utilizing bachelor's level folks (who might have a degree in History or something) to 'audit' (really supervise) the clinical work of doctoral-level providers via a chart review and judge the 'quality' of their written treatment plans. We don't even treat trainees/interns that way. At least if you are going to critique a grad student's work, you have to actually meet with them face-to-face and interface with them to provide some actual supervision. One issue is that probably 80% of VA workers (non-providers) have had positions where they did, say, 5 hours of work in a 40 hour work period but now with an increased emphasis on 'productivity' (along with the fact that they can't fire anyone), all the non-provider positions are having to make more work for themselves (which generally involves them 'reviewing' the work of providers for 'quality assurance'), making the providers miserable and actually less productive for having to satisfy the 20 different 'masters' who are continually taking more and more pieces out of the providers as we struggle to provide complex patient care services. It's a death spiral at this point for the organization.

 

[WisNeuro]

Get out while you can, folks, the possibility of a pension isn't worth it.

 

[cara susanna]

I thought BHL was only for PCMHI.

 

[Sanman]

To be fair, it is an improvement over MHA; in fact, it appears that clinicians may have actually had some input into its development (which is astonishing). However, I often wonder how my mentors from grad school (who write books about how to do cognitive therapy) or the likes of Judith Beck, David Barlow, or Marsha Linehan would try to make it practicing in the current VA environment. I'm all for 'evidence-based care' and quality therapy. However, the VA is currently utilizing bachelor's level folks (who might have a degree in History or something) to 'audit' (really supervise) the clinical work of doctoral-level providers via a chart review and judge the 'quality' of their written treatment plans. We don't even treat trainees/interns that way. At least if you are going to critique a grad student's work, you have to actually meet with them face-to-face and interface with them to provide some actual supervision. One issue is that probably 80% of VA workers (non-providers) have had positions where they did, say, 5 hours of work in a 40 hour work period but now with an increased emphasis on 'productivity' (along with the fact that they can't fire anyone), all the non-provider positions are having to make more work for themselves (which generally involves them 'reviewing' the work of providers for 'quality assurance'), making the providers miserable and actually less productive for having to satisfy the 20 different 'masters' who are continually taking more and more pieces out of the providers as we struggle to provide complex patient care services. It's a death spiral at this point for the organization.

To be fair, lots of insurance based care can be the same way. I left the private arena because of garbage like this, but it seems to follow me wherever I go. Out of the frying pan into the fire.

 

[Fan_of_Meehl]

I

I thought BHL was only for PCMHI.

I work in post-deployment. I'd imagine local autocrats got to choose what subset of their workforce had to pilot it at first. Because...reasons.

 

[Fan_of_Meehl]

To be fair, lots of insurance based care can be the same way. I left the private arena because of garbage like this, but it seems to follow me wherever I go. Out of the getting pan into the fire.

I'd actually have no problem entering one or two outcome measures into BHL as long as it spat out a CPRS progress note (with me adding some brief progress note text specific to the encounter) and as long as that covered my documentation requirements. Something like this + a decent clinical case formulation and simple problem/goal list is all the documentation that the luminaries in the field of CBT utilize/require. But that ain't up to the VA's 'standards.' We have to do double-, triple-, and quadruple charting, increasing points-of-failure in the system and making efficiency impossible.

 

[cara susanna]

I just found out that my facility is also getting rid of in-house C&P and that this is a nationwide thing. So, yup, this is really happening.

 

[AcronymAllergy]

I just found out that my facility is also getting rid of in-house C&P and that this is a nationwide thing. So, yup, this is really happening.

With the plan being to do it all via contract workers, or to move C&P to separate facilities?

 

[WisNeuro]

With the plan being to do it all via contract workers, or to move C&P to separate facilities?

I think contracting out. I've already been contacted to do this. Yeah.....no.

 

[thebalmofhurtminds]

With the plan being to do it all via contract workers, or to move C&P to separate facilities?

To contract out. Some of the sites I've been at have been slowing moving toward that for years and steadily cutting the C&P jobs.

 

[cara susanna]

Yes, contracting out.

 

[AcronymAllergy]

I've not been overly impressed with most of the contracted reports I've seen, but that's not my battle to fight. I do think this at least has the potential to reduce the confusion of providing healthcare services and disability evaluations in the same building(s), even if the providers are technically working for two separate divisions.

 

[cara susanna]

I've not been overly impressed with most of the contracted reports I've seen, but that's not my battle to fight. I do think this at least has the potential to reduce the confusion of providing healthcare services and disability evaluations in the same building(s), even if the providers are technically working for two separate divisions.

Yeah, I have mixed feelings. On the one hand I'm sure that the quality of C&P will go down. On the other, I'm happy that I won't have to do them anymore and we can do a better job keeping the boundary between VBA and VHA.

 

[psychRA]

The C&P reports that are contracted out are generally terrible, in my experience. Certainly there are exceptions, of course. But the majority of the ones that I've seen appear to have been written by someone who never even accessed CPRS, let alone someone who actually did a thorough chart review. I get that the reimbursement rate is terrible, but in my opinion it's unethical to accept payment for a C&P exam when you haven't done the background work necessary to make a full assessment. Which is why it makes no sense to dismantle a system where paid VA staff members are hired specifically to do C&P - at least a full-time C&P psychologist isn't going to be motivated to cut corners in order to maximize their hourly rate.

I have no interest in doing C&P myself, but there are VA psychologists who do this (or did this, I suppose) as their full time job.

 

[Fan_of_Meehl]

The C&P reports that are contracted out are generally terrible, in my experience. Certainly there are exceptions, of course. But the majority of the ones that I've seen appear to have been written by someone who never even accessed CPRS, let alone someone who actually did a thorough chart review. I get that the reimbursement rate is terrible, but in my opinion it's unethical to accept payment for a C&P exam when you haven't done the background work necessary to make a full assessment. Which is why it makes no sense to dismantle a system where paid VA staff members are hired specifically to do C&P - at least a full-time C&P psychologist isn't going to be motivated to cut corners in order to maximize their hourly rate.

I have no interest in doing C&P myself, but there are VA psychologists who do this (or did this, I suppose) as their full time job.

I'm not even joking by saying that they think they can effectively differentially diagnose all disorders in the DSM-5 including (and especially) PTSD in...

15 - 20 minutes.

Friggin wizards, they are.

 

[Sanman]

I'm not even joking by saying that they think they can effectively differentially diagnose all disorders in the DSM-5 including (and especially) PTSD in...

15 - 20 minutes.

Friggin wizards, they are.

It's not hard really. Just say whatever the payor wants you to say.

Nothing like trading good jobs for crappy ones. Another win for the field.

 

[Fan_of_Meehl]

It's not hard really. Just say whatever the payor wants you to say.

Nothing like trading good jobs for crappy ones. Another win for the field.

...slingin' PCL-5's and professional opinions.

Good assembly-line gig if you don't give a damn about the profession.

 

[Sanman]

...slingin' PCL-5's and professional opinions.

Good assembly-line gig if you don't give a damn about the profession.

It would only be good if it paid well. Most of those, the person that gets the contract takes half the money and the psychologist doing the evaluation gets the liability. Only good if you want to set some suckers up for poor pay and have the money to bank roll it.

 

[Fan_of_Meehl]

It would only be good if it paid well. Most of those, the person that gets the contract takes half the money and the psychologist doing the evaluation gets the liability. Only good if you want to set some suckers up for poor pay and have the money to bank roll it.

It is an abysmal and prostitutorial gig, to be sure. We all have our boundaries. And that is one I enforce on myself.

And it doesn't even help people. Why did we go into the profession?