2011 - Everything Changes
Change is good. All the folks I work with will experience big changes in 2011.
ARRA, the American Recovery and Reinvestment Act that has been a cornerstone of the Obama administration in pumping dollars into the economy will affect mental health and substance abuse treatment for both consumers and professionals in the upcoming year. $19 Billion has been set aside for Healthcare Technology, and a good portion of that will be fed into organizations in the form of Medicare and Medicaid incentives for using the Electronic Health Record (EHR). Large agencies have been banking on this and buying EHR software in 2010, hoping that legislation that has been moving through the political system will pay either $44,000 or $63,750 for each doctor/prescriber using the EHR.
A number of healthcare providers are now in a race to implement the EHR and qualify for the big bucks. They will need to meet 15 core measures of performance with their EHR, so folks just now implementing software will need to hustle through the implementation and prove they meet specific functionality, or the money doesn't come. They have until September to have all the 15 elements in place if they want to collect incentives in 2011.
ARRA is forcing significant change in the way professionals work and consumers receive treatment. Some professionals are struggling with central scheduling, having to turn over control of their schedules to somebody else in order to serve more consumers.
Consumers who have been accustomed to being able to drop-in for treatment are being encouraged to make appointments, and sometimes need to wait longer to see a professional if they do drop-in to their friendly neighborhood community mental health center to discuss an emerging problem.
In 2011, more consumers will see treatment documentation first hand, some for the first time, becoming involved in developing their own treatment plan. The professionals and consumers are working together more and more often to organize their discussions into focused efforts to (1) address items in the treatment plan or include new problems in that plan to address (2) write the progress note to summarize the discussion from the perspective of both the professional and the consumer, and (3) plan next steps for treatment. The elements of this interaction are not new, however some professionals have kept them behind the scenes, and the transparency of the EHR is forcing them out into the open. Funding that includes documentation in the price of a session is forcing use of the EHR; documenting on paper is just too cumbersome and inhibits the effectiveness and speed of audits from Medicaid, accrediting bodies and internal quality control people.
But wait, there's more change in 2011!
January 3rd, New York OASAS licensed substance abuse treatment organizations follow a number of other states in moving from "threshold billing" (one charge per day pays for all that day's treatment), to "APG" billing (a fee charged for each service provided, under extremely complicated rules). This is a huge change for professionals and consumers. I work with an organization that plans to continue using a paper record and another that is committed to electronic treatment documentation. The major difference between the two methods is tracking the services for billing purposes. Connecting a billing record to the treatment documentation is easier to follow with the EHR. Both clinics have fine professionals treating the patients, and the consumers get what they need. The paper record is simply more of a hassle.
So, you see, the conspiracy to move to the EHR is in full swing. In 2011, some of the changes forced by the EHR may leave a bad taste in some mouths. On the other hand, it helps pay the bills.