Copy
WOMHA IPA Newsletter

WOMHA: An Independent Practice Association
Newsletter for May 2016



Notes from Nick

Dear WOMHA members,

This months newsletter is once again packed with many important topics. I realize that it is hard to focus on such matters with the beautiful weather that we have had, but please take a few minutes to carefully read. 

Nick Dietlein, Psy.D.
WOMHA President


SCREENINGWARE IS OUT OF BETA PHASE...NOW IS LIGHTQ
Screeningware is being retired on or around May 15th and being replaced with new software called LightQ (available May 1st). Click here to see the details for this change. Screeningware is being retired because it was a beta program.  LightQ is replacing Screeningware and is available anytime after May 1st for those of you who are interested at www.LightQ.co (Note: not .com!!)

For those of you who are on contract with MODA, you need to either use LIghtQ or collect data via paper and pencil to remain compliant with your contract.   

If you chose NOT to switch over to LightQ software you can survey your clients using the paper and pencil versions of the MH Comprehensive or MH Brief survey.  You will have to score the surveys and report the treatment alliance information.  You can get the scoring system using the GAD 7, PHQ9 and PHQ 15 from the website http://www.phqscreeners.com/ and you can report results in the Measurement tab in Carepaths.  

For those of you who may have "many" clients entered into Screeningware, LightQ has obtained the services of Lynn Conway (click here) for more information) who can assist you in setting up your clients in LIghtQ. Lynn Conway (Screeningware IT engineer) is offering to convert over high volume Screeningware practices (lots of active patients) for $30. Click here for BAA. To review privacy and security policies and other documents, click here

The reports from other users on the LightQ software have been very positive thus far. Additional information will be provided as it becomes available.

PROTOCALL CHANGE
Given the organizational changes within MODA, the funding for the ProtoCall project did not come to as hoped. MODA had hoped to be able to fund part of the ProtoCall costs in order to provide service to their urgent and post hospital clients. AMHA-NW received a generous donation to pay for the set up and first few months of ProtoCall service. MODA has been utilizing our website to make referrals and calling point persons within each IPA Chapter for specialized needs to make referrals. Thus, we have suspended our services with ProtoCall. Thank you to the providers who participated in the urgent and post hospital on call schedule. Your services have been invaluable.

NEW SIGNS OF AGGRESSIVE INSURANCE AUDITS:
OUR RESPONSE

Recently one of our members notified the WOMHA board that Optum had conducted a telephone review of his billing practices. We have since learned that at least two other therapists have faced similar reviews. Optum did not always identify the primary purpose of the review in advance; however, the therapists all believed that the purpose was to deliver the message to stop using the 90837 psychotherapy billing code. After the phone review, Optum sent our WOMHA member a follow-up letter stating, “Based on our discussion, we will continue to monitor your practice patterns and claims. If needed, specific cases may be reviewed through peer consultation or the audit process".
 
Optum categorizes 90837 as an extended outpatient session lasting longer than 45 minutes.  They consider 45 minute sessions “routine” and their policy is to reserve longer sessions for only very specialized purposes.  These “non-routine” 90837 sessions are reserved for: prolonged exposure therapy to treat PTSD, panic disorders, and OCD; EMDR to treat PTSD; and, Trauma Incident Reduction (TIR) to treat PTSD.  

This represents Optum’s policy designed to regulate the CPT code rather than a definition of the code itself, which is defined by the American Medical Association as simply: Individual psychotherapy, insight oriented, behavior modifying and/or supportive, 60 minutes with the patient and/or family member. 

As you might imagine, this type of contact from insurance companies is intimidating as well as disruptive to a therapist’s schedule.This is the type of restrictive regulation we hope to address and reverse through our work on the Legislative Committee. We hope to identify whether it is appropriate for insurance companies to design such a unique set of policies to restrict payment of this code, which is commonly used and does fit within most therapists’ hourly schedules quite easily.In fact, Wisconsin psychologist, Gordon Herz, wrote an article citing data, which identified therapists as billing 90837 routinely within the Medicare system (http://drherz.us/2016/02/53-minute-psychotherapy-sessions-remain-a-standard-of-care/), arguing that 53+ minute sessions represented a common therapeutic practice, and that it could actually be considered a “standard of care”.
 
If the insurance companies are within their rights to set these restrictive billing policies, we hope to investigate further whether they apply equivalent policies to their management of time-based CPT codes used by physicians.If insurance companies are engagingin these restrictive management practices only with mental health clinicians and not with physicians, this would likely be considered a violation of the Mental Health Parity
 
Currently, the Legislative Committee with the help of our lobbyist firm, the Professional Affairs Counsel, has collaborated with the State Insurance Division to investigate whether the parity law will also apply to a number of other issues in which mental health care may be treated differently by insurers.The Insurance Division took many of our questions designed to reveal mental health parity discrepancies and used them to formulate a data call to insurers.

The Insurance Division is investigating whether trends in provider reimbursement or procedures to determine proper reimbursement rates have been applied equally to both mental health and physical medicine over the course of the years between 2007 and 2015.We suspect they are not, but we have never been in a position to determine whether this is so with real data.We hope the Insurance Division will use this vetted data to eliminate restrictive insurance practices like Optum’s intrusive management of the 90837 billing code. Furthermore, we hope to utilize data to promote the division’s regulatory oversight or to create legislation that will improve mental health reimbursement by requiring equivalent methodology to determine fees in both medicine and mental health.
 
If needed the Insurance Division has offered to help us craft a legislative bill to bring about fair mental health reimbursement.In the future, we may call upon your support to help move legislation forward towards the governor’s desk.Together as a multi-disciplinary independent practice alliance, we can be strong advocates for our profession and push back against insurers’ aggressive and intrusive efforts to manage our practices.

INFORMED CONSENT
Thank you to Jean Vanlue for her work and sharing her expertise on the Health Informatics Quality Committee (HIQC) to make sure that all disciplines are protected with informed consent and disclosure to clients in regards to the MODA contract, using Carepaths EHR, screening clients, dis-identified data and disclosure issues, etc. Sample wording to include has been approved with a legal consultation by Mr. Parrot out of the Dunn and Carney Law Office. Click here to view. 

MODA UPDATE
Four months remain before our review with MODA. In September, the data will be reviewed for participating providers in the AMHA-NW contract. The second year of the contract will begin with increased rates for those who meet one or both of the targets identified in the contract. 

SURVEY PARTICIPATION
Last call to express your opinions in our latest WOMHA Questionnaire. If you have not had a chance to complete yet, please do so now. As a board, we are very interested in your feedback and direction for the remainder of 2016. To access the survey, click here


OFFICE VACANCY
Office space is available 2.5 days a week in addition to two Saturdays per month. The location is 2985 River Road S. in Salem. The space is approximately 300 square feet. The rental cost is $300/month, including Internet access. There is a nice waiting area and a private exit with plenty of parking. The office is owned by a local lawyer, Mari Bailey. Mari’s practice is also located in the building; there are currently no other renters there. There is also a kitchen with a microwave and refrigerator for use by those in the building. Please help me in spreading the word in case you’re not!  If you’d like to see the space please contact me at (503) 365-3038.  You can also reach me by email at:  counseling@hirt.org 

Donna Hirt, LCSW, CADC III
      

GO FUND ME FOR DAWN HILL
To receive updates on how Dawn is doing or to help financially, click here.

UPCOMING EVENTS


May 11th, 6:30 - 8  pm

Board Meeting
at Salem Pastoral Counseling
 
Future Board Meetings
May 27th, 7-8:30 am
June 8th, 6:30-8:00 pm
June 24th, 7-8:30 am
July 13th, 6:30-8:00 pm 
July 22nd, 7-8:30 am
August 10th, 6:30-8:00 pm
August 26th, 7-8:30 am
 
Care Paths Training
TBD
Cost $25 per session
Broadway Commons
8-10:00 AM Getting Started Session
10:30-12:30 PM Refresher Session

 
WOMHA Membership
Adam Fenske, PsyD
Amanda Arthurs, PsyD
Barbara Balowitz, LCSW
Carey Zeeb, LPC
Carlene Benson, LCSW
Christina Steele, LMFT
Dawn Hill, LPC
Deborah Johanson, LCSW
Denise Polacek, LCSW
Donna Hirt, LCSW
Ellen Margolis, LCSW
George Olson, LPC
Janet Rickman, LPC
Jean Vanlue, LPC-LMFT
Jennifer Huwe, PsyD
Jody A de Ruijter, PsyD
John Milnes, LCSW
J Patrick Mooney, PhD
Judy Tuttle Zollner, LPC
Kathleen Boeve, PhD
Kathryn Strobel, LCSW
Kathy Outland, LCSW
Keith Swanson, PsyD
Kristine Villanueva, LCSW
Kurt Webb, PsyD
Laura Mangum-Childers, LCSW
Leslie Pitchford, PhD
Loren Meltzer, LPC, CADC
Mary Ann Fahlstrom, LMFT
Nick Dietlein, PsyD
Patricia Bjorkquist, PhD
Peggy Grace Chun, LPC
Philip Prewette, LMFT
Randall Green, PhD
Robert Gitelson, LCSW
Sandra Stradley, LCSW
Scott Cook, PsyD
Susan Hall, PsyD
Susan South, PsyD
Wayne Palmer, PhD


WOMHA Board Members
President:
Nick Dietlein 
ndietlein@gmail.com

Vice President:
Judy Tuttle-Zollner 
Jtuttl@aol.com

Treasurer:
Carlene Benson
cbenson@salem-psych.mvipa.org

Secretary:
Keith Swanson 
keith.swanson@hotmail.com

Lobbying & Legislative:
Patrick Mooney 
mooney.patrick@comcast.net

Continuing Education:
Susan Hall 
drsjhall@gmail.com

Lobbying & Legislative:
John Milnes
jmilnesmsw@concast.net

Newsletter & Website:
Denise Polacek  
dpolacek@hotmail.com 

Phillip Prewette
prewette@comcast.net 

Health Informatics & Quality:
Peggy Grace Chun

pgracechun@msn.com 

WOMHA Commiittee Members
Health Informatics & Quality:
Jean Vanlue

info@jeanvanlue.com 
 

Treasurer News

May 2016

Checking Balance
$10,029.60

Savings Balance
$2,893.24

Total
$12,922.84


 


Have a question, please let us know. Others are likely to benefit by your asking.





 

Continuing Education News


We are looking for ideas for shorter (3-4 hour) CEU opportunities. If you have been to a training that you would like to recommend, contact Susan or any board member. 
Please contact Susan Hall at drsjhall@gmail.com for other ideas for future CE opportunities or questions.  
 
  Forward to Friend 
Copyright © 2016  WOMHA  All rights reserved.
May 2016

Contact Information
Western Oregon Mental Health Alliance
Attn:  Nick Dietlein
2601 25th St. SE, Suite 420
Salem, Oregon 97302
womha1@gmail.com
Website:  www.womha.org

Newsletter Contact
dpolacek@hotmail.com
unsubscribe from this list | update subscription preferences