Moving Toward Clinical Accountability Is A Must
There are those in the healthcare industry that seem to believe behavioral healthcare needs to be held to a higher standard than the rest of healthcare. Maybe that’s alright, or at least expected, since we have been reticent to be held to objective standards of care. Some of who are, shall we say, of a certain age, remember that the days when the most important course we took in graduate school was Theories of Psychotherapy. Theoretical orientation mattered because there was no data about clinical efficacy. What you did therapeutically really didn’t matter so long as you were able to describe your clinical orientation clearly in the context of any particular client. Outcomes didn’t matter.
Despite the fact that there is now enough evidence about the treatment of certain disorders that clinicians should be sued for malpractice of they don’t deliver them, there is still a surprisingly loud voice that refuses to believe the evidence. Comments like “It’s an art, not a science” deny the huge volume of literature about clinical efficacy.
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It’s also not surprising that those who pay the bills want more clinical accountability. Besides our inherent resistance, there is a risk that the standards used for behavioral healthcare will be more stringent and more onerous than those applied to our medical brethren.
We have all heard the old adage “if it wasn’t documented, it wasn’t done.” Community mental health providers have dealt with a lot of challenges from with Medicaid auditors around this issue of documentation of medical necessity. In many cases, their concerns were well-founded. Organizations frequently did a poor job of documenting for services that were billed to Medicaid. The documentation was sometimes poor and often non-existent. In those cases, the auditors were correct to impose penalties on us. However, for many providers, this was just the beginning of escalating requirements to “prove” medical necessity that included interpreting the progress notes and even weighing the length of notes relative to the duration of the service rendered. Most organizations have responded to these challenge and been able to improve their documentation capabilities.
Now, the bar is being raised yet again. This time, the domain is clinical care. As with the medical necessity problem, the payers’ expectations of us are correct. We haven’t done a very good job of demonstrating that the work we do actually produces real changes in those we serve. The reasons for this deficit are many, but at the end of the day, the people in our care deserve to have objective evidence of improvement (or maintenance of gains) as do those who pay the bills. Most of what we do is measurable. But we need to step it up. Let’s start providing the data --not just because someone is asking for it -- but because it’s the right thing to do.
In the next few weeks, we’ll be posting on this page the next installment of our imperative videos. The video, Focus Matters, centers around Netsmart creating tailored-to-fit solutions for clients and how we’ve aligned our organization to focus on understanding the communities in which we serve. In fact, we share the common goal of recovery and healthy lives with each of you. Check back for this don’t-miss video.
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