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Correction: We got doughnuts.
Correction: We got doughnuts.
Mayhaps, it just sucked when you had a 30-40% no show rate that the VA won't do anything meaningful about, have no work on Friday, and can't leave because if your "tour of duty." I much prefer the new system of if an IME no shows, I still get paid for the day, and then I work on other stuff, essentially earning double time for the same work.
Glazed, because we're classy.Plain cake?
I’ve been audited. It’s really not a big deal.
The insurance company asks for a random sample of your patient files. In this case, they asked for 5 specific patient files. We sent them off. They looked at the files, and said “looks right”, and that was the end of it. Took less than a month.
I did have a dementia patient complain to Medicare that I had never seen them. They asked that I send the file over to them. I included a note that dementia patients seem to forget things. They said everything was fine, and resumed payments.
URs are something different. I'm referring to post hoc insurance reviews.That is interesting and I think depends on the insurance company. When Optum did their utilization reviews (different from the formal audits but a pain nontheless), they required 45 min with the provider and if they escalated to level II (which always happened with more complex nursing home patients) that was another 45 min call. I once spent 2 hours on the phone to justify getting paid for 2 or 3 sessions of 90832 and they wanted me to go get an updated screener because it was done when I first saw the patient 3 mths prior (mind you they had not paid for the previous sessions). Multiply that by the dozen or so clinicians I managed and I was not getting paid enough to deal with it.
That's why SDN exists. Not being able to leave your duty station has different meanings in the age of telework and remote work.
URs are something different. I'm referring to post hoc insurance reviews.
For URs, I immediately tell the reviewer that I need their name and license number to put in each chart note, and that I will need the exact references from their provider handbook. Then I proceed with the review. Throw in a few reports to the state department of insurance, and suddenly I don't get URs.
Speaking of burnout.
DK about other VA's , but mine now requires we attend a whole health course for our performance evals. Like a LIVE one. Minimum time requirement is 4 hours.
I'm currently in one of these trainings and we have to keep our cameras on.
This is what burns folks out.
We're required to attend so many Whole Health trainings. They will just block our clinics and tell us we're going. It hasn't been tied to performance evaluations...yet.
That's why SDN exists. Not being able to leave your duty station has different meanings in the age of telework and remote work.
the beatings will continue until morale improvesYou will be less burned out...or else!
The "long wait times" are ubiquitous to much of healthcare in general and, when you can't "fire" patients and can just file a congressional complaint when you aren't getting the care (or SC) you think you deserve, won't be going anywhere anytime soon.
That being said, VA leadership doesn't have the best record for transparency. Saying you're not going to fire front-line providers while then firing front-line providers (or rescinding offers to such) is not a good look. If it were accurate that of the 10,000 cuts, most or all would be programmatic/managerial staff, that'd be great; VA could probably spare twice as many "champions" and such.
The interesting part would come when VA's funding continues to balloon and becomes a matter of VA vs. Medicare and Social Security.
The "long wait times" are ubiquitous to much of healthcare in general and, when you can't "fire" patients and can just file a congressional complaint when you aren't getting the care (or SC) you think you deserve, won't be going anywhere anytime soon.
That being said, VA leadership doesn't have the best record for transparency. Saying you're not going to fire front-line providers while then firing front-line providers (or rescinding offers to such) is not a good look. If it were accurate that of the 10,000 cuts, most or all would be programmatic/managerial staff, that'd be great; VA could probably spare twice as many "champions" and such.
The interesting part would come when VA's funding continues to balloon and becomes a matter of VA vs. Medicare and Social Security.
And their funding was cut BY YOU GUYS, what do you expect them to do?? Make money appear out of thin air?
Just saw that they cancelled a bunch of EBP trainings because of the budget deficit. Sigh.
I have a thought that, except for schizophrenia (and select cases of other conditions) service connection for mental health conditions should be 0% ( or thereabouts) so treatment is payed for but illness is not, because psychiatric conditions can generally be reliably put into remission or cured.
Maybe in 3 to 5 years--when the total VA budget tops $500 billion (half a TRILLION) dollars and medicaid/medicare and SS are feeling the pinch--the wind will start blowing in the other direction. Then the VA leadership will do a 180 and basically raise the bar so high on diagnosing PTSD that even legit cases won't be properly diagnosed.Oh, I totally agree, or at least make the standards higher and more rigorous like state disability does. But I don't think the genie can be put back into the lamp anymore.
I would not disagree with that setup, but the uphill battle being it goes against pretty much all other worker's comp/disability systems. But that'd be an interesting optic to have to debate, and would the politicians be willing to debate that same thing for other worker's comp situations (i.e., does a person need or deserve to be paid for a treatable condition when all treatment costs are covered). Or assign perhaps a flat-rate, time-limited benefit for the various MH conditions.I have a thought that, except for schizophrenia (and select cases of other conditions) service connection for mental health conditions should be 0% ( or thereabouts) so treatment is payed for but illness is not, because psychiatric conditions can generally be reliably put into remission or cured.
I stopped doing that a while ago. Even for new patients. They get the clinic number on their reminder letter. Most of them get my business card when the complete orientation for our program.I'm tired of calling people 5 min into VVC appts when they don't show. From now on, I'm gonna wait 15 min, unless it's a new patient who doesn't have my phone number, and if I reach them say that we have to r/s.
I stopped doing that a while ago. Even for new patients. They get the clinic number on their reminder letter. Most of them get my business card when the complete orientation for our program.
My in-person appts doing get a 5 minute phone call, why should vvc be any different?
I think the difference here is that I call and make all of my intakes and appointments with vets. If it is vvc, I assess their comfortability with the tech and provide help desk phone numbers. I do alert them if it takes more than 5 minutes to connect to call me/the clinic.I usually end up calling my VVC clients. I have tried to give the feedback that I'm not just going to no-show them and they should call the front desk if I'm not there in 2 minutes. I'm weak though and just end up calling them anyway.
Welp, our facility is on a full hiring freeze. Wooo
Trying to control the lives of your
They are actually calling it that? Ours is on a "don't call it a hiring freeze" hiring freeze. Though I think we had one new MH hire. MSAs are completely frozen.
Do you have a link to the SOP?In addition to firming up my boundaries with VVC, I am now implementing a new EBP policy where if you cx or no show 2 consecutive appts, I am not going to give my usual call to check in and give a week grace period, but will rather cx future appts and move onto the next person who's on deck. This is actually in line with clinic policy, btw.
The recent change to the MH minimum scheduling efforts SOP is a gamechanger.
Do you have a link to the SOP?
Could he have gotten adjustment or another MH condition if he'd just adjusted his claim? Is he upset because he wants PTSD specifically, because PTSD is the "cool" mh diagnosis in the VA? Or is he one of those veterans who thinks it's PTSD or nothing?
Make sure to complete the Time Machine TMS training firstAnyone else get the urgent email this morning from FSAfeds that the deadline for 2023 claims is April 30th? Let me just hop back in my time machine...
Supreme court case that will be coming up...Bufkin v. McDonough. All I can say is, 'wow.'
Here's a news article (that doesn't contain the relevant details)
Supreme Court to hear another major veterans benefits case this fall
The high court will consider whether VA officials are properly reviewing benefits decisions that deny veterans medical help.www.militarytimes.com
Actual details (details of Bufkin's situation start on page 9):
TLDR:
Veterans suing because they are alleging that VA didn't follow the 'benefit of the doubt' principle in adjudicating disability claims for PTSD.
Haven't looked into the second case yet but the first one (Bufkin) is a real doozy.
Basically, Bufkin is claiming that an administrative decision to give him an ultimatum was his traumatic stressor that caused him to develop PTSD. He was in the Air Force and said that because his wife had so many mental health issues (including suicidal ideation, gestures), he couldn't perform his duties. Air Force said, 'Yeah...well...either you find a way to perform your duties or divorce your wife but...this is the military and you have to be able to perform your duties.' Yeah, I know, 'shape up or ship out' is so yesterday, I get it but...there is no way it is a Criterion A traumatic event. Appropriate diagnosis is far more likely to be adjustment disorder or MDD. Finding oneself in a difficult situation (conflicting responsibilities between work and familial obligations) and having, therefore, to make a difficult choice is not a Criterion A stressor.
So, Bufkin gets (I think THREE) several providers to write letters (or maybe complete DBQ's) arguing that the administrative decision (ultimatum) by the Air Force was his Criterion A trauma and caused bona fide PTSD (even though the apparently minimally competent (at least) VBA examiner said 'nope, not a Criterion A stressor').
An excerpt from one of Bufkin's providers writing in support of the PTSD diagnosis:
In support, he
submitted a letter from yet another VA physician,
who determined that Mr. Bufkin “suffers from chronic
PTSD due to a number of issues, but the primary is-
sue is that he was essentially forced out of the mili-
tary due to intense family problems that put him in a
very difficult psychological situation. … Some exam-
iners do not consider this to be PTSD, but it was
clearly traumatic for” Mr. Bufkin.
So, Bufkin and his lawyers are arguing that since they were able to find three incompetent providers to misdiagnose him as having PTSD (per the explicit criteria in DSM-5), the VBA did not extend to him the 'benefit of the doubt' when medical evidence stands in equipoise.
No doubt this case will be cited as evidence that the VBA follows the implicit policy of 'deny, deny, until they die' and is doing everything possible to deny veterans their right to be diagnosed with PTSD.
With all the fanfare about 'quality' and 'best care anywhere' and 'zero harm' and 'high reliability organization...'
...and all the ridiculous mandatory trainings (annual required demonstration that we know how to use a fire extinguisher)...
at what point will licensed, MD psychiatrists (or doctoral level psychologists) be required to demonstrate that they have the core competency of being able to identify a clearly insufficient 'traumatic stressor' as not crossing threshold to qualify as a Criterion A event for possible diagnosis of PTSD? This is UNDERGRAD level material. In my opinion this is malpractice on the part of the incompetent providers. Medication prescribers are choosing medication treatments (with both presumed therapeutic and adverse effects) based on accurate diagnostic determinations. The 'differential diagnosis' (especially of PTSD) is so horrible/non-existent in VA mental health it is unreal and the fact that this case even exists--let alone is being appealed to the SUPREME COURT--is 100% proof of it.
Parenthetically, I am doing a chart review for a PCT intake this morning that has in his chart---not joking--at least 100 chart notes/encounters with paid licensed mental health providers and at least 10 'assessments/evaluations' by same without ONE provider doing a basic military/trauma history or even doing the most preliminary diff dx interviewing around trauma/sterssor disorders despite numerous acute inpatient and residential stays for MDD/substances/mental health. Taxpayers have paid probably more than a million dollars, to date, for ostensibly competent MH services for this veteran but no one has done a military/trauma history or attempted to rule in/out PTSD for this veteran patient in his late 60s getting VA care for over 20 years.