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I wonder how the Supreme Court will rule.
I wonder how the Supreme Court will rule.
I'm reading the case materials. Granted, I'm not a lawyer, but I find this bananas. In what world do we give more weight to the treating clinician (who is biased) than the independent evaluator?
Actually, this is a common tactic in personal injury/WC/disability cases.
Actually, this is a common tactic in personal injury/WC/disability cases.
Tell me more, please.
Actual differential diagnostic workups to rule in/out PTSD in the VA system are unbelievably variable in terms of their detail, validity/reliability and their quality. Basic stuff like doing a military/trauma history, verifying at least one Criterion A stressor, doing a detailed clinical interview around ostensible trauma- and stressor-related disorder sxs (and their connection to traumatic events vs. other causes and comorbidities), establishing functional impairment, onset of symptoms, etc, is almost NEVER done/documented at VA.
Usually it's people slinging PCL-5s (if that) and using 'begging the question' and 'arguments from authority': "I'm a provider and Mr. X CLEARLY has PTSD." Not even kidding.
The fundamental organizational pathology/issue is, of course the reward/punishment (incentive) structure. There is every incentive in the world to either ignore the issue or be a PTSD diagnosis "rubber stamper" while there is every disincentive to conduct a thorough, accurate, multi-modal differential diagnostic eval process that may result in actually ruling out PTSD and upsetting a veteran. The iron-clad but almost never-spoken-aloud 'rule' that you NEVER question a PTSD dx (no matter how flimsily supported) if the veteran has been service-connected for PTSD results in PTSD specialty clinics being 'haunted' for decades by treatment resistant/immune cases of "PTSD" whose sx self-reports are only worsened by trials of PE/CPT/EMDR/meds/residential stays, etc. At least until that 90% total s/c becomes a 100% P&T or TDIU with some caregiver support or aid and attendance on the side. And now, most of the PCT intakes are recently retired veterans in their late 60s and early 70s who are presenting with requests to be evaluated for PTSD right after retirement from a stellar career at the sheriff's office or fire department. I'd wager that half the local sheriff's departments are 70%+ s/c for disability, most of that being due to PTSD/MH.
I am convinced that the sickness runs too deep in the organization to ever change, short of complete collapse and privatization. I am not advocating privatization, but VA isn't going to change. 'Leaders' will watch the system collapse before they will exhibit the courage to call for accurate PTSD assessments or condone saying 'no' on occasion to a veteran. Disability compensation is going to get so out of control (there is no governor on the system right now) and 'leadership' will keep cannibalizing full time provider positions (idiotically) to help their cronies out (hooking their buddies up with those sweet, sweet GS13/14 non-clinical non-caseload-having expertologist and excellentologist positions) until access becomes so problematic and the remaining providers retire/quit that the system will grind to a halt. What happens then is anyone's guess.
Do you use consult tracking manager? I prefer to use that app rather than messing with consults in CPRS.I swear, the consult toolbox is getting to be as bad as Mental Health Suite in terms of things that are well intended but only make our lives more difficult
Is there a way to stop receiving CPRS notifications for patients who are no longer on my caseload? I get so many.
Nope. From what I can gather, I will see notifications for them if I closed the psychotherapy consult regardless of whether or not I took them on as a client.Are you listed as their MHTC?
Our facility (which includes many CBOCs) is supposedly under a directive to cut about 100 more positions overall.There is buzzing around my facility that our budget deficit is so high, they will likely have to cut positions in the future. Eep. Our CBOC is super busy, so hopefully it wouldn't be here.
There is buzzing around my facility that our budget deficit is so high, they will likely have to cut positions in the future. Eep. Our CBOC is super busy, so hopefully it wouldn't be here.
Our facility (which includes many CBOCs) is supposedly under a directive to cut about 100 more positions overall.
We’ve already paused/cancelled new or backfill positions that were deemed non-essential/priority.
But there’s obviously a pretty big difference in salary for an MD and an MSA so I don’t know how that is being factored into the supposed 100 FTEs that we need to eliminate.
And there are tons of non-patient care related positions like in fiscal.
If I had to guess, some of these back of the house things will be first on the chopping block so good luck ever getting a hold of somebody responsible for things like EDRP in the future if it goes in that direction.
Starting to look like the VA isn't the safe haven of guaranteed predictable, easy work and a pension anymore.
I think Wis would agree that the typical VA patient isn't easy. I'm guessing it may be more in relation to workload expectations relative to other settings. Which I would say can of be a mix of pretty light (e.g., explicit wRVU quotas) vs. neverending (e.g., implicit pressure to always see more people and attend more meetings).I'm not sure it has been easy for a long time. WWII and Korean War folks were a different breed and often easier to manage. Vietnam and gulf era veterans seem to be lower SES and larger headaches overall as far as patient management. More folks trying to live off that disability income as the economy changes. I personally found the work easier outside of the VA, but the productivity expectations were higher. That said, always look out for yourself first and save your pennies for a rainy day.
I think Wis would agree that the typical VA patient isn't easy. I'm guessing it may be more in relation to workload expectations relative to other settings. Which I would say can of be a mix of pretty light (e.g., explicit wRVU quotas) vs. neverending (e.g., implicit pressure to always see more people and attend more meetings).
In neuropsych, for example, my expectation was 4 outpatient evals/week (no testing support) + associated feedback appointments. That was pretty much it. Not sure there are many other hospital systems that'd give a similar workload.
To clarify, AA is correct, I was referencing the workload expectations. At least at the several VAs I was at, expectations were about half or less of what would be expected in an outside job. It was comical how easy it was to hit my targets.
VA Improperly Awarded $10.8 Million in Incentives to Central Office Senior Executives
In September 2023, VA announced it had erroneously awarded millions of dollars in critical skill incentive (CSI) payments to senior executives at its central office. VA cancelled the payments, notified Congress, and requested the Office of Inspector General (OIG) review the matter.www.vaoig.gov
Agreed, not at all surprised. It's nice that they caught it, though. This time at least. Now if only they'd actually terminate problematic leadership as opposed to just perpetually shuffling them around between different VAs.Not really surprising. Though, it does amuse me that even the government admits it is not hard to recruit central office managers.
Agreed, not at all surprised. It's nice that they caught it, though. This time at least. Now if only they'd actually terminate problematic leadership as opposed to just perpetually shuffling them around between different VAs.
Edit: to be fair, I should also mention that I had many excellent supervisors/senior leaders at VA. There were also just some really, really bad ones.
My supervisor said that they aren't going to cut existing and filled positions, after all (unfilled or open, yeah, those are gone). Apparently the deficit is so bad that even cutting hundreds of positions would barely make a dent, so it's pointless.
I'm pretty relieved. I'm not worried about getting another job, either, but I like a lot of things about my job that I don't think I could get elsewhere without moving to a new city (which is not gonna happen).
Losing psychology staff or other positions, like nursing?I just heard that our Primary Care is losing staff and not able to hire replacements, and not allowed to close new referrals because of the Sprint initiative. They even took away their team meeting time because they're so swamped.
Classic Congress, make the VA take on a bunch of new patients and then underfund them
Losing psychology staff or other positions, like nursing?
I just heard that our Primary Care is losing staff and not able to hire replacements, and not allowed to close new referrals because of the Sprint initiative. They even took away their team meeting time because they're so swamped.
Classic Congress, make the VA take on a bunch of new patients and then underfund them
Followed by VA then being forced to refer patients out into the community after enough people complain about wait times, not getting whatever meds they want, etc. So Congress yells at VA, says VA is incompetent and can't do its job, says vets deserve the best care, etc., and says, "we're going to make that happen by approving a(nother) program that gets vets into the private sector where everything is better anyway." Then patients go into the private sector, hate it (because wait times are just as bad or worse, care provided isn't better, they can be fired as patients, etc.), and want to return to VA. Quietly, in the background, Congress funds more VA positions because they knew that was going to happen, and they can then come in afterward and talk about how they fixed everything.Par for the course and when the rest of them get sick and tired of the extra work, they will leave too. This is how the government works. Make big promises and push unfunded mandates onto others.
Followed by VA then being forced to refer patients out into the community after enough people complain about wait times, not getting whatever meds they want, etc. So Congress yells at VA, says VA is incompetent and can't do its job, says vets deserve the best care, etc., and says, "we're going to make that happen by approving a(nother) program that gets vets into the private sector where everything is better anyway." Then patients go into the private sector, hate it (because wait times are just as bad or worse, care provided isn't better, they can be fired as patients, etc.), and want to return to VA. Quietly, in the background, Congress funds more VA positions because they knew that was going to happen, and they can then come in afterward and talk about how they fixed everything.
Except we are going to require tons of confusing paperwork for providers, reimburse poorly, and provide this poor reimbursement very slowly. What could go wrong with community care?
Except we are going to require tons of confusing paperwork for providers, reimburse poorly, and provide this poor reimbursement very slowly. What could go wrong with community care?
I've always wondered...do the community care providers get to bill their customary fees for, say, no-shows and last-minute cancellations? If not, then given the high rates of these by veteran outpatients, there's NO WAY it would be feasible to see a lot of veterans. If so, then that would just be added expenses for providing these services in the community vs. at VA hospitals.
I've always wondered...do the community care providers get to bill their customary fees for, say, no-shows and last-minute cancellations? If not, then given the high rates of these by veteran outpatients, there's NO WAY it would be feasible to see a lot of veterans. If so, then that would just be added expenses for providing these services in the community vs. at VA hospitals.
They can't bill customary fees to most insurance providers for cancellations or no-show. However, they can opt to not reschedule the patient unlike us. Therefore, single time occurrence. That said, many VA folks have to wait so long for a community appt , they don't miss it. Our system encourages the behavior.
My patients wait 2-3 months, many have MCI/mild dementia and still show up to their appointments, and on time.
OK, I think I know the answer to this...
I work in a BHIP setting, general mental health clinic at a VA. How do we effectively manage chronic no showers that keep asking to get back on our panel? More or less I was told we have to deal with it. Is this something I can effectively use in my informed consents going forward or would it be largely non-enforceable because of larger VA policy that allows for Veterans to do this without any consequences?
I generally don't like being annoying (who does?). But you're right, I need to make it a focal point until either they a) start coming and we can do actual work on a treatment plan or b) they go away because they don't want to deal with itVA policy is that you have to take them back. That said, nothing stops you from addressing this in session and making it a goal of treatment. Usually this makes you so annoying that they prefer to be someone else's problem.
OK, I think I know the answer to this...
I work in a BHIP setting, general mental health clinic at a VA. How do we effectively manage chronic no showers that keep asking to get back on our panel? More or less I was told we have to deal with it. Is this something I can effectively use in my informed consents going forward or would it be largely non-enforceable because of larger VA policy that allows for Veterans to do this without any consequences?
It depends on clinic local policy. We have a policy that, with two consecutive NS or cx, future appts will be cancelled and not r/s until the patient is able to demonstrate regular attendance (through Whole Health, peer support, groups, etc). They are informed of this at intake or their first appt.
Overall, there is nothing in VA national that prevents clinics from having this, it just depends on if your administration will be supportive when you get pushback or complaints.
Curious how they would demonstrate regular attendance if not rescheduled? Unless they are kicked to a group or something.
Whole Health, peer support, or group.
That is really the loophole that some services can use depending on what else is available. I know that in our BHIP, there are no groups and you are responsible to take them back if they return within a year or so.