Role & Fiscal Sustainability of PMHNPs within Primary Care Susan Marie, PMHNP PhD Medical Director for Behavioral Health Old Town Clinic, Central City.

Role & Fiscal Sustainability of PMHNPs within Primary Care

Susan Marie, PMHNP PhDMedical Director for Behavioral HealthOld Town Clinic, Central City Concern

Success =Clear Roles & ProcessesPreventing Cultural PitfallsSustainable Revenue

Roles

BehavioristWho: various flavors- social workers,

counselors, psychologists, unlicensed mh staff- check licensing/revenue

What Crisis intervention/suicide intervention Diffusing hostility Brief cognitive-behavioral treatment anxiety IMPACT problem solving intervention Linking to resources Teaching skills: relaxation, trauma management

RolesPsychiatric Expertise

WHO Psychiatric nurse practitioner or psychiatrist

WHAT Just-in- time consultation to primary care providers Focused psychiatric assessments Psychiatric medication management “weave in & out” Crisis/suicide support PCP psychopharmacology support and training

Preventing Cultural Clash

Specialty Mental Health

Caseload of clients- “full”

Values confidentialityIndependenceNever interrupt

Integrated Primary Care

Serve PCP panelsValues collaborationTeamEncourages

interruptions

MENTAL HEALTH

“Therapist”“Sacred 50 min hour”Full evaluation before treatmentEpisodic

PRIMARY CARE

Varied RolesShorter appointmentsDevelop assessment as you goOngoing, as needed

Sustainable Revenue

OHP Health Plan (medical)E&M CodesHealth & Behavior Codes

Mental Health Plan “Mental Health” codes

FCHP pays E & M codes Operationally defined “primary care

behavioral health”Assessing, diagnosing, and treating mental

illnesses What the primary care provider would be doing if psychiatric provider was not there

Provided in same physical and temporal space of primary care

E & M Codes

1) Less cost2) Less stigma3) Increased access 4) Better outcomes

E&M Codes: The Rationale

Similar charting requirements as PCPSimilar billing as PCP

No same day paymentNo coverage of non-medical BH staffOnly brief interventions covered (99212,

99213)

E&M Advantages/Disadvantages

Services to diagnose and treat mental illnessesExpectations inconsistent with primary care

modelClinical record keepingClinical supervision & reviewQuality improvement processes

Increased administrative burdenCredentialing/licensing

AuditingPrior authorization procedures

OHP Mental Health Plan

Same day with PCP visit Case management, counseling services Wider variety of providers

Requires state license as behavioral health provider

Requires contracting with MHO State expectations (eg CPMS)Differing expectations by MHO

Advantages/Disadvantages

Now It’s Your Turn. Questions??