6/4/15 1 + Helen L. Coons, PhD, ABPP Women’s Mental Health Associates Texas Psychological Association CE Workshop June 13, 2015 Transitioning Your Psychology Practice to Primary Care and Specialty Health Settings: Competencies, Collaborations and Contracts + Psychologists in Mental Health Settings + Collaborative Strategies with Health Care Providers Small Group Exercise List collaborative strategies
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TPA 2015 CE Trans to Health Settings PP Handout€¦ · Health Settings: Competencies, Collaborations and Contracts Texas Psychology Association June 13, 2015 Workshop learning objectives
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+
Helen L. Coons, PhD, ABPP Women’s Mental Health Associates Texas Psychological Association CE Workshop June 13, 2015
Transitioning Your Psychology Practice to
Primary Care and Specialty Health Settings:
Competencies, Collaborations and
Contracts
+Psychologists in Mental Health Settings
+Collaborative Strategies with Health Care Providers
Small Group Exercise
List collaborative strategies
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+ Psychologists in Primary Care
Pediatrics and
Adolescent Medicine
Family Medicine
Obstetrics and
Gynecology
Internal and Geriatric Medicine
+Psychologists in Specialty Health Settings
Neurology Rehab
Medicine Oncology Cardiology Surgery
+Psychologists in Specialty Health Settings
Reproductive Endocrinology
Sports Medicine
Gastroenterology and Bariatric
Surgery
Nursing Homes/Elder
Care
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+What is different in 2015?
Patient Protection and Affordable Care Act
Health Care
Mental Health and Substance Abuse Care
+ACA à Triple Aims
Increase Access to
Care
Improve Health
Outcomes
Reduce Costs
+ Implications of Health Care Reform for Psychology Independent Practice?
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+Affordable Care Act
n Change in service delivery, financing, reimbursement & outcomes
n PCMH: Patient Centered Medical Home
n ACO: Accountable Care Organization
n Improve quality and lower costs
n Public and private sectors
Integrated Health Care Systems
+ Transitioning Your Psychology Practice to Primary Care and Specialty Health Settings: Competencies, Collaborations and Contracts
Texas Psychology Association June 13, 2015
Workshop learning objectives n Describe models of co-located psychology practices in health settings.
n List clinical and professional competencies for practice in adult and pediatric primary care and specialty medical settings.
n Identify strategies to transition a psychology practice to medical offices in the private sector.
n Understand regulatory, legal and contractual issues related to developing co-located and integrated practices with private health care providers.
n Assess business plan and readiness to transition to primary care and specialty medical settings.
+Workshop Participants
n Your professional settings now?
n Professional goals and settings in the future?
n Your learning objectives for today?
n Workshop guidelines and requests.
n Slides and handouts.
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+Interactive Workshop
n Clarify your interest in transitioning to medical settings
n Clarity about competencies for these settings
n Strategies to collaborate with health care providers and transition your practice to medical settings
n Business planning and challenges
+Affordable Care Act
n Increased funding of CHIP
n Expanded coverage for young adults (until turn 26)
n Protection for pre-exiting conditions and gender
n Coverage for early retirees
n Changes in Medicaid n Increase access: changes in
eligibility n States to receive federal matching
funds to cover additional low-income individuals and families
Increasing Access to Affordable Care
+Affordable Care Act
n Medical information on line
n Insurance companies can’t rescind coverage and can appeal decisions
n Eliminating life time limits on coverage
n Regulating annual limits on coverage
n Can’t denying coverage to children or adults with pre-existing coverage
n Hold insurance companies accountable for unreasonable rate increases
n Establish consumer assistance programs in States
Consumer Protections
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+Affordable Care Act
n Prevention and public health fund
n Focus on prevention of illness and chronic disease
n Free preventive care for seniors
Free Preventive Care Prevent Costly Conditions
+Affordable Care Act
n EMR
n Improve provider communication-interoperability
n Improve care coordination
n Reduce costs
n Reduce errors
n Improve quality of care
Reduce Paper Work and Administrative Costs
+Affordable Care Act
n Value based care vs volume
n Bundled and global payments
n Offer hospital financial incentives to improve quality of care
n Hospital quality becomes public
n Patient clinical outcomes
n Patient perception of care
n Satisfaction with care
Payment and Quality
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+Affordable Care Act
Health Care Reform
n Paradigm shift
Ø health care delivery
Ø financing
Ø reimbursement
n Diverse models of service delivery
+Affordable Care Act
n PCMH: Patient Centered Medical Home
n ACO: Accountable Care Organization
Ø Improve Quality and Lower Costs
Integrated Health Care Systems
+PCMH and ACO’s Financing Shift to Organization
u Patient Center Medical Home (PCMH) u Accountable Care Organization (ACO)
ü Access ü Comprehensive ü Seamless - Coordination ü Patient Centered ü Continuum of care onsite or refer ü Quality measurement – at least 33 benchmarks ü Organizational payment - capitation and pay for performance Ø Entirely different model of reimbursement for PC and MH providers Ø No mandate for mental health providers
Ø On site behavioral health & substance abuse tx Ø Refer to community providers
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+ Benefits of Integrating Behavioral Health Services in Primary Care Settings (Coons, 2012)
ü Convenience of “one stop” care
ü Trusting relationships with providers/team
ü Avoid stigma associated with psychiatric settings
ü Lack of parity in insurance coverage for mental versus physical health services
ü Fewer geographic, cultural and linguistic barriers
ü Improved health and mental health outcomes
ü Increased satisfaction among women
ü Decrease unnecessary utilization and cost ü Cost offset ü Patient outcomes
Coons (2012, 2103)
+Behavioral Health in Primary Care Summary Stats
n PCPCC: Patient Centered Primary Care Coalition
n AHRQ: Agency for Health Research and Quality
n SAMHSA: Center for Integrated Health Solutions
n CFHA: Collaborative Family Healthcare Association
n National Council for Behavioral Health
n SBM: Society of Behavioral Medicine
n APA Division of Pediatric Psychology
n APA Center for Psychology and Health
n Behavioral Health Integration Group, LinkedIn
+Health Care Reform and Psychology Practice
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+Health Care Reform – Implications for Mental Health Care
n Psychologists may or may not play role in PCMH/ACO n Pubic sector vs private sector n Increase in IPC positions
n Changes in behavioral health delivery model n Integrated and interprofessional --- shared care model n BSIRT – short term interventions or specialty referrals n Referrals from PCMH, ACO, and medical practices to community BH
providers
n Focus on health promotion and prevention
n Consumer choice in mental health care n Market for private, fee for service tx will continue
+Health Care Reform – Implications for Mental Health Care
n How to pay for psychologists in IPC settings n New payment models with bundled and global payments
n Fee for service models n Reduced reimbursements rates from Medicare and private
plans n State and county models for MH care - Coons (2011)
n Mental health medical homes
+Opportunities in Private Medical Settings
Primary Care
Specialty Care
Other Health
Settings
Individual and Group Exercise
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+Opportunities for Psychologists in Primary Care
n VA and DOD
n FQHC
n AHC and Community Family Practice
n Private Medical Practices
n School based health centers
n Nursing homes
n Wellness programs
n Urgent PC sites at malls, Walgreens
Likely IPC Settings Area
+Integrated Care Perspective
Ø Integrated care is not …. o Multidisciplinary, Multi-specialty, Interdisciplinary,
Transdisciplinary
Ø Integrated care is ….. Ø Paradigm shift Ø Change in care delivery model Ø Interprofessional Ø Team based
Ø shared responsibility for patient care and outcomes Ø Anton (2013)
+ www.integration.samhsa.gov/integrated.pdf
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+
Heath B, Wise Romero P, and Reynolds K. A Review and Proposed Standard Framework for Levels of Integrated Healthcare. Washington, D.C.SAMHSA-HRSA Center for Integrated Health Solutions. March 2013
+Models of Successful Transitions to Private Health Settings
+ Primary Care, Multispecialty & Specialty Health Settings
Primary Care
Specialty
Multispecialty Inpatient/Outpatient
Patients, Families and Communities
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+ Psychologists in IPC in the Public Sector Coons (2011), BPA Retreat on Health Care Reform
n VA
n DOD
n IHS
n FQHC
n School based health centers
n Planned parenthood
n Prison health centers
Federal Community
+ Psychologists in Primary Care and Specialty Settings in the Private Sector Coons (2011), BPA Retreat on Health Care Reform; Coons (2012), CHOP (2012)
q Academic Health Centers q Family Medicine
q Pediatrics
q Ob/gyn
q Community Health Centers
q Community Hospitals
q Community Family Practice and Family Practice Residencies
n Family practice with two physicians and a nurse practitioner
n Dennis Given, Psy.D.
n www.ChesterCountyPsychology.com
Family Practice
+Psychologists in Private Sector PC Settings
President and Clinical Director
Helen L. Coons, Ph.D., ABPP
Independent Consultants Trudy D. Helge, Psy.D.
Elizabeth D. Krause, Ph.D.
Eva D. Greenberg, Ph.D.
Expertise
Clinical Health Psychology
Women’s Health and Mental Health
Completed Post-Doctoral Fellowships
Collaborative and/or integrated care in health settings
ABPP in CHP
+ Women’s Mental Health Associates Practice since 2000
q Current locations § Bryn Mawr Women’s Health Associates – Ob/Gyn practice at two locations § PA Oncology Hematology Associates, Penn Medicine at Radnor
q Past Locations § MCP Hahnemann Center for Women’s Health § Women’s Multispecialty, University of Pennsylvania Health System, CCA § Women First, University of Pennsylvania Health System, CCA § Joan Karnell Cancer Center, Pennsylvania Hospital, POHA § Penn Health for Women, Penn Medicine at Radnor, University of Pennsylvania Health
System, § Reproductive Medicine Associates § Dahlia M. Sataloff, M.D., Breast Surgeon and Chair, Pennsylvania Hospital
n Recent discussions § Two primary care offices § Reproductive Endocrinology § Urology/pelvic floor
n Relocation and rebranding in CO and nationally
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+Psychologists in Private IPC Large Group Practice
Delaware County Professional Services Pennsylvania
n Aetna Behavioral Health IPC Mental Health Project
n Multiple internal medicine and family practice sites in Greater Philadelphia area
n Practices owned by TJHU, UPHS, private
n Sent providers to IPC program at U Mass
n Contact is Lynne DiCaprio, MA
Family practice Internal Medicine
+ Center for Integrated Care 765 Allens Ave., Suite 102 Providence, RI 02905 (401) 490-8900 www.PsychologicalCenters.com
Staff:
• 7 doctoral psychologists with prior specialized training in behavioral medicine
• 3 psychologists who perform only supervisory and administrative functions within CIC
• 4 doctoral psychologists without behavioral medicine backgrounds
• 4 Masters level clinicians with prior specialized training in behavioral medicine
• 9 Masters level clinicians without behavioral medicine backgrounds
• 2 Advanced practice prescribing psychiatric nurses
Rental sites (Medical practices):
• 3 Pediatric practices, 4 sites
• 1 Ob-Gyn practice
• 5 Internal Medicine and 3 Family Medicine practices, 9 sites (one with pain specialization)
n Located within a Family Practice Residency n 3 psychologists are residency
faculty members n Provide Behavioral Science
training to FP residents n Frequent consultations with FP
physicians and Sports Medicine
n Serve ages 2 to 90+
n General Services n Individual, couple’s, and
family therapy n Diagnostic evaluations
n Specialty Services n Pediatric Neuropsychology n Sport Psychology n Pre-surgical psychological
evaluations n Interpersonal process group
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+Psychological HealthCare, P.L.L.C.
n www.phcny.com
+
Gary X. Lancelotta, Ph.D., ABPP Clinical Child and Adolescent Psychology Pediatric Psychologist, Baptist Children's Hospital Behavioral Medicine Program Coordinator West Kendall Baptist Hospital – Florida International University: Family Medicine Residency - Clinical Assistant Professor Department of Psychiatry, Florida International University Serving children and families in South Florida Large Group Practice
+Co-location in Specialty Settings Small practice
Reproductive Endocrinology
n Prepare for procedures
n Decision making
n Needle phobias
n Coping with infertility
n Coping with pregnancy loss
n Consult and psychoeducation re donor egg and sperm
n Donor and GC evals
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+Co-location in Specialty Settings Small practice
n Kate Hays, Ph.D.
n Canada
+Co-location in Specialty Settings Small practice
Helen L. Coons, Ph.D., ABPP
Women’s Mental Health Associates
Oncology
Surgical
Medical
+Co-location in Specialty Settings Small practice
Surgery
Steve Walfish, Ph.D.
Atlanta
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+
Ψ Consultation-liaison psychology group practice in Austin, Texas
Ψ Founded in 1998 by Clif Moore, PhD and Lloyd Berg, PhD, ABPP
Ψ Began seeing referrals for one consulting MD in a long-term acute care hospital
Ψ Now 10 psychologists in ›25 facilities Ψ 6 acute care, 5 acute rehab, 2 LTAC hospitals
+ Prerequisite Checklist For Hospital-Based Psychology Practice
q Behavioral health competence q Must be fluent in speaking,
reading and writing “medical”
q Understand credentialing & privileging process
q Strong differential diagnosis skills
q Strong crisis intervention skills
q Competence in suicide risk and decisional capacity evaluations
q Competence in evidence-based, short-term psychotherapy
q Interdisciplinary competence
q Willingness to see ALL referrals
q Proactive billing service
q Cross coverage
www.bhc-austin.com
+
Transitioning Your Practice To Primary Care and Specialty Medical Settings: Is It Right For You? Kelly and Coons
PPRP (2013)
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+ Transitioning Your Practice to PC and Specialty Medical Settings
Pairs/group exercise
Ø Which primary and/or specialty health setting? Ø Competencies in complex roles and skills? Ø Is the setting the right fit? Ø Practice transition strategies? Ø Contractual issues?
see Coons & Gabis (2010); Ruddy, Borresen and Gunn (2008);
Readiness Self Assessment
+Transitioning Your Practice to PC and Specialty Medical Settings
n Which setting is right for you?
n Readiness Self Assessment
+ Primary Care, Multispecialty & Specialty Medical Settings
Primary Care
Family and Internal Medicine
Pediatrics and Adolescent Medicine
Obstetrics and Gynecology
Geriatric Medicine
Specialty
Multispecialty Inpatient/Outpatient
Patients, Families and Communities
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+Specialty Medical Settings Individual and Group Exercise
+Specialty Medical Settings
n Surgery
n General
n Transplant
n Bariatric
n Plastics
n Oncology n Surgical n Radiation n Medical n Survivorship n Palliative care
n Reproductive Endocrinology
n Labor and Delivery
n Maternal Fetal Medicine
n NICU
n Sports Medicine
n Neurology
n Rehab Medicine
n Palliative care
+Specialty Medical Settings
n Cardiology
n Rheumatology
n Pulmonary
n Urology and Urogynecology
n Sexual Medicine
n Otolaryngology
n Gastroenterology
n Dermatology
n Endocrinology
n Psychiatry
n Emergency department
n Other
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+Other specialty medical settings
n Dental offices
n Physical therapy
n Nutrition
n Retirement communities
n Assisted living and long term care facilities
+Transitioning Your Practice to PC and Specialty Medical Settings
n Competencies in complex roles and skills?
n Readiness Self Assessment
+Health Service Psychology Competencies n Health Service Psychology: Preparing Competent Practitioners. Health
Service Psychology Education Collaborative (HSPEC)
Competencies
I. Science
II. Professionalism
III. Relational: Interpersonal Skills & Communication
IV. Applications
V. Education
VI. Systems American Psychologists (2013)
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+Competencies for Roles in Primary Care
n Evaluation, Consultation and Treatment
n Collaborative n Evidence based n Brief problem focused n Individual, couples, family (defined by pt) n With or without other health care provider
n Workshops, groups, presentations
n Curb side consult
n Crisis management: community, system or practice
n Home visits with or without other provider
n Resident, medical, nursing, psychology student training and supervision
n Program development
n Staff training
n Health systems outcomes research
n Leadership roles for team, practice, education and training, health system
n Grant writer n clinical services, resources, health provider education, research
+APA Competencies for Psychological Practice in Primary Care n The Inter-Organizational Work Group on
Competencies for PC Psychology Practice (2012) n Initiative of APA President Dr. Suzanne Bennett Johnson
n Chair: Dr. Susan McDaniel
n Charge: Integrate extant material on competencies for psychological practice for primary care into a single document
n Slides from Catherine Grus, Ph.D., APA
n APA.org/ed/resources/competencies-practice.pdf
n American Psychologist (May-June, 2014). McDaniel et al.
+The Inter-Organizational Work Group on ���Competencies for PC Psychology Practice (2013)
n Competencies: 1A. Science Related to the Biopsychosocial Approach 1B. Research/Evaluation
Grus, 2013
+IPC Competencies: Science
n Evidenced based n Assessment strategies n Treatment interventions n Prevention approaches n Team development n Diversity and health outcomes
n Health Systems Research n Patient outcomes n Provider outcomes n Health system outcomes n Community outcomes
Coons, 2013
+Cluster 2: Systems
n Competencies: 2A. Leadership/Administration 2B. Interdisciplinary Systems 2C. Advocacy
Grus, 2013
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+IPC Competencies: Systems
n Language shifts
n Team building
n Health systems finance structure
n Leadership skills
n Advocacy for care, programs, staff, field n Practice, hospital, health system n Local, State and Federal level
+Value based IPC practice
n Health financing and outcomes n Assess outcomes n Value added n Pay for performance
+Cluster 3: Professionalism
n Competencies: 3A. Professional Values and Attitudes 3B. Individual, Cultural, and Disciplinary Diversity 3C. Ethics in Primary Care Setting 3D. Reflective Practice/Self-Assessment/Self-Care
Grus, 2013
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+ Primary Care Interacting and Complex Factors Coons (2011, 2012, 2013, 2014)
+ Ethical Issues in Primary Care and Specialty Health Settings
o Disclosure
o Who is the patient? o Child or parents
o Individual or family
o Donor or intended parent
o Privileged communication
o Reporting requirements
o EMR
o Technology
o Different health professions with diverse ethical codes of conduct
Coons (2011)
+Cluster 4: Relationships
n Competencies: 4A. Interprofessionalism 4B. Building & Sustaining Relationships in Primary Care
Grus, 2013
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+Integrated Care Perspective
o Integrated care is not: o Multidisciplinary, Multi-specialty, Interdisciplinary,
Transdisciplinary
ü Integrated care is:
• Paradigm shift • Change in care
delivery model • Interprofessional • Team based
• Anton 2013
+Interprofessional Communication and Teamwork
n Models for Interprofessional Skills and Communication
n Teambuilding
Interprofessional Education for Practice
Curriculum Reform and Training Innovation
+Interprofessional Competencies
n Cultural/language of medicine n Internal and family medicine
n Obstetrics and Gynecology n Pediatrics
n Specialty settings n Administrators
n Mission of health care providers
n Theoretical framework n Clinical decision making/problem solving n Concrete
n Goals during clinical encounter n Action-oriented n Specific recommendations
n Build a relationship
n Practice expectations
n Boundaries between and across providers
n Flexibility in roles at any time
n Consultation framework
n Collaborative reports
n Respect for other health professions and staff
McDaniel et al
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+Relationships with Providers and Staff
n Physicians
n Physician Assistants
n Nurse Practitioners
n Pharmacists
n Nurses
n Nutritionists and physical therapists
n Social workers
n Genetic counselor
n Medical assistants
n Secretaries, office staff and manager
Collaborators Penn Health for Women -- Nurses, MA’s, Receptionists
+ Pediatric and Adolescent Primary Care
n Providers n Pediatricians
n Family Practice Docs
n Nurse Practitioners
n Physician Assistants
n Other health providers
n School teachers, counselors and psychologists
n Social services
+Cluster 5: Application
n Competencies: 5A. Practice Management 5B. Assessment
Ø Trains psychologists to fulfill clinical and academic roles in primary
care medical settings
Ø Education in family psychology and systems theory, collaboration, and health psychology through didactic, individual/group supervision, seminar, and clinical experiences
Ø Pediatric, Women’s Health, Family Medicine/Geriatric Internal Medicine tracks
PRIMARY CARE FAMILY PSYCHOLOGY FELLOWSHIPS
+
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The Center for Integrated Primary Care
• Workforce Development • Technical Assistance • Evaluation Services
For practices, health systems, and states wishing to integrate behavioral health and primary care services.
http://UMassMed.edu/CIPC
Alexander Blount, EdD Director
Alexa Connell, PhD Assistant Director
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+
+Post-Doctoral Certificate in Clinical Health Psychology
n Year long program
n Courses
n Clinical rotations in medical settings
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+Certificates vs Board Certification
n CE courses
n Planned curriculum in primary care
n Useful training
n Not recognized by any credentialing board or organization
n Documents expertise in specific area
n National standard for health service providers
n Consumer protection
n 14 specialty areas
n Benefits
n See www.ABPP.org
Board Certification (ABPP) Certificates
+Transitioning Your Practice to PC and Specialty Medical Settings
n Are Health Settings Right for You?
n Readiness Self Assessment
+ Transitioning Your Practice to Health Setting Is the setting right for you?
Clinical Approach
ü Focus on evaluation, consultation and short term tx
n SBIRT n Health behavior change n Limited time contact (15-20 vs 50 min hour) n Referral following 1-6 sessions
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+ Transitioning Your Practice to Health Settings Is the setting right for you?
Sitting with uncertainty n Practice
n Provider and staff support n Rooms n New ownership
n Health system n Different priorities n CMS MAPP designation
n Reimbursement challenges
n Coons, 2013, 2014; Kelly & Coons, 2013
+Strategies to Transition Your Practice Into Health Care Settings
+Strategies to Transition Your Practice Into Health Care Settings Individual & Group Exercise
List collaborative strategies you currently use?
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+
Building Collaborative Relationships with Health Care Providers
Psychologists in Independent Practice
+Strategies to Transition Your Practice Into
Integrated Health Care Settings Coons (2012, 2013, 2014)
n Send consult notes to current collaborators
n Which practices generate the largest number of referrals now
n What types of relationships do you have with provider(s)
n Ask providers about their practice and interests and refer patients to them
n Attend team meeting for complex patients and families
n Inquire about their interest in having you on site n To see individuals n To offer groups n Crisis management n Patient outcomes assessment
+Collaborative Consultation Communication Guidelines
n Communicate with provider prior to consult n Ask patient for verbal consent to speak with provider when she
calls for appointment
n Speak with the provider to clarify reason for referral
n Communicate with provider following the consult n Obtain written consent per HIPAA guidelines
n Phone call, letter, consult note, follow-up
n Recommendations for patient, family and/or provider
n Ongoing communication with provider n Prior to patient’s follow-up visits with the provider
n Discuss concerns, response to meds, progress, what provider can support
n Hospitalization, death, crisis, etc.
n Be flexible n provider schedule
n Phone issues (e.g., introduction)
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+Opportunities for Provider Communication and Relationship Building
n New patient - physician referred
n New patient - non physician referral
n Ongoing patient - no physician contact
+Consultation Reports
n Reports need to be brief!
n Include patient’s date of birth (and no SSN)
n Give concise treatment recommendations for the patient, couple, family
n Do not include interpretations!
n Give recommendations for the provider
n Provide referral information (name & number)
n Include follow-up plans
n Other
+Consultation Reports
“When seeking a consultation from a psychologist or other providers, “ physicians are likely to expect clear statements of observed facts and specific intervention recommendations.”
Pace et al. 1995
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+Consultation Reports
n Be relatively prompt n 1-2 weeks or before visit or call
n Watch what you say! n Reports can be sent on to others or seen by
others (e.g., other providers, lawyers, disability review, etc.).
n Consider HIPAA related issues and forms
n Mail, email, EMR > security
+Example Consultation Report
Dear Dr. Martinez:
Thank you for referring Sarah J. Smith (DOB: 1/19/25) for a consultation. As you know, Mrs. Smith is an 88 year old, retired school teacher with a history of HTN, DM, and Breast Cancer who cares for her husband of 68 years with an advanced dementia. In addition, her 47 year old daughter has advanced colon cancer and is in hospice. Mrs. Smith’s two sons live several hours away and her siblings are deceased.
Mrs. Smith was seen for an initial evaluation on September 8, 2013 and will continue in individual CBT to: 1) treat her marked symptoms of anxiety and depression with out suicidal ideation; 2) discuss her practical and emotional support needs; 3) assess her own cognitive status; 5) address options for ongoing care of her husband in their home or on a dementia unit; and 6) discuss her anticipatory grief during this very difficult time.
Mrs. Smith is willing to consider a medication consult to stablize her mood and sleep, and agreed to make a follow-up appointment with you. She is also willing to speak her Parish nurse as well as xx county Office on Aging to learn about respite care options.
Thank you for the opportunity to participate in Mrs. Smith’s care. If you would like additional information about her history and the treatment recommendations, my cell is:
Cc: other health care providers
+Calling & Texting Health Care Providers
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+Collaborate!
n Take care of health care provider’s patients! n Offer effective, ongoing treatment!
n Be available, visible and flexible
n Provide mini or curb-side consults on patients/families
n Offer to see a patient/family at the provider’s office
n Offer to do a home visit
n Discuss and provide referrals
n Offer to do groups at the provider’s office
n Do not do secondary referrals before talking with the provider
n Consider joining their managed care panels
+Share or Provide Resources!
n Assist with referrals – give names and cards of other providers
n Patient education pamphlets
n CD’s and links for relaxation with guided imagery
n Videotapes
n Recommend/design assessment or screening tools
n Journal articles relevant to clinical practice
n Handouts from CE conferences
n Other resources (e.g., community services)
+Preparing for Cancer Treatments
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+ Strategies to Transition Your Practice Into Integrated Health Care Settings Coons (2012, 2013, 2014)
n Staff training
n Lunch and learn
n Holiday lunches
n Grand rounds
n Invite providers to present with you
n Invite providers to write with you
n If rural, send letters with example consult note –
Steve Walfish, PhD.
+Strategies to Transition to Health Settings
Groups Medication Stress management Weight Chronic pain Fertility Pregnancy loss PPD/PPA
HIV/AIDS Smoking cessation Parenting skills Cancer survivors Caregivers Bereavement
+Interprofessional Approaches
n Physicians
n Physician Assistants
n Nurse practitioners
n Nurses
n Social workers
n Genetic counselors
n Physical therapists
n Nutritionists
n Pharmacists
n Medical assistants
n Secretaries, office staff, office manager
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+Collaborative Settings
n Internal medicine n Family medicine
n Obstetrics and Gynecology n Pediatrics n Adolescent medicine n Geriatric medicine
Primary Care Specialty Settings
+ Contractual, Legal and Regulatory Issues Affecting Co-Location in Private Health Settings
ü Contracts
ü Legal challenges
ü Regulatory issues
+ Contractual Options in Integrated Private Health Settings
n Employee
n Independent consultant under contract
n Independent contractor with rental agreement
n Group contract
n Grant funded
n Insurance funded- special initiative
n Fee for service Coons (2012, 2013)
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+ Contractual Issues in Health Settings Negotiating On-Site Collaborations (Coons and Gabis, 2010)
ü Clarify expectations n Time n Space n Staff needs n Patient scheduling n Computer access n Patient records
n Ownership n Access to and use of EMR
n Referrals n Signage n Patient billing n Groups/workshops n PR/advertising n Proprietary issues
n Coons & Gabis 2010
+Contractual Issues in Private Health Settings
Rental Agreement
n Time n Four hour blocks
n Space n Consult room n Exam room n Rotate n Groups Coons & Gabis, 2010
+Contractual Issues in Private Health Settings
n Patient Scheduling n Mechanisms n Warm hand off n Providers give patient your name n Provider gives you patient’s name to call
n Referrals n No fee splitting n Referrals to you and others
n Coons & Gabis (2010)
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+Contractual Issues in Health Settings-Technology
q Computer access n Patient information n EMR n Other
n Patient records n Ownership n Access to and use
of EMR n Content
n Coons & Gabis 2010
+Understand Contractual Relationships and Partnerships
n Privately held medical practice
n Group held medical practice
n Health system owned
n Public – FQHC
n ACO
+Contractual Agreements
Contacts for Co-located Practices
n Individual psychologist
n Group practice at one or more medical offices
Contracts for Referral Agreements in Community Practice
n Accept referrals from PCMH
Organizational Contracts
see Good Practice (October, 2014)
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+Contractual Issues in Health Settings
ü Hospital Privileges
ü CMS MAPP
ü Secure a contract and lease n Know Federal and State laws
n Contracts n HIPAA n Referrals
n Partnerships
ü State Corporate Doctrine of Medicine Laws
ü Stark Laws - referrals
Coons & Gabis (2010). Contractual Agreements for Independent Psychologists in Medical Settings. Independent Psychologist.
Legal and Regulatory Issues
+Contractual Issues in Health Settings
ü Seek legal consultation from health law lawyer
ü Secure liability and property insurance ü “other” Coons & Gabis (2010). Contractual
Agreements for Independent Psychologists in Medical Settings. Independent Psychologist.
Legal and Regulatory Issues
+Contractual Issues in Health Settings
n Negotiation
n Relationship building n Key players not just physicians n Who owns and runs practice?
n Go slow! Go slow!
n Understand expectations of practice and staff
n Considering shadowing providers
n Talk to key players
n Focus on needs of health practice and patients
n Coons & Gabis, 2010
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+Challenges with Practice Transition
n Time of uncertainty in health care, national and global economy
n Reimbursement challenges
n Regulatory issues
n Contractual options for individual and group practices
n Need for effective advocacy by all of us
n Coons (2012, 2013)
+Rewards of Co-Located and Integrated Care
n PC is defacto MH system
n Where the national focus and dollars are
n Problem focused
n We make a difference
n Learn every day
n P, I and P gratifying
n Relationships
+Transitioning Your Practice To Medical Settings: Is It Right For You?
6/4/15
49
+ Walk, Run or Avoiding the Train to PC and other Health Settings?
+Opportunities for Psychologists in Independent Practice
n Independent practice is not going to vanish
n Consumer choice n Need more than limited
sessions n Want to chose private
behavioral health provider n Theoretical orientation n Past experience with
therapy
n Referrals from medical practices, PCHM, ACO’s, schools, employers
+Referrals from ACO’s and PCMH’s
n Pediatric & Adult
n Network
n Build referral relationships
6/4/15
50
+Collaborative Strategies with Health Care Providers
Individual & Group Exercise
List collaborative strategies you currently use?
Benefits of Collaborative Care for Patients and Families --- and our Practices
TEAM
n Together n Everyone n Accomplishes n More
+Feelings about practice? Excited? Overwhelmed? Stuck?
6/4/15
51
+Health Care Reform and Psychology Practice
+Where will you practice in 2015-2020?
n Same location or ?
+What are the consequences of not leading or changing your practice model now?
6/4/15
52
+ Business of Practice 2014-2017
q Maintain
q Expand portfolio > pts and/or size
q Merge or transition to medical or other settings