Resources on Post-Storm Trauma, CPT Codes, Veterans’ Services and More

If you read this blog often, you will notice that I regularly link to articles and other resources posted by The National Council. While we have exhibited at their conference, our organization has never been a member of The National Council. We have, however, been a grateful promoter of the resources that this organization shares freely with the behavioral health community. If you have never gone to their website or attended a webinar, you should take the opportunity to do so. They provide outstanding information in a timely manner. In spite of not being members, we have never been prevented from attending webinars or sharing in their well-researched and well-documented information.

I wanted to point you to some of the current information being provided by The National Council.

  1. Last week I talked about the need to have your own emergency contingency plans in case of storms and other natural and unnatural disasters. Since most of you are providers of behavioral health services, you will also find yourselves dealing with clients who have experienced the same trauma you have gone through. Just this afternoon, a webinar entitled Mitigating Disaster Trauma: Lessons from Sandy was presented by The National Council. While the webinar is over, The National Council routinely records webinar presentations for later viewing. You should be able to view this one within 48 hours.
  2. On November 9, Manon and I attended the Council’s webinar on CPT Code changes for 2013. Both the recording of the webinar and the slide deck from the presentation are available. In addition, a December 3 webinar has been scheduled to provide additional information about the new Evaluation and Management CPT Codes and how to use them. Registration is still open for that event.
  3. A new report announced by The Council reveals the incredible costs of the unmet mental health needs of returning U.S. Veterans. Having just passed Veterans Day, this is a sad reality we all need to be educated about. Those of you who provide services to Veterans will find the report of interest.

Please be sure to reference these resources properly if you refer to them in any of your own newsletters and announcements. The National Council does outstanding work in educating the behavioral health community and deserves credit for all the work they do!

Please share other resources that you find useful in your work. We love to be able to let our readers know about the wonderful materials that are available to them to enhance the outstanding work you all do in providing mental health services to all who need them.


Will Your Organization Weather a Storm…or Other Catastrophe?

Superstorm Sandy has had major impact on the lives of large numbers of our fellow Americans and colleagues who live in the Northeast U.S. The loss of life, property, and access to conveniences like electricity, warm showers, and transportation has made clear how vulnerable we are to the impacts of catastrophic events.

Sandy has also given us the unfortunate opportunity to evaluate the policies and procedures we have in place for dealing with physical catastrophes.

The Health Insurance Portability and Accountability Act (HIPAA) requires that organizations have in place a Contingency Plan (STANDARD § 164.308(a)(7) Contingency Plan, see page 19):

The Contingency Plan standard requires that covered entities:

“Establish (and implement as needed) policies and procedures for
responding to an emergency or other occurrence (for example, fire,
vandalism, system failure, and natural disaster) that damages systems that
contain electronic protected health information.”

This requirement is not aimed at giving you one more thing to do. The purpose is to protect the health information of your patients and to make sure that they have access to continuing care. Hurricane Andrew in 1992 and Hurricane Katrina in 2005 demonstrated how poorly prepared we have been to maintain continuity of care for our patients. The requirements of HIPAA are designed to prevent such huge failures as happened previously.

FiercePracticeManagement newsletter suggests three key steps.

  1. Know how your remote data is stored and can be accessed. This assumes that you have your data stored offsite, as it should be. Knowing just where it is and how to access it so you can get your system back up and running without delay is crucial. 
  2. Duplicate needed paper and have it with you. Make sure you have a copy of your schedule with you. Assure that you have with you ways to contact your patients so you can let them know your alternative arrangements for meeting with them.
  3. Plan where you will relocate physical data. Know where that alternative location will be so you can get access to your data again quickly.


In HealthCare IT News, Benjamin Harris covers some of the same ground. He also suggests three basic processes, but starts at a more basic level.

  1. On-site safety. How is your hardware and software and record systems protected at your site? Is your server located in the building basement along with the generator? As demonstrated by Sandy, the basement is not the best location for such equipment or records in the case of flooding . . . something that had previously been an issue in hurricanes Andrew and Katrina.
  2. Off-site data. If you are relying on a remote (cloud) storage facility or you need to access your data by means of the Internet, what do you do if your ISP (internet service provider) is down? And if your EHR is an online product, what do you do if those remote computers are underwater and without electricity? Having your schedules for the next week and treatment summaries for each of those patients printed out gives you a week of buffer time to give your vendors a chance to get back up and running.
  3. Accessibility. If you are using such remote storage or providers and they are not in the affected area or can implement access to backups quickly, having the capability of connecting to them becomes your responsibility. You can tether your laptop to your cell phone to reach your service or data in an emergency, as long as you have prepared in advance.


Madeline Hyden of the Medical Group Management Association (MGMA) suggests a slightly different but very practical list of steps.

  1. Secure your electronic information.
  2. Get the support of your professional colleagues.
  3. Immediately start securing new office space.
  4. Establish authority: Make sure someone in your organization is responsible to and has the authority to activate your contingency plan.
  5. Communicate with your vendors (hardware, software, backup services, electrical company, landlord, billing service, answering service).
  6. Develop a notification protocol: decide who to contact and how and who does the contacting. Determine just what they will be told.
  7. Communicate honestly with your patients.
  8. Protect your records so you are sure you can have access even if your main system is not accessible.
  9. Practice your emergency plan. If you have not done so, it is possible you will be too traumatized to carry it out.

If you are not sure how to go about establishing a contingency plan, AHIMA has some suggestions for you. This does not need to be a complicated process, but it is a process you need to address if you have not already done so. After all, the U.S. northeast coast did not think they were susceptible to a hurricane-like storm that could cause such disruption.

Whether it is hurricanes, snowstorms, tornadoes, earthquakes, or fires, our electrical systems and business facilities are not impervious to disasters. We must be prepared so our patients can rely upon continued care.  Behavioral health clients are especially susceptible to negative consequences from disruptive events. After all, they are likely to have just experienced the same trauma you did.

We hope all our SOS customers and their patients are safe and recovering in the aftermath of Sandy. We hope any of you, our readers will share your experiences and how you have assured the security of your data.


PHI Thieves Are Usually After Financial Information

Now that many physicians and other healthcare organizations are purchasing and utilizing EMRs, they seem to be focused on safeguarding the clinical Protected Health Information (PHI) of their patients. In the process, some are forgetting to protect patient financial information even though it is also PHI.

The FierceHealthIT newsletter of October 24, 2012 indicates that healthcare system data thieves are usually after financial information.

Despite reports of efforts to blackmail patients and the possibility of hacking pacemakers, healthcare data breaches in the end are similar to other cyber crimes, according to a new report from Verizon. In an examination of approximately 60 confirmed data breaches over the past two years, the report concludes that those who attack healthcare systems primarily look for information from which they can make a profit.

According to this Verizon report, point-of-sale systems (credit card machines) and desktop and laptop computers are the most common points of breach. Thieves attack the weakest links in the payment chain. Rather than going after your server, they hack into peripheral equipment that can get them access to this financial information.

Here at SOS, we harp on the need to secure the data in your billing and clinical record software. We have been amazed at the lack of awareness of even our largest customers. Every week, we receive emails that contain PHI or a direct way to get to PHI. Employees of behavioral health organizations often do not realize that sending an email with PHI in it is like sending a postcard with the same information. Anyone who sees that postcard and who knows how to read can take a look at your message. The same is true with insecure, unencrypted email. Anyone who knows how to do so and who has any interest can take a look at your email.

This study indicated that, among the breaches they studied, most of the incidents occurred at businesses that had from one to one hundred employees.

The simple solution….encrypt all PHI while it is resting on your system and while it is in transit from one place to another. If you don’t know how to do that, learn how, now!

Please share your experiences, direct or indirect, with safeguarding PHI. Do you encrypt? What procedures has your organization developed to assure that all of the PHI in your possession is as safe as possible from thieves?

Integrated Medical and Mental Health Care

Almost every time I bring up the topic of behavioral healthcare being integrated with general healthcare delivery, a private mental health practitioner responds questioning how this could possibly work. In response to my June post on this issue, one of our customers shared his thoughts (see comments) about just how this might occur and the obstacles to making it happen in the private setting. I responded like this:

I think many private practitioners are in the same position you are. Unless they do a very health-oriented practice, they see themselves continuing to function quite separately from general healthcare.

The picture is not the same in the public arena. At this time, about 60% of the funding for all mental health and substance abuse services comes from public, not private, sources. Of the people receiving such services, a large percentage have serious physical illnesses as well.

SAMHSA and The National Council for Community Behavioral Healthcare are moving forward with pilot programs and research on the integration of general and behavioral healthcare since this makes lots of sense in the public sector for the seriously mentally ill. But it may also have implications in the private arena. In fact, the move to provide integrated healthcare services in the public sector, and wherever possible in the private sector (like in Accountable Care Organizations – ACOs) has many folks exploring obstacles that may exist to such integration and ways to overcome those obstacles.

Yesterday, I was reading a September SAMHSA-HRSA Center for Integrated Health Solutions newsletter that linked to an interesting article on the use and evaluation of Telephone Administered Cognitive Behavioral Therapy (CBT) for depression. The research started from the current reality that most treatment for depression is provided in primary care physician offices. Of course, this treatment usually consists of medication. While patients prefer psychotherapy to medication for treatment of depression, and both CBT and medication appear to be about equally effective, access to psychotherapy is limited for most people. Cost or convenient access to a psychotherapist covered by their health insurance or some other equally valid reason interferes with provision of psychotherapy.

The research demonstrated that telephone administered CBT was more effective in keeping the client participating in therapy. Both telephone administered CBT and face-to-face CBT were equally effective in diminishing symptoms of depression at time of termination. Face-to-face CBT seemed to maintain the effects better at a six-month measure.

At this point in reading the results, I was reminded of Dr. Suzanne Bennett Johnson’s initiative as President of American Psychological Association (APA) for 2012. She wanted to remind psychologists that they are part of a healthcare profession, and that most of us are well-trained in conducting research. We are ideally suited to design and conduct the studies that will demonstrate just where psychologists and other mental health professionals can best serve in integrated healthcare. I could instantly imagine the re-design of the study reported above to include Skype or other Internet service-based delivery of the CBT so that at least some of the elements of the face-to-face therapy would be present.

There is already lots of opinion about the potential benefits and detriments of remotely-administered behavioral health treatment. Psychologist David C. Mohr, Ph.D., Professor in Preventive Medicine, Medical Social Sciences, and Psychiatry and Behavioral Sciences at Northwestern University lists Internet Intervention and Telemental Health as significant aspects of his interests. Quoted in that 2008 Time Magazine article, Dr. Mohr sees distinct areas where teletherapy or other internet programming might be of use, especially CBT for depression.

Other cutting-edge practitioners have already added internet-based services including videotherapy into their retinue. Given a solid research foundation, video-based therapeutic services might well be a way for the private practitioner of behavioral healthcare to integrate their services with general healthcare.

We can sit back and watch as our healthcare system changes all around us, letting others dictate to us the role we will play. Alternatively, we can be active participants in designing the models for inclusion of behavioral healthcare in primary care. We can design the models, do the research, and market the methods to ACOs, health plans, and medical providers.

We would love to hear from any of you who already work in a setting where mental health services are integrated into primary healthcare. Please let us know your experience and what you think.


Psychiatry CPT Codes for 2013

A few weeks ago I wrote about the upcoming changes in the CPT codes for psychiatric services. Lots of people have been looking for detail on those changes, but the American Medical Association has not yet released all of the specifics. They are planning major changes to the general illness codes as well.

The AMA invites the health care community to learn more about the significant changes to the 2013 CPT codes and descriptors by attending the CPT/RBRVS Symposium in Chicago from Nov. 14-16, 2012. For additional information, please visit the AMA website at:

If you are not going to be in Chicago in November for the symposium, there will likely be some other venues through which you can obtain more detail. The American Psychiatric Association (aPa) has created some documents that should be helpful, but they too cannot release the codes to the general public until the AMA gives them the go ahead. aPa members can obtain more specific information at their website.

The National Council announced their own upcoming workshop in today’s Public Policy Update. The challenge is that the codes are changing for everyone who provides mental health services. While some changes happen every year, this is a pretty involved set requiring the use of evaluation and management codes. The Council has already put together a fact sheet that you might find helpful. You might consider attending the webinar they are planning in November.

This is a topic for all of us to get informed about and stay on top of. Please share any information or links that you become aware of. Just enter them in the Comments below.

Energy at Work: What recharges you?

Last night I saw a great horned owl sitting at the top of a tall pine tree silhouetted against the sky.

We had been hearing the hoots of the owls for the past several weeks. Sometimes we would hear him near bedtime when we walked outside briefly to say good night to departing guests or to pet our front porch cat. A few times I heard him calling early in the morning.

I had looked for him before, but seeing a bird in the dark is a real challenge, especially not really knowing where to look. It can be a challenge to localize the source of a bird call, especially one as loud and deep as that of an owl. The sound bounces off nearby houses and trees.

Last night, I walked out into an open part of my front yard and looked up toward the tops of very tall pine trees a couple of properties away from mine. I saw movement at the top of a tree, then saw a very large bird fly off. As I kept watching, I saw a second bird fly from the same location to the top of a nearby pine tree. It sat on the very top of the tree so I could see its 2+ foot height dark against the lighter sky. I ran inside to get my binoculars and he waited in the same spot. I had no camera with the power to photograph it, so my brain will need to store the image. And it will!

I am not a serious birder. I do not have a life list that I seek to fill. I do get significant pleasure from sighting birds that share my locale. It is a major recharge event for me.

You see, I have long found that I require a great deal of self-care and stress management to function well. When I worked as a psychologist, I used a variety of methods, mostly focused on professional involvement and time spent with other people. After 15 years of practice, I had burned out. I had not done enough to take care of myself.

I believe this is a major problem among behavioral healthcare workers. The job of assisting other people in being mentally healthy is a very difficult one. The chronically and seriously mentally ill can be a very satisfying but very draining population with which to work. Finding ways to recharge and re-energize is crucial to doing this work well.

Now that I work with providers of behavioral healthcare services instead of with patients themselves, I still need to do lots of self-care. Bicycling, gardening, watching the birds in my garden and near my home . . . these have become the ways I energize myself.

How do you take care of yourself? What recharges your batteries? Does your practice or organization have tools to help you with your self-care? When did you last see a great horned owl?

Please share your thoughts and experiences. When you offer your insights, you give other readers additional ideas to explore. Please do so!

New IOM Report: Best care at lower cost

In early September, the Institute of Medicine published its most recent report on the state of healthcare in the U.S. Best Care at Lower Cost: The Path to Continuously Learning Health Care in America, identifies three major “imperatives for change: the rising complexity of modern health care, unsustainable cost increases, and outcomes below the system’s potential. You can download a free, prepublication .pdf version of this 450 page report before it is out in print.

The committee explored in detail some of the pressing needs of the system. They are convinced that we must move toward a healthcare system that learns from itself as rapidly as possible or the system is likely to self-destruct. We must learn how to incorporate research results more quickly, we must learn to change delivery systems that cost too much, we must move the system closer to its highest potential. In short, we must develop a culture of “continuous improvement to produce the best care at lower cost.”

FierceHealthFinance focused on the reported waste of $750 Billion a year (about 30% of the cost of healthcare in the U.S.) as one of the most important things to change. While that number is appalling, the fact that the figure reported was from 2009 is the most striking thing about it to me. Our system has become so complex that it takes three years before we know what it costs. We are constantly behind the curve, and must find ways to speed up the process of information assessment, dissemination, and implementation for change.

The behavioral healthcare system is often far behind the curve in implementing change that might be more productive. The public health and public behavioral health systems are deep in conversation and pilot programs related to integrating physical and behavioral healthcare. Suzanne Bennett Johnson, Ph.D., current President of the American Psychological Association (APA) identified the need to increase psychology’s role in integrated care as a primary thrust of her presidency; her presidential address also focused on this issue. I wonder how many mental health providers in the private sector are even willing to consider what changes to their work such an integrated system might bring.

Take a look at the very brief summary of the IOM report to see if you would like to read the whole thing. What do you think we need to do in behavioral healthcare to begin to address some of these issues?

Where is the Consumer in Health IT?

On Monday, September 10, 2012, I listened in on the first few hours of the 2012 Consumer Health IT Summit: Expanding Access to Health Information. The program was streamed live on the HHS website. The information presented was pretty fascinating, but what impressed me most was the passion of the presenters. They were really excited about what they call the Blue Button.

Most of Monday’s session focused on increasing patient involvement in their health care through access to their health information, mostly by way of Blue Button technology. While there are many reasons for our healthcare system to move toward our medical records being entirely electronic and interoperable, one of the most important of those reasons is patient access. It is widely believed that engaging consumers in the process of their healthcare is essential to effective prevention and management of chronic health conditions. Unless we get chronic illnesses well-managed, we will never get control of healthcare costs.

This is an important arena for Behavioral Health. I went to the website of The National Council for Community Behavioral Health and did a quick search on “chronic illness and mental health” and came up with 762 documents that contained reference to those terms. Obviously, this is an area that has been written about a great deal. Approximately 78 percent of all health care spending is for individuals with chronic conditions.  There is a high co-occurrence of mental illness and substance use disorders and chronic physical health conditions.

Involving the consumer of healthcare services and their families in their treatment may go a long way toward controlling some of the costs involved. Having access to our medical records is just one way to assist in this process. Hence, the focus on the Blue Button.

The Office of the National Coordinator for Health Information Technology has made patient access to their health data a priority. They have created a Pledge program whereby corporations and individuals can pledge to work to make patient health information available to them.

There are Two Types of Pledges. Data Holders, those who manage or maintain individually identifiable health data such as providers, hospitals, payers and pharmacies) would take this pledge:


We pledge to make it easier for individuals and their caregivers to have secure, timely, and electronic access to their health information. We further encourage individuals to use this information to improve their health and their care.


Non-Data Holders, that is folks

 who do not manage or maintain consumer health data, but have the ability to educate consumers about the importance of getting access to and using their health information (e.g., employers, consumer and disease-based organizations, health care associations, product developers) . . .


would pledge the following:

We pledge to engage and empower individuals to be partners in their health through information technology.

This is an interesting approach to involve as many people as possible in a process that is huge and will undoubtedly take many years to complete. In the spirit of sharing as much information as possible so we can all learn about our own healthcare information and find ways to gain access to it, I thought I would at least share some links with you.

The Office of the National Coordinator (ONC) maintains a website that contains a wealth of information about healthcare technology and events related to it. The goal of consumer involvement or putting the “I” in healthcare IT is the current focus at this site. If you would like to see the progress physicians and hospitals are making toward adopting electronic medical records, take a look at this dashboard. I am sure there are many other useful sites. I will do my best to share them as we all move forward with this process. Please share the ones you know about as well.

If your doctor had a patient portal for you to visit and have access to your health record, would you use it? Is this something that is important to you? Do you use a Personal Health Record now? Please let us know what you think about this whole move toward patient involvement in and responsibility for their healthcare and using Electronic Medical Records to help it happen.


Ongoing HIPAA Care: What is your plan?

Here at SOS Software, we have been in an ongoing process to develop, maintain, and implement detailed policies and procedures to assure that we are doing everything possible to act as responsible Business Associates to our Covered Entity customers. We have been holding monthly training for our staff in which we all take a pre-test, watch an instructional video together, discuss what we have learned, take a post-test to measure how much we have learned, then discuss the results of our testing to be sure we all understand these important concepts.

HIPAA (Health Insurance Portability and Accountability Act of 1996) mandated that electronically stored protected health information (PHI) be handled in such a fashion as to assure the privacy of the patients to whom it belongs. The HITECH (Health Information Technology for Economic and Clinical Health) sections of ARRA (the American Recovery and Reinvestment Act of 2009) also required additional security measures be utilized for all PHI. HITECH extended the same privacy and security requirements to Business Associates of Covered Entities as to the entities themselves.

We have been distressed to find that many of our customers have no idea what HIPAA actually requires. While it is true that the requirements are scalable (small organizations like solo psychiatric or psychological practices do not need to do as much as large ones), some customers seem to think that scalability means they need to do nothing since they are not a community mental health center or a hospital. This is far from accurate.

Every organization that handles PHI is responsible to assure that the privacy and security of that information is guaranteed. Not doing a security risk assessment, not having an incident response plan, not having a disaster plan, not having usable backups of your patient information off site . . . all of these things could easily be considered “willful neglect” by the Office of Civil Rights (OCR), the agency responsible for enforcing HIPAA. If an unhappy patient reports you to OCR as ignoring the requirements of HIPAA and you are found to be guilty of “willful neglect”, OCR must penalize you. Are you prepared to pay at least a $10,000 to $50,000 fine . . . or worse?

If the items I just mentioned above are not very familiar to you, that means you and your organization may not have done your HIPAA homework. You may not need to start at the beginning, but reviewing some of our old posts and links might help you get started. We have found that there are many resources available on the Internet free or at low cost. You might consider some of those. Seth plans to attend a free webinar he got notice of last week. He has started a workgroup of some of our customers who are trying to help themselves and one another move their security and privacy programs forward.

What do you need to do to become HIPAA compliant?

What do you or your organization already do to assure your compliance?

Do you know who your Privacy Officer is?

Please share some of the steps you and your organization have taken to assure that your organization is HIPAA compliant. Let us know what you do on an ongoing basis to be sure new employees are educated to the requirements. Just enter your comments below.


CMS: Are you familiar with their newsletters and eLists?

Since I was once a Medicare provider, I have long received newsletters from the Center for Medicare and Medicaid Services (CMS). Several years ago, they started to make major improvements to their websites offering large quantities of information for both providers and consumers of services. I am not sure how I wound up on an email list, but I now received regular information about a variety of topics related to healthcare and CMS.

While all healthcare providers need this information, we have found that behavioral health providers are often out of the information loop. Unfortunately, under most laws, HIPAA included, ignorance of a law and its requirements offers you no protection from the law. If you have not already done so, it might be time to begin to inform yourself about various subjects related to Medicare.

The number of topics available is outstanding.

I subscribe to both the CMS Industry ICD-10 Update and to the Caregiver eNewsletter. I find both resources quite useful.



If you would like to stay informed on any topics for which CMS is responsible just sign up for one of their eLists. Once you start receiving information on one topic, you can determine if it is useful and manage your preferences for the updates you receive.

Which of these lists are among those to which you subscribe? Please share your preferences!




Psychiatric CPT Codes Changing in 2013

Every year, changes are made to the Current Procedural Terminology® codes to reflect changes in actual practice of medicine and related fields. Use of these CPT® codes, as they are called, is required for reimbursement by insurance carriers. The American Medical Association establishes procedures including workgroups in various disciplines to assure that the codes keep up with the times. Since payment is based on the codes used, it is essential that providers keep informed about changes.

In 2013, significant changes to psychiatry and psychotherapy codes will occur. While those changes are not yet finalized, providers should understand what they are and be on the alert for the publication of the final codes.

The American Psychological Association participated with the American Psychiatric Association, the American Academy of Child and Adolescent Psychiatry, the American Nurses Association and the National Association of Social Workers to examine the definitions of the CPT psychotherapy codes. Most of the codes that have previously been used will be removed and new ones adopted.

Since these codes are the basis for payment for most behavioral health services, the billing of most behavioral health organizations will be affected. The National Council and other professional groups will be reporting on these changes. Stay tuned…


Current Procedural Terminology (CPT®) copyright 2012 American Medical Association. All rights reserved.

APA Convention in Orlando: Customers, colleagues, and more

From Thursday August 2 through Sunday August 5, 2012, Synergistic Office Solutions exhibited at the American Psychological Association (APA) convention in Orlando. The last time we exhibited at APA was in New Orleans in 2006. As a New Orleanian, it was my way of thanking APA for holding the convention there so soon post-Katrina.

This time, the meeting was held in Orlando. Since the SOS headquarters is located in Clermont, FL, a mere 30 miles west of Orlando, we felt we should attend. We had a few other outstanding reasons to be there.

Three SOS customers also exhibited this year, and we definitely wanted to see and support them.

University of Missouri Community Psychological Service received a large grant that will allow them to expand their services. Dr. Rob Harris was at APA interviewing for their open positions for psychologists.

Alliant University - CSPP booth

Alliant International University – California School of Professional Psychology (CSPP) attends every year. According to Michael Newman, the Assistant Director of Alumni Relations, many CSPP alums attend the convention. For them, it is a great opportunity to reconnect with alumni and to talk with potential new students.

Southeast Psych is a private group psychology practice in Charlotte, NC. Though we had spoken with Dr. Frank Gaskill and Dr. Jonathan Feather many times since 2000 when they started using our software, we had never met. We do receive their monthly newsletter, so we knew that their approach to the practice of psychology is unique. How many practices do you know that have as one of their goals the pursuit of fun?

Dr. Feather and Dr. Verhaagen of Southeast Psych playing at APA









Southeast Psych has begun to do some consulting with others who also want to develop their Dream Practice. I was glad to join in some of the fun while there.

Kathy with Darth Vader and Storm Trooper








I had a few other pleasant tasks while at the convention. I got to visit with and then hear the presentation of my long-time colleague and friend, Dr. Ellyn Kaschak, this year’s Carolyn Wood Sherif Award recipient. I attended a University of Florida reception for alumnae of the program in Clinical and Health Psychology (of which I am a graduate).

Trish and I hosted other visitors/friends at our booth.

Fred Coolidge, Ph.D.

Dr. Fred Coolidge is Seth’s cross-country riding buddy, Professor at University of Colorado – Colorado Springs, author and rock guitarist. Dr. Bob Neimeyer was Seth’s student while at University of Florida. He is Professor at University of Memphis, prolific author and frequent Continuing Education speaker.

Robert Neimeyer, Ph.D.

Finally, I attended a panel on women presidents of APA and the APA Presidential reception hosted by Dr. Suzanne Bennett Johnson, 2012 President of the American Psychological Association.

Suzanne Bennett Johnson, Ph.D. President, APA

Suzanne was an intern and then a post-doctoral fellow when I was a graduate student at University of Florida. We have worked together on the Board of Directors of the Florida Psychological Association over the years. She has had a distinguished career in Health Psychology practice and research, spending many years at U of F and then moving to the Florida State University College of Medicine. It was a special pleasure to attend the APA convention when a career-long colleague and friend was presiding. I’ll bet she had even more fun than we did!

Were you at APA? Do you have memorable convention moments you would like to share? Please do so below.





Global Warming Revisited

I just read NYTimes food writer Mark Bittman’s OpEd piece about about global warming (The Endless Summer), and I feel like part of the problem. The last two years have been so overwhelmingly busy that I have not been blogging regularly. And beyond that, I have not mentioned climate change since August 2010; that mention followed five other blog posts on the subject starting in September 2009.

That is precisely what Bittman points out in his column. We seem to have become blind to climate change and our part in it as we struggle to deal with our day to day lives.

Here’s what American exceptionalism means now: on a per-capita basis, we either lead or come close to leading the world in consumption of resources, production of pollutants and a profound unwillingness to do anything about it. We may look back upon this year as the one in which climate change began to wreak serious havoc, yet we hear almost no conversation about changing policy or behavior.

In the two years since I last wrote about this subject, most serious scientific objection to the fact of climate change and global warming has disappeared. It seems pretty apparent that the people who benefit from our lack of action are those in the fossil fuel industry or those who do not want to spend money limiting the impact of their industries upon our shared climate. Those who lose are the rest of us….every one.

I live in Florida where we have just had our 49th day of 90 and above temperatures this year, an extreme even for Florida. Yep, we are just over 200 days into the year and fully one quarter of those days have had temps 90 or above. Because we live in Central Florida where the weather can suddenly become very interesting, we have a local weather station and connect its output to Their website contains a whole section on climate change with lots of detailed information.

I know we are still struggling economically. I understand that it is hard to face difficult issues day in and day out. I realize that most of us feel pretty powerless to address an issue as large as global warming. But there are certainly things each of us can do . . . even if our leaders will not take charge on this issue.

In 2009, Paul, Mary and Stella McCartney started the Meat Free Monday movement encouraging ordinary folks like you and me to eat meat one day less per week. Their website contains lots of useful information about the impact of our food choices.

The UK’s Food Climate Research Network suggests that food production from farm to fork is responsible for between 20-30 percent of global green house gas emissions . . . . Livestock production is responsible for around half of these emissions.

Also in 2009, Mark Bittman wrote Food Matters: A Guide to Conscious Eating. According to Bittman, this book “explores the links among global warming and other environmental challenges, obesity and the so-called lifestyle diseases, and the overproduction and overconsumption of meat, simple carbohydrates, and junk food.”

In March 2012, Brad Tuttle of Time wrote about the The Meatless (and Less Meat) Revolution.

You and your organizations work daily with people who struggle with obesity among other food-related health issues. Research has long indicated that successful weight loss is only maintained when an individual learns about healthy food choices and practices making those choices over the long term. For some people, finding a larger reason to eat more sanely can serve as a powerful motivator.

Perhaps making the connection between global warming and healthy eating would be just the pairing someone struggling with food-related behavior needs.

I used to care that people understood how humans contribute to global warming. I no longer care. It does not matter whether human behavior caused the crisis we are facing. What matters is that there are behaviors each of us can do that can have an impact on climate change.

Are you up for the challenge? It will save you money, help you lose weight, and have a significant impact on global warming.

Habits, Habits, Habits: How do they affect your life?

In May, I received an email from Charles Duhigg, NY Times reporter and author of The Power of Habit. Or rather, I should say that I received an email from Charles Duhigg’s publisher/publicist who is very good at finding bloggers who have written about psychological topics and who might be interested in his book. Their marketing research was right on target, (see chapter 7, How Target Knows What You Want Before You Do), no pun intended. I am, indeed, interested in certain psychological research, and I did find his book fascinating and very well written. In my former life as a psychotherapist, I would even have recommended it to patients. Instead, I will recommend it to you.

How many times have you discovered a pattern of behavior that you would like to change? How many times have you been successful in making the change?

If you struggle as much as I do with habit change, it is not because you are weak-willed. It is likely because you do not have a complete understanding of the behavior you are trying to change, what cues the behavior, and how the reward impacts you. Even if you are clear about those elements, you might have ignored the necessary step of substituting a competing behavior to replace the one you are trying to change.

Not sure you know what I am talking about? No surprise to me. Most of us are not very good at even realizing that we are engaged in habitual behavior until someone else points it out to us.

I recently had a visit from my nephew and his family. Near the end of their stay, his 3-1/2 year old son was using the word “actually” appropriately in many of his comments. “Actually, that’s a tufted titmouse. He takes a seed from the feeder, then goes to the bush to eat it.” It was not until he left that my sister-in-law and I heard me using “actually” often in my comments. It took a 3-1/2 year old to help me see habitual speech behavior that has been with me for who knows how long.

Duhigg’s book is an excellent exploration of habits and their power in our personal lives, in business, and in society. He clearly presents a framework for habit change that most individuals and any therapist can use:


• Identify the routine

• Experiment with rewards

• Isolate the cue

• Have a plan

Duhigg, Charles (2012-02-28). The Power of Habit: Why We Do What We Do in Life and Business (p. 274). Random House, Inc. Kindle Edition.

Part of what appeals to me about this Framework is that it presents a simple system. My personal inclination in life is toward making things systematic and understanding the systems that apply when something is not of my making; so this approach is appealing to my sense of order.

  1. Observe and assess the behavior. Determine what is included in this habit. Get a good picture of the whole thing and how it functions in your life. In Duhigg’s words, identify the routine.
  2. Take a look at just what is rewarding to you in this behavior. Since the reward is a large part of what is keeping the habit in place, understand it well and look at as many aspects of the reward as you can. You may think one part of the reinforcement is what is maintaining your behavior when another part is actually the driver. As Duhigg says, experiment with rewards.
  3. Get a good understanding of just what the trigger is for the habit. What sets it off? For me, sitting down at my desk at work in the morning is my cue to check email. Even if I have decided to do something else first (like write a blog post), the strong pull is for me to check email. According to Duhigg’s framework, isolate the cue.
  4. Finally, in order to change an habitual behavior, you need to determine what you want to do instead, how you will make yourself aware of the cue so you do not go into automatic, what reward you will use to alter the habit, how long you will do the changed behavior to solidify the new habit…as Mr. Duhigg suggests, have a plan.

The simplicity of this framework is part of its power…and part of the power of habits in our lives. If your own habits, the habits of your business or organization, or the habits of our society are important to you, take a look at this book. It is simultaneously a good read and enlightening.

Do you have experiences with habits and habit change that you would be willing to share? WAIT…this is where you would usually STOP READING. Maybe you could change that habit and offer a comment today? Your reward? My profound thanks for reading and commenting. Just enter your comment below.


Secondary Insurance and Medicare

It is fascinating to me how rapidly and completely something can move from primary to secondary. I started writing this blog post one and a half weeks ago. After all sorts of interruptions, it has finally made it back to primary position in my task queue. Since I have no formal rules for how a task becomes primary or secondary, it can sometimes be a challenge to prioritize.

An active discussion on our SOS User Group site on Medicare Crossover claim filing started me thinking about this matter of primary and secondary insurance. Somehow, in our day-to-day lives, we have complete understanding of what these words mean, even if we have no formal definitions. When it comes to insurance, everything changes; the meanings and functions of primary and secondary become murky. Because we have addressed this issue here in this blog and in a couple of documents on our web site, internet searches for ‘filing secondary insurance’ often hit upon the article that Manon wrote on the subject or on the blog post. I am surprised at how frequently those searches and hits happen.

Our User Group discussion (just scroll to the top for the start of the thread) talked about the requirements placed upon Medicare Participating Providers to file secondary or crossover claims for their patients. Most of the participants indicated their understanding that it is necessary for Participating Providers to do this. Some discussants indicated that crossover claims are sent to the secondary insurer automatically. A couple of others indicated that there is some special process that they must go through to make this happen.

I know that one of the most important improvements in the 5010 version of the 837 claims transaction is requirement for the inclusion of more specific Coordination of Benefit information in the claim. Manon attended a Medicare webinar this week that discussed progress on meeting the 5010 requirements. Apparently, crossovers have been a big issue in this 5010 transition, but CMS indicates that they have made significant advance in working out the issues about crossovers.

Medicare regulations detail requirements for Coordination of Benefit Agreements and Coordination of Benefit Contractors. Unfortunately, wading through 124 pages of regulations to completely understand this process seems like overkill for an individual provider. Add to that the fact that different Medicare Administrative Contractors (MACs) may have different procedures, different Coordination of Benefit Contractors, and be in different stages of implementation of this process. In fact, a Google search for Medicare Crossovers comes up with documents created by many of the different MACs.

Getting your MAC to tell you what must be in your claims, what you as a provider are required to do for your patient, and what your patient may be required to do to complete the filing of secondary (crossover) claims seems like the reasonable course of action. I would be amazed if there is not detailed information on your MAC’s website.

Let us know if you are able to find out useful information. We can post the links here to make it easier for others to find what they need about the topic of Medicare Crossovers. Please share your comments below.

Where’s the Behavior in Healthcare?

A couple of recent articles have reminded me of how important behavioral components will be in our new healthcare marketplace. My only question is whether and how behavioral health providers will position themselves to take advantage of the restructuring of our healthcare system.

A couple of days ago, I received a newsletter from SAMHSA and the National Council for Community Behavioral Health through the SAMHSA-HRSA Center for Integrated Health Solutions. The focus of this newsletter was the necessary core clinical features for the creation of a Behavioral Health Home.

I am not sure exactly what a Behavioral Health Home is, but SAMHSA has been working to be sure behavioral health services are included in the Health Home concept and implementations. It is very likely that integration of healthcare services will occur with behavioral health services being provided as part of a larger health system.

Today’s email announced June workshops on finance and billing integration.

Billing for Integrated Health Services
When: Tuesday, June 12, 2012, 2:00-3:30 pm EDT
Presenter: Kathleen Reynolds, Senior Consultant, SAMHSA-HRSA Center for Integrated Health Solutions, and Vice President, Health Integration and Wellness Promotion, National Council for Community Behavioral Healthcare

Financing integrated healthcare is one of the key challenges encountered by organizations during implementation of services. This webinar will feature the state based Interim Billing and Financial Worksheets developed by the SAMHSA-HRSA Center for Integrated Health Solutions.

The worksheets identify the major CMHC and Health Center CPT codes used for billing integrated health services and their availability for use in each of the 50 states. The webinar will address the core aspects of billing for integrated health services and assist participants in successfully using the worksheets to maximize billing opportunities for integrated health services.

If your organization would like to overcome financing barriers and better understand billing rules and regulations, this webinar will help you to:

  • Learn about financial viability and sustainability of integration efforts through appropriate and accurate billing for services.
  • Understand how state Medicaid programs determine the types of services, codes, and individuals credentialed to provide services, resulting in unique billing rules and regulations in each state.
  • Get familiar with CPT codes that can be used to bill for services and the discipline and credentials required by the public funding source (i.e., Medicare, Medicaid) to bill for the codes.

Register today. The webinar is free, but space is limited.

Preparing for Bidirectional Integration: Lessons from the Field
When: Thursday, June 14, 2:00–3:30 pm EDT
Presenters: David Lloyd, Founder, MTM Services; Anthony Zipple, President/CEO, Seven Counties Services; Frank Berry, CEO, View Point Health

Significant practice changes lie ahead for community behavioral healthcare as parity, coverage expansion, and new practice paradigms make integration of care the expectation, not the exception. In July 2011, the SAMHSA-HRSA Center for Integrated Health Solutions launched the Integrated Health Provider Learning Collaborative program. The program engaged 15 organizations to help answer one question — how can community mental health and addictions treatment organizations shift their practices to support bidirectional integration?

During this 9-month program, participating sites learned how to nurture three primary values required for community behavioral health organizations to serve as partners in new service delivery models — be accessible, be efficient, and produce measurable outcomes. They share their experiences on this webinar.

If your organization is interested in preparing for bidirectional integration, this webinar will help you to:

  • Learn how to assess readiness levels for integration.
  • Get a firsthand view of integration challenges and accomplishments from two of the collaborative participating sites.
  • Identify key areas of change in service delivery models, administrative processes, and culture shifts to get ready to integrate with community partners.

Register today. The webinar is free, but space is limited.

Traditional mental health problems will certainly be addressed in this integrated manner, particularly in the public sector. Simultaneously, physical problems that involve significant behavioral components are likely to be treated using integrated care.

An article in Fierce Health Payer newsletter talked about insurance carriers developing anti-obesity programs.

“Is there coverage [for obesity] is yesterday’s conversation,” Karen Ignagni, president of America’s Health Insurance Plans, told KHN. “Today’s conversation is how to design coverage to encourage people to use it and continue using it.”

UnitedHealth, for example, is considering offering a version of the Diabetes Prevention Program, which is an intensive weight-loss intervention, for overweight and obese adults. “Doctors are in short supply,” so the insurer wants to introduce intensive behavioral change programs through the community rather than doctor offices, Deneen Vojta, senior vice president of UnitedHealth’s Center for Health Reform & Modernization, told KHN.

Read more: Insurers launch more anti-obesity programs – FierceHealthPayer

While some insurers will focus partially on use of physical treatments and surgeries to facilitate weight loss, it seems to me that this is an ideal arena for behavioral health specialists. Cognitive and behavioral changes are crucial to weight loss. Who is better prepared to facilitate these changes than mental health providers?

Where is your organization currently in considering the evolution of healthcare services to incorporate behavioral health? Do you currently operate a practice that works with physicians on physical care? Are you part of a community health center with integrated general health and behavioral health components? Please share your experiences.

Caring for the Caregiver: 5 Self-care Tips

When I worked as a psychotherapist, I constantly struggled with the issue of self-care. I was always much better at taking care of others than I was at taking care of myself. I attended workshops and became involved in my professional associations because those activities felt good and were part of my self-nurturing, but they also ate up energy, so they were not as restorative as necessary.

When I had the opportunity to move out of the practice of psychology and into business, I jumped at the chance. Mental health care can be very demanding and eighteen years of other-focus seemed like my limit.

Then Katrina flooded my Mother’s home. Since September of 2005, she has lived with us and is now 92. I have become her primary caregiver. Although she is able to take care of many of her own needs, as she has aged and become more frail, the time and energy required of me has increased.

Last week I attended a webinar offered by my health insurance carrier. United Healthcare seems pretty intent on offering services that might prevent or mitigate illness. When I got their newsletter announcing the workshop, Take Care of the Caregiver, I signed right up. The information and suggestions they offered will undoubtedly prove valuable for me. My guess is that other insurers offer similar resources.

After attending their seminar, I got to thinking a bit about their ideas and others I have heard. These are a few I have gleaned over time.

  1. Practice mindfulness. Being really ‘present’ in whatever you are doing diminishes the frittering away of time and energy. This can be quite difficult to do when you feel great pressure and the demands of caring for others, but it is very much worth the effort to practice some activity that will assist you in focusing on the things and people for which you are responsible. For some of us, meditation can be helpful. For others, exercise does the job. Whatever method you prefer for increasing your ability to attend well to the persons in your care, use it. Get rid of the excuses and move forward.
  2. Set limits on what you can and will do.You cannot possibly be responsible for everything. Most psychotherapists know this, but it is often difficult not to feel responsible for the entire well-being of clients. Once you have learned to set boundaries as a therapist, it is easier to maintain your energy.The same is true when doing other sorts of caregiving. Know what you are able and willing to do and only do that. This will mean that you may need to find others to provide what you cannot, but that is OK. Just make sure that you know where your abilities and willingness end, that it is perfectly OK to have those end points, and that and your charges will be happier and better off for that clarity.
  3. Let others help you. It is much easier to set limits on what you will do if you let others help you. If you are taking care of children, that means letting their grandparents, aunts and uncles pitch in. If you are taking care of an elder, it may mean involving your siblings or finding programs and assistance in your community. If you are taking care of clients with behavioral health disorders, it may mean delegating tasks to others i1 your organization as well as finding a network of resources in your community that your clients can use.
  4. Take some time for yourself. Give yourself a moment whenever you can. Even brief times can have major impact. Just sit still and breathe for a minute or two. Go for a walk alone. Sit and watch the sun set. Schedule a manicure or a facial or a mini-spa day…or give yourself one. Indulge in a massage. If possible, schedule regular time away from those to whom your provide care. Utilize some of the others in your life so you can schedule an afternoon, a weekend, or a week away. You need vacation time. Take it.
  5. Schedule rest. Do your best to get enough sleep. If adequate continuous sleep is not a possibility, schedule mini-rest breaks into your day. If you always feel exhausted, you are less likely to be the kind of caregiver you would prefer to be. If you are permanently tired, you are more likely to experience suppression of your immune system and susceptibility to illness. Letting others help you may give you the time you need to rest.

I wish I could say I am good at these five things. I am working to be better at them. I’ll let you know when I get there.

I am sure many of you have found ways to take care of yourselves so you can do a better job of taking care of others. Please share some of your secrets. Inquiring minds want to know!

Favorite Technology Tools

I know that most of you work in behavioral health organizations. You probably use the technology that is provided to you even if you know of better tools that would make your work life smoother and easier. After all, the goal is to serve consumers of substance abuse and mental health services, not to the be the coolest technology shop around.

But maybe that is not totally the case. . . . Do you have a favorite technology tool that you love to use in your practice or workplace or at home? Is there something that has become so indispensable that you cannot imagine getting along without it?

I am not a big searcher for new software programs or apps for my Android cell phone or Amazon Fire. I tend to try things that are offered by family or friends, choose the ones that work for me, and then leave well enough alone. If I have chosen well, the updates offered by the company from whom I have purchased the product almost always keep up with and even anticipate my needs. But that is not always the case.

A few years ago, I was considering creating a training video for our electronic claims module. I saw some information about a program named Camtasia Studio, by TechSmith. I liked the description so much that I tried the free demo.

I was in love! This program does everything I need a video-creation tool to do, and it does it simply. I started with Camtasia 4 and am now at version 7.1. Like I said, when I find a tool that works for me, I tend to stick with it.

This is the sort of video you can create with Camtasia.

When I first started doing these movies, I let our web server handle them and just gave the direct link to the file to the customers we wanted to see them. This got the training module into the right hands, but did not make the video available at large.

Now I want to go farther. I want to be able to create videos and to embed them here on my blog or on our web site. Even though I am not an expert video maker, I want to create more of them and get them out there. The more I do, the better I will get at them.

What cool tools do you have that you rely on every day? Is there some program or app that you cannot do without?

Please tell me what you think. Your feedback and comments are always appreciated.

Professional Identification and Behavioral Health Providers

Well, I have finally done it. I have completed the state of Florida Psychology License Renewal form to change my license status to Inactive. After nineteen (19) years of not practicing, I think it is time.

While it may be time, it is not a simple matter. For me, as for many other professionals, a large portion of my personal identity is tied up with my education and my work. In spite of not having worked as a  psychologist for so many years, being a psychologist has continued to be a strong part of my identification of who I am. I think I have a reached a phase of my life where it is time for me to re-define that. I still have a great deal of work to do to figure out exactly how to do that re-definition.

In the meantime, I continue to be fascinated by the changes in the behavioral healthcare world and the challenges being faced by mental health provider organizations. Last week, I attended the Spring members meeting of the Software and Technology Vendors Association (SATVA) at the tail end of the National Council annual conference in Chicago. For the past couple of years, we at SATVA have been focused on the future interoperability of our products and the need to assure that exchanged EHR data will be secure and released in accordance with law and the desires of the person to whom the record belongs.

I was delighted to have the opportunity to observe two of my colleagues/competitors participating in a panel and demonstrating an exchange of patient data between their systems. The protocol that is being used for the exchange is designed to meet the requirements of 42 CFR Part 2, and may become a model for the exchange of all ultrasensitive patient information. SATVA plans to share the methods and protocol so other behavioral health EHR software vendors can implement the same protocol in their exchanges. Dennis Grantham, Editor-in-Chief of Behavioral Healthcare Magazine sums it up this way in his summary review of the conference.

  • Members of the Software and Technology Vendors’ Association, or SATVA, closing ranks around an EHR interoperability solution – a cloud-based Health Information Services Platform (HISP) – with a new twist: an interoperable Continuity of Care Document that allows for real—not simulated—interchange of “ultrasensitive” addiction treatment information. SATVA members argue that demonstrating compliance with federal 42 CFR Part 2 requirements electronically eliminates the technical barriers posed by compliance with a range of federal and state health-information protection laws that go beyond HIPAA requirements.
This is very exciting progress in the behavioral health EHR world. We who are SATVA members hope that other behavioral health software vendors will also use this protocol to speed the movement toward interoperable EHR programs.
And who knows, I may even find myself consolidating my professional identity as a software entrepreneur. Maybe it is time; we have been doing this business for twenty-seven years. I would love to have your suggestions about how to migrate my professional identification. Any ideas?

Acquisition, Retention, and Long-Term Customer Care

I am a dyed-in-the-wool Star Trek fan. The Next Generation was my clear favorite. I was not crazy about Voyager, but each of the other series up to and including Deep Space Nine was a regular watch. Last week, while watching an old episode of DS9, I was reminded of one of the most interesting aspects of watching the show. The multiple ‘cultures’ represented by various species were always sources of social insight.

One of my least favorite, but simultaneously a most fascinating species, were the Ferengi, the most acquisitive species in the universe. While watching this episode, Quark, owner of the space station bar scolded his brother and made him recite the First Law of Acquisition: “Once you have their money, never give it back.”

When I was in private practice, it was my goal to put myself out of business; that is, if I did my job well, I would help people enough so they did not need me anymore. They would get better and leave therapy. In order to stay in business, it was necessary to continually attract new clients. Accordingly, during my practice years, my marketing was always aimed at acquisition of new clients.

Here at SOS, we have always been of the belief that we should never give a customer a reason to want their money back. In fact, we have applied this Ferengi ‘law’ to getting and keeping customers . . . ‘once you have a customer, never let them go!’, just the opposite of my goal while doing a psychology practice.

We are excited to be marking twenty-seven years in business this month. We are even more pleased to realize that almost one-third of our current customers who have active support agreements have been SOS customers for more than twenty years. Thirty percent of those have maintained continuous support/update contracts since we initiated maintenance agreements in 1996.

While it is necessary for any business to attract new customers in order to stay healthy and to thrive, in the software world, it is just as important to keep customers by keeping them happy. We here at SOS are committed to doing that. Thanks to our current and long-term customers for sticking with us!