Sunday, February 17, 2013

It's Not So Bad, Hon



Here in B'more, it's not uncommon for people to call each other "hon," especially strangers.  So the checkout person at the grocery store may well say, "Have a good day, hon."  It's kind of endearing.

So here at Shrink Rap we've been discussing some difficult things going on in psychiatry -- major changes in the way we code appointments -- I'll avoid the 3 letter acronym we've all come to dread -- and gun legislation that targets, and therefore stigmatizes, those with mental illnesses.  I, for one, have been among those ranting, and it's for that reason that I have a blog: I like to rant.

Our commenters have joined me in kvetching about changes and possible changes.  I have to say, though, that I don't think things are so bad, hon.

So I've learned how to use the new codes and I've learned to incorporate this into my practice so that I'm doing nothing different when I see patients, which is good, because I was worried that the new coding would force me to derail part of the session to ask questions or do things that are irrelevant to the individual patient's care, and so far they haven't.  I've computerized my progress notes, and the first couple of weeks were very painful. I was in the office hours longer each day, but now I have a rhythm.  What still hasn't been sorted out is how to code so that insurance companies will reimburse patients, and at this point it seems that some insurance companies are reimbursing significantly better, some are disallowing psychotherapy, and some don't even have prices assigned to the codes and have all claims as "pending."  Through our state listserv, we've engaged with the Insurance Commissioner's office, and at least they know there are problems.  But I do think that in a few months it will just be what we do and psychiatry will move on, hopefully with sustained and improved reimbursements.  At this point, I still think it was a bad move to do this -- more paperwork with unclear gains -- but it is what it is and I don't think this will be a devastating change for psychiatry.  If you're still confused, my YouTube tutorials have had over 2800 views, and when once it falls out as to what insurers will reimburse, I may do a quick and easy synopsis. 

Regarding upcoming legislation, I remain annoyed at the quick response of our legislators.  I've rejoined our psychiatric society's legislative committee, and I wrote an op ed piece in our local paper.  One commenter noted they didn't think it would do any good, but I remain optimistic that these efforts have some meaning.  Of course, no one wins all the time in going against a system, but last year Clink and I wrote a joint op ed piece opposing legislation to make marijuana legal, it was run the day the legislature voted, and it was defeated.  When my op ed piece ran last week discussing why it's a bad idea to mandate that psychiatrists report patients, I got a lot of emails, including one from one of the governor's appointees asking how I thought the Firearms Bill should be changed.  I may not win on my issues, but I'm planning to go down making a lot of noise, and I'm not at all hopeless. And if you have a cause or an issue, please, please: DO SOMETHING.  People who say "you can't fight the system," don't fight the system.  It's not always fun and it's not always gratifying, but at least you can say you tried and you might just make a difference.

At the end of the day, I still like my job, hon.