{"id":63867,"date":"2016-03-05T13:44:56","date_gmt":"2016-03-05T18:44:56","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=63867"},"modified":"2016-03-05T13:47:38","modified_gmt":"2016-03-05T18:47:38","slug":"deja-vu-aka-psychic-pneumonia","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2016\/03\/05\/deja-vu-aka-psychic-pneumonia\/","title":{"rendered":"d\u00e9j\u00e0 vu<\/em> aka psychic pneumonia<\/em>…"},"content":{"rendered":"
\n
\n
Standardized Evaluation of Mental Health Treatment on the Way<\/a><\/div>\n
Medscape Medical News: Psychiatry<\/font><\/strong><\/div>\n
by Alicia Ault<\/div>\n
February 25, 2016 <\/div>\n

Starting in 2017, the Joint Commission will require the 2300 behavioral healthcare organizations it accredits to initiate standardized measurement of interventions designed to improve patients’ mental health outcomes. "We’re going to put in place a measurement-based care requirement," said Margaret VanAmringe, the Joint Commission’s executive vice president for public policy and government relations, at a meeting sponsored by the Kennedy Forum<\/a> and the Satcher Health Leadership Institute’s Kennedy Center for Mental Health Policy and Research<\/a>.<\/p>\n

Attendees from government agencies, patient and mental health advocacy groups, philanthropic organizations, and academic institutions applauded the announcement. Systematically tracking and reporting outcomes could help build an evidence base of best interventions and practices. In turn, the data could be used to reduce coverage exclusions, which are still common despite laws that require benefit parity for medical and mental health services, such as the Mental Health Parity and Addiction Equity Act of 2008.<\/p>\n

According to the State of Parity<\/em> report released at the February 26 meeting by the Kennedy Forum, founded by former congressman Patrick Kennedy in 2013 and the Scattergood Foundation<\/a>, "insurers still circumvent the [Parity] law’s requirements." Samuel Nussbaum, MD, executive vice president and chief medical officer for Anthem, Inc, said that insurers are often stymied when trying to apply both the letter and the spirit of parity, in part because of a lack of evidence. "How do we determine what works?" Dr Nussbaum asked. <\/p>\n

The Joint Commission hopes to help answer that question with its new requirement, VanAmringe told Medscape Medical News<\/em>. The current standard for the 2300 behavioral healthcare organizations it accredits requires outcomes assessments, but there is no requirement to use standardized measurement tools or to aggregate patient data, she added. The new policy will require a standardized method of measurement that is sensitive enough to show that an intervention improved a patient’s outcome. Organizations will also be required to assess outcomes on a population-wide basis and to use the information for continuous quality improvement, VanAmringe said.<\/p>\n

That kind of data collection can "make your organization more valuable" to insurers, she said, "because you show that you are improving outcomes." The data can also be used to show that mental health care services work, she said. "Too often, people don’t think that they are that effective," said VanAmringe. A Joint Commission committee will review the proposed requirement in March. The requirement will then be made available for comment by accredited organizations, and it will be reviewed by the Joint Commission’s board. It is hoped that the new standard will be announced in July, VanAmringe told Medscape Medical News<\/em>.<\/p>\n

Use of the new standard would not be required until January 2017 — about the time that the Centers for Medicare and Medicaid Services will start payment for its collaborative care model, which was made final<\/a> in the 2016 Medicare fee schedule rule. The model, developed at the University of Washington, creates a team involving a primary care physician, a care manager, and a psychiatric consultant. It is still not clear what that model will look like or how physicians will be reimbursed. The CMS will "propose the details of that methodology" this year, said Patrick Conway, MD, the agency’s acting principal deputy administrator, at the meeting. <\/div>\n<\/blockquote>\n
Notably unmentioned in the audience of<\/font><\/em> "Attendees from government agencies, patient and mental health advocacy groups, philanthropic organizations, and academic institutions"<\/font><\/strong><\/em> who<\/font><\/em> "applauded the announcement"<\/font><\/em><\/strong> were psychiatrists, primary care physicians, psychologists, social workers, patients, etc. – anyone who might be tasked with either delivering or receiving these services… <\/font><\/em><\/div>\n

It’s 1980 again, or maybe still – the same rhetoric. The only place that this really fit was in the medical modeling of certain physical diseases, so that’s the direction things took. Known diseases, diagnosed with clear criteria, treatable with defined treatments [time limited] – something like psychic pneumonia<\/font><\/em><\/strong>. We built a diagnostic system based on that model [and even messed up the places where it fit eg depression], and set out to prove drug efficacy based on clinical trials of treatments aiming towards creating guidelines that could then be generalized to those diagnostic groupings. Medications were approved based on the specific diagnoses. Since we had no markers or lab tests, the clinical scales or their derivatives from the clinical trials became the proxies. So the whole system became modeled on the Randomized Controlled Trial [RCT]. Now, the whole system will actually become a Randomized Controlled Trial [RCT] with outcome variables.<\/p>\n

Problems?<\/div>\n
    <\/p>\n
  • \n
    There’s no provision for the actual mental illnesses that come closest to fitting their model – Schizophrenia, Manic Depressive Illness, Melancholia [or whatever you choose to call them]. Are the PCP’s to treat them too?<\/div>\n<\/li>\n
  • \n
    Practically speaking, the only available treatment to recommend will be medications, or some different medication, and right now we’re at the end of that road rather than the beginning like we were in 1980. This system is based on the fantasy that a psychiatrist can help a primary care physician use medications better, yet we are in a time when the limitations of symptomatic medication alone are staring us in the face. How will this make anything better?.<\/div>\n<\/li>\n
  • \n
    Candidly, this is backwards, "Samuel Nussbaum, MD, executive vice president and chief medical officer for Anthem, Inc, said that insurers are often stymied when trying to apply both the letter and the spirit of parity, in part because of a lack of evidence. ‘How do we determine what works?’ Dr Nussbaum asked.<\/font><\/em>" A better version might be, "How are we to determine that insurers are actually interested in the treatment of their client’s mental illnesses [<\/font><\/em>speaking of a lack of evidence]<\/font><\/em>?<\/font><\/em>"<\/div>\n<\/li>\n

    <\/span><\/ul>\n

    They are implementing a system that they dictate, removing us from direct contact with the patient,  and adding the requirement that we need to prove in an ongoing way that such a thing is working? Perhaps those who deliver these services might be asked how they think things ought to be going forward instead of being told to do something impossible, and then provide proof that it isn’t.<\/div>\n","protected":false},"excerpt":{"rendered":"

    Standardized Evaluation of Mental Health Treatment on the Way Medscape Medical News: Psychiatry by Alicia Ault February 25, 2016 Starting in 2017, the Joint Commission will require the 2300 behavioral healthcare organizations it accredits to initiate standardized measurement of interventions designed to improve patients’ mental health outcomes. "We’re going to put in place a measurement-based […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[5],"tags":[],"class_list":["post-63867","post","type-post","status-publish","format-standard","hentry","category-opinion"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/63867","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=63867"}],"version-history":[{"count":12,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/63867\/revisions"}],"predecessor-version":[{"id":63879,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/63867\/revisions\/63879"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=63867"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=63867"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=63867"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}