Closing the Loopholes

I just went on a lovely long walk with a friend of mine who still works at Kaiser’s Psychiatry Department in Santa Rosa. It was a lovely day. And she’s a lovely person. But it was an especially lovely trip because she told me about one particular change in charting policy, mandated by the Department of Managed Health Care (DMHC), that let me know those folks are on it. And not getting off it any time soon.

To summarize my previous post (Run DMHC!), in their latest report the DMHC indicated that they had conducted a review of 300 electronic medical records from 2012-2013. They employed a panel of experts to review these cases to assess if Kaiser is providing timely access to follow-up visits with therapists and psychiatrists. The reviewers’ job, however, was made difficult by the fact that therapists do  not indicate in their notes when their clients should be seen next, only when they will be seen next. To chart when a client should be seen next creates an accountability on the part of the therapist and the organization to make it happen. And the rare therapist who remarks (in their notes) on the discrepancy between what a client needs and what is available stands on the shaky ground of insurgency.

And so… what was the exciting news my colleague shared with me on that lovely day?

She let me know that the DMHC has mandated that Kaiser mental health clinicians add to each and every chart note a plan for follow-up. This plan will include the clinician’s recommendation for frequency of visits. To me, the inference is clear: the DMHC intends to conduct a follow-up assessment, using an improved technology for chart review. Instead of hiring a panel of clinicians to guess how often someone in a specific clinical situation should have been seen, they’re going to rely upon the treating clinician’s assessment. And, since Kaiser has punished those of us who have put this material in the charts, they are mandating that future encounters include a statement specifying the clinician’s recommendation.

I indicated in my last post that the recent DMHC’s finding that 20% of Northern California clients and 9% in Southern California are having to wait too long for mental health appointments is a serious underestimate of the problem. Now, it seems, the DMHC is developing a strategy to get a more accurate figure. My friend let me know that Santa Rosa managers have yet to come up with a workflow to meet the new mandate about charting. But it sounds like they will have to. And then the data will be (even more) out there.

It may be the Taylor Maid coffee talking, but woo-hoo!