Sunday, March 2, 2014

Smoky Mountain Center introduces mental health literacy program

Press release

From Smoky Mountain Center:

Smoky Mountain Center, in collaboration with the Mountain Area Health Education Center (MAHEC*) and Western North Carolina Health Network, is pleased to add up to thirty new instructors to the Mental Health First Aid team in a training session March 3-7, 2014 at the MAHEC Mary C. Nesbit Biltmore Campus.

The MHFA training course is designed to give members of the public key skills to help someone who is developing a mental health problem or experiencing a mental health crisis. Through this program, conducted by the National Council for Behavioral Health, new instructors will be certified to teach the 8-hour course to a variety of audiences. MHFA is one of several evidence-based programs Smoky Mountain Center provides to the community. The program is intended to identify opportunities for early intervention for individuals experiencing mental health concerns.

“We are thrilled to bring Mental Health First Aid to our Western North Carolina communities,” said Elizabeth Flemming, MA, LPC, Continuing Education Planner at MAHEC. “Most people know how to recognize and appropriately react to medical emergencies, but there is little knowledge in the general public about what to do in a mental health crisis.”

“I’d like to see people as familiar with MHFA as they are with CPR,” states Carolyn Dorner, Quality Coordinator at WNC Health Network. “We need to know how to respond when our friends, family, coworkers and neighbors need help.”

Genny Pugh, Senior Director for Community Collaboration at Smoky, said, “Mental Health First Aid is one of several evidence based programs we provide in our communities. Offering Mental Health First Aid classes to citizens across our 23 county catchment supports wellness for individuals and families through early identification and intervention for mental health concerns.

“We’re enthused to welcome MAHEC as a partner in extending mental health first aid across the country” says Linda Rosenberg, MSW, president and CEO of the National Council. “We anticipate the new instructors will have a great impact on the mental health communities throughout Western North Carolina and will be key players in improving mental health literacy nationwide.”

More than 3,700 U.S. instructors are already certified by Mental Health First Aid USA (MHFA-USA)** as instructors in all 50 states, the District of Columbia, and Puerto Rico. Instructors come from a variety of backgrounds, including behavioral healthcare, law enforcement and public safety, universities, faith communities and primary care. Included on SAMHSA’s National Registry of Evidence Based Programs and Practices, studies show that training in Mental Health First Aid builds confidence in helping an individual experiencing a mental health challenge, reduces negative or distancing attitudes towards individuals with mental illnesses, and increases mental health literacy – being able to identify, understand and respond to signs of mental illnesses and substance use disorders.

Smoky Mountain Center manages mental health, substance abuse, and intellectual/developmental disability services in Alexander, Alleghany, Ashe, Avery, Buncombe, Caldwell, Cherokee, Clay, Graham, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Polk, Rutherford, Swain, Transylvania, Watauga, Wilkes and Yancey Counties in North Carolina. Access to services is available 24 hours a day, 7 days a week by calling 1-800-849-6127.
*MAHEC was established in 1974 and is a leader in healthcare, education and innovation. Located in Asheville, MAHEC serves a 16-county region in Western North Carolina. It is the largest Area Health Education Center in North Carolina, which evolved to address national and state concerns with the supply, retention and quality of health professionals. MAHEC’s mission is to train the next generation of healthcare professionals for Western North Carolina through quality healthcare, innovative education, and best practice models that can be replicated nationally.

**Mental Health First Aid USA (MHFA-USA) is a collaboration between the National Council for Behavioral Health, the Maryland Department of Health and Mental Hygiene, and the Missouri Department of Mental Health.

The National Council for Behavioral Health (National Council) is the unifying voice of America’s community mental health and addictions treatment organizations. Together with our 2,000 member organizations, we serve our nation’s most vulnerable citizens — the more than eight million adults and children living with mental illnesses and addiction disorders. We are committed to ensuring all Americans have access to comprehensive, high-quality care that affords every opportunity for recovery and full participation in community life. The National Council pioneered Mental Health First Aid in the U.S. and has trained nearly 100,000 individuals to connect youth and adults in need to mental health and addictions care in their communities.

Mobile health initiative's goal: Cut hospital costs, readmissions

Community EMS, a Southfield-based ambulance and consulting company, has begun pilot testing a mobile health initiative to use paramedics and telemedicine to assess the health of chronic disease patients who develop non-emergency health problems. 

The pilot is viewed as a way to reduce costly hospital readmissions and unnecessary visits to emergency departments. 

"When a patient is discharged from a hospital to home or long-term care facility and they have a chronic illness, many things can trigger a patient being sent back to the hospital," said Greg Beauchemin, CEO of Community EMS. 

"Some symptoms can be addressed by home health agencies. But after hours, they use an ambulance," Beauchemin said. 

Because the average cost of an ambulance run to a hospital is $3,700, Beauchemin said, Community EMS can make a house call for "one-tenth of that cost." He said at least 50 percent of the ambulance runs in the city of Detroit's Detroit EMS are unnecessary.

Under the mobile health initiative, Community EMS and its consulting firm subsidiary, Parastar, will send advanced practice paramedics toBotsford Continuing Care Center in Farmington Hills to test its system on patients who have been screened by nurses and physicians, said Kevin Bersche, Parastar's director of operations.

Bersche said the advanced practice paramedics will be in close contact with emergency physicians at Farmington Hills-based Botsford Hospital, which owns Community EMS and is collaborating on the initiative.

He said similar community paramedicine programs in Texas and Minnesota are showing promise. 

"We want to legitimize that treatment can be done and that it does not jeopardize care," said Bersche, who was deputy chief of the Farmington Hills Fire Department for 32 years before joining Parastar last June.

Sanford Vieder, D.O., Botsford's ER director, said nurses at Botsford Continuing Care have been trained to determine when a patient needs an ambulance or could be served by the mobile health program. 

"Based on our protocol, the nurses call a 1-800 number and a (Botsford) ER physician screens the call," Vieder said. "We go through a series of questions and determine if a patient is a candidate. If we don't think so, 911 is called." 

When paramedics arrive at nursing homes, Vieder said, they will help evaluate the patients and connect them to "VideoDoc" telemedicine devices provided by Wixom-based Health Net Connect Inc., a subsidiary of J&B Medical Supply Co. Inc.

Health Net's VideoDoc, which features high-definition cameras and two-way audio systems, allows physicians to remotely examine patients, talk with them and monitor vital signs. 

"Under the supervision of a physician, paramedics will use VideoDoc to find out why (patients) are wheezing, coughing or having a problem," Vieder said. "They will give antibiotics or steroids and treat them as needed. If they are not improving, they will be transported to the hospital." 

Beauchemin said the mobile health initiative will test the care of about 130 patients to determine if Parastar's system reduces costs and protects patient safety. 

"We will prove to payers (and the Centers for Medicare and Medicaid Services) that from a long-term perspective, patients are better off and costs are lower by treating (patients with non-emergency conditions) at home," Beauchemin said.

Vieder said the problem is that Medicare and private payers don't have a reimbursement code to pay for paramedic house calls or the use of telemedicine. 

"We hope Medicare and payers adopt a shared savings model where the money saved by eliminating transport and treatment costs can be shared" with providers, Beauchemin said. The shared savings model could be a precursor to a formal reimbursement code, he said. 

Bersche said Community EMS has applied for a $3.9 million CMS Innovation Center federal grant to fund the test program. If approved, the funds would help pay for the mobile health initiative, he said.

Vieder said elderly patients at nursing homes and residencies are often unnecessarily sent by ambulance to hospital emergency rooms when they have some sort of medical distress. 

"If they have a medical problem, they frequently get put into a truck, brought to a chaotic ER, treated, then sent back to the nursing home," Vieder said. "The benefit is not pulling them away from a comfortable environment they are in unless they have a real medical emergency." 

Vieder said many 911 ambulance calls are avoidable by assessing patients and providing at-home paramedic or nursing care. 

Besides reducing unnecessary hospital readmissions or admissions, Bersche said, the project also could reduce ER utilization that could lower staffing costs. 

At Botsford Hospital, for example, 26 percent of patients who enter the ER are admitted to the hospital. Of total hospital admissions, 70 percent come through the ER, Vieder said. 

"There is no doubt that if we reduce the number of people coming into the ER, we would have fewer inappropriate hospital admissions and lower costs to the system," he said. 

Gregory Berger, M.D., executive medical director with Detroit Medical Center's Michigan Pioneer ACO, said the Community EMS initiative is a promising method that can save money and improve quality.

"A lot of people end up at the hospital for many reasons," Berger said. "There might be a social problem or a prescription or food program. The idea of getting extra eyes at the home is valuable." 

Jay Greene: (313) 446-0325, Twitter: @jaybgreene

Phila. area blocked from new Medicare ambulance enrollment

Citing a "significant potential for fraud, waste, and abuse," federal Medicare officials put a moratorium on the enrollment of new ambulance operators in Philadelphia and six surrounding counties.
The Philadelphia moratorium, which took effect Jan. 31, is just the second time officials at the Centers for Medicare and Medicaid Services have exercised this new power under the Affordable Care Act. It is intended to root out fraud.
A similar moratorium, which blocks new ambulance companies from getting paid by Medicare and Medicaid, was ordered in Houston last summer and has been extended for six months, authorities said.
The clampdown on new ambulance companies in the region came after a series of federal indictments since 2011 charged local ambulance operators with more than $15 million in fraudulent Medicare bills.
At issue is the medical necessity for nonemergency ambulance transportation. Medicare is supposed to pay for an ambulance only if a cheaper form of transportation would endanger the patient's health.
In 2011, Medicare paid an average of $289 for a one-way nonemergency trip. By contrast, the payment for a one-way trip in a wheelchair van - which makes up the bulk of business for law-abiding medical-transportation firms - is less than $50.
Most recently, in January, an emergency-medical technician who worked for Brotherly Love Ambulance Inc., of Philadelphia, pleaded guilty to signing up patients for relatively expensive ambulance rides when he knew they could walk or use cheaper transportation.
In addition, the EMT gave riders cash to entice them to keep using Brotherly Love, which fraudulently collected more than $2 million from Medicare from July 2010 through October 2011, the U.S. attorney in Philadelphia said.
An ambulance-industry trade group was in favor of the crackdown on small, fly-by-night ambulance operators that targeted dialysis and other patients for fraudulent rides, and then disappeared before regulators could catch up with them. The ambulance companies would then reinvent themselves with new names and logos.
"This whole moratorium is designed to prevent that reincarnation process," said Dean Bollendorf, president of Ambulance Association of Pennsylvania and vice president of HealthFleet Ambulance Inc., in the Roxborough section of Philadelphia.

Out-of-line costs

To support its moratorium in Philadelphia, federal regulators analyzed ambulance payments for U.S. counties with at least 200,000 Medicare beneficiaries, including Philadelphia. It found that in 2012, ambulance suppliers in Philadelphia were receiving $1,314 per year for the average ambulance patient, compared with $803 in comparable counties.
The analysis also looked at the number of ambulance companies in Philadelphia relative to the number of people receiving Medicare benefits under Medicare Part B, which is voluntary coverage with a premium paid by seniors that covers doctors visits, outpatient care, and other services not covered by basic Medicare Part A.
Philadelphia had 4.8 ambulance companies for every 10,000 Medicare beneficiaries in 2012. That ratio averaged 1.4 in comparable large counties. Only two other counties had more ambulances relative to the Medicare population than Philadelphia.
The regulators did not identify the counties that ranked higher.
Excluded from the analysis were Harris County, Texas, which is home to Houston and where widespread fraud has already been detected, and Manhattan (County of New York), because of its population density.
In the fall, there were about 80 ambulance companies in Philadelphia, including a small number of nonprofits, according to data from the Pennsylvania Department of Health, whose Bureau of Emergency Medical Services oversees licensing.
But nearly half of them had three or fewer ambulances, state data show.

Fraud pays well

The business is attractive to small operators. With just three dialysis patients taking three round-trips a week, an ambulance operator can earn about $250,000 a year, as long as those trips are billed to Medicare, said Daniel Herman, an owner of EMStar Medical Transportation, one of Philadelphia's largest ambulance companies.
"You can do $250,000 in revenue with three patients," Herman said, "and you can be done at 10 in the morning."
However, only 10 percent to 20 percent of dialysis patients actually need ambulance transportation, according to government and industry estimates. Medical necessity is determined on the "honor system," said Herman's partner, Joseph Zupnik.
Transporting the same three patients by wheelchair - which is much more likely to be appropriate - would bring in less than $50,000 annually.
Ambulance fraud involving dialysis patients gets most of the attention, but abuse extends beyond that.
For example, a person who had cancer surgery might go home but still need an ambulance to go for radiation treatments.
"They may not be able to get around for that first week or two. Guess what. We hope everyone's going to get better, and after two weeks," Zupnik said, "they may not need an ambulance."
There could be an approval for 90 days of ambulance rides, but "our nurses will go in and periodically review those cases and transition the person to what we feel is the appropriate level of medical transportation," Zupnik said.
"Other providers," he said, "will run the billing for the whole length of time, and maximize the revenue."

Incorporate patient-generated health data into the EMR

A few months ago, I spent 15 minutes filling out a detailed health data form at the doctor’s office. The paper form contained multiple questions about my health, family history, medications and basic demographic information. I assumed that an administrative specialist would code it into the practice’s electronic medical record (EMR) to be put to use. So it came as a surprise when I spent another 5 minutes reviewing the form with my physician, who then proceeded to type this information into the EMR herself. I’m confident neither my physician nor I felt enabled by the experience.
Countless people have had a similar experience — or worse, filled out a form with no sign that any clinician ever saw the information. Though the industry has made outstanding progress in adopting EMRs, the practice of data acquisition from patients remains cloudy. Patient-generated health data (PGHD), a term encompassing all forms of data that patients provide on their own, is a relatively new concept in health care. It falls into two broad groups: historical data and biometric data.
Historical data is the type that clinicians are familiar with obtaining from patients: It includes the patient’s medical history, allergies, medications, family history and lifestyle features. Biometric data, little used at present, are health data gathered by consumer medical devices, such as blood glucose meters and fitness trackers.
Scenarios like mine above underscore how ill-prepared the health care infrastructure is for the sharp rise in both opportunities and requirements for PGHD, and the challenges of wrestling these data into the workflow of clinicians. Now, however, an important milestone is on the horizon. A recommendation from the HITSC Meaningful Use Workgroup would require practices with electronic health records (EHRs) to allow 10 percent of patients to report PGHD electronically. If approved in meaningful use stage 3, the final stage of’s EHR incentive program, it could push hospitals to incorporate patient-generated data.
This requirement may seem like a relatively simple intervention, but the ramifications are quite significant. If clinical decision-making is made on the basis of data supplied by patients and documented in the EMR, how can clinicians be sure that such data is complete, correct and valid? And will clinicians like me learn to rely on it, or will we disregard it due to concerns about its validity or barriers to integrating it into care flow? Furthermore, if a patient is in control of her health data entry, who is ultimately responsible for its completeness and accuracy — the patient or the clinician?
Incorporating biometric data into the EMR, an exciting prospect, is even more complex. Though clinicians are quite familiar with data entry from FDA-approved medical devices such as blood glucose meters, pacemakers and pulmonary function units, data from a myriad of consumer-driven health devices (Fitbit and others) will soon seek to flex their way into EMRs. Patients clearly value these data; a recent Pew Research report noted that 60 percent of adults claim to track their exercise routine, weight or diet, meaning providers have some catch-up to do in order to meet patients halfway. Some health systems, such as Partners HealthCare, have already been experimenting with the incorporation of PGHD from remote devices into the EMR, and other institutions should follow. Consumer health data devices are moving ahead at a staggering pace, and while the health care system can’t quite keep up, strategic planning should be happening now.
Meanwhile, patients are flocking to sites like PatientsLikeMe and 23andMe to compare and track health data, symptoms and treatment results. Though the connection between clinical medicine and these services is still quite murky, the data show that large contingents of our patients value the notion of comparing and visualizing their health data.
Despite the challenges, incorporating PGHD is a necessary evolutionary step for health care. Intelligently designed, well-executed systems that fully incorporate and display PGHD in a meaningful way will improve shared decision-making and enable patients as active care partners. Keen clinicians and patients will stay closely tuned to the numerous transformations to come.
Israel Green-Hopkins is a pediatric emergency medicine fellow who blogs at Vector, the Boston Children’s Hospital science and clinical innovation blog.