[AVAPL Members] Data and "Model of Care" for Psychology and MH?
- From: "Graves, Peter K" <Peter.Graves@xxxxxx>
- To: <members1@xxxxxxxxx>, "Graves, Peter K" <Peter.Graves@xxxxxx>
- Date: Fri, 27 Aug 2010 15:48:16 -0700
Hi all,
As we in VISN 22 become ever more data driven ...
One thing we're noticing is that our leadership may not understand our
Model of Care very well. Often by default, they try to impose models
more familiar to them (such as Primary Care's "panel size," "physician
extenders," "teamlets," etc.). Those models don't always fit very well,
and lead to further confusion and frustration for everyone.
In our various Psychology and Mental Health Data and
Discipline groups, we're struggling with how to develop ways to explain
ourselves in ways that Leadership can better understand. We believe an
emphasis on data will help. Among things we're generally
considering/using to varying degrees are the following. This email is a
request for any input on OTHER things you may be using or trying out, in
hopes of brainstorming ideas that may lead to a more understood
Psychology (and MH) Service generally. Then we'll work on World Peace.
Here's what we've been using/considering so far:
1. Uniques and Encounters: the most readily available information,
but with all the pitfalls everyone knows. Our VISN leadership asked us
to develop some minimum/maximum "trigger points" for an average
clinician's unique and encounters. The idea is that, with many
exceptions for good reasons, an average clinician's workload should be
looked at if it's below or above the range of triggers. For example,
psychologists were pegged at 250-400 uniques and 1300-1900 encounters.
The data, of course, is all over the map for all those reasons alluded
to, and can be seriously misused. But at least our Leadership has
something as a reference standard.
2. RVU and DSS: some of us are further along than others on this,
but we hope the variable weighting of encounters overcomes some of the
above pitfalls. It's not clear how available data is on individuals.
We have a LOT to learn here, and are plugging away.
3. Hybrid data: I understand there's an existing system (which I
believe Russ Lemle and others use) which is kind of middle ground
between 1 and 2 , where group encounters are separated from individual
encounters, offering some level of refinement.
4. "Carve outs:" Of course, in some programs there are mandated
maximum caseloads (MHICM, VASH, Day Programs, Home Based Care, etc.).
And in others there may be similar rationale for measuring by a
different standard, which would obviously need to be explained and
supported.
5. "Extras:" We're also starting to try to identify and measure
"special extras" we are bringing, such as:
a. Comp and Pen exams
b. Employee Assistance
c. ED backup coverage
d. Police Evals
e. Boards of Investigation
f. Other tasks for which "Psychology is so good," and so seems to
get a disproportionate share of the load, without full appreciation of
the cost in other workload.
6. Guidance: In all of this we've referred to and quoted from the
two very helpful reports from Bob Gresen's groups (the 2003 revised MH
Provider Workload document and the 2009 PowerPoint about FY08
Productivity and Staffing), which we believe is the closest material to
official guidance.
7. Teaming up: And of course we all lack sufficient resources to
make a serious effort in any of these areas. So by working together in
the VISN we're hoping to support each other in our collective efforts
and get further than any of us could on our own. We'll also be able to
help our VISN Leadership understand us better. We hope.
8. Bribery, sweet talking, threats.
Any other ideas you all have been using or are considering will be very
welcome. I'll recommend NOT using "reply all" to reduce email blizzard,
but be happy to share a summary of what I learn from your replies.
We're betting some of you are further along this trail than are we, and
will very much appreciate any specific concepts you find helpful.
THANKS!
Peter Graves, Ph.D., J.D.
Associate Chair of Psychology
for WLA Outpatient Programs,
U.S. Dept. of Veterans Affairs
11301 Wilshire Blvd.
Building 257, Room 12B
Los Angeles, CA 90073
(310)268-3771
cel (best) (213) 305-1444
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