[AVAPL Members] Re: Data and "Model of Care" for Psychology and MH?
- From: "Lovett, Steven Ph.D." <Steven.Lovett@xxxxxx>
- To: <members1@xxxxxxxxx>, "Graves, Peter K" <Peter.Graves@xxxxxx>
- Date: Fri, 27 Aug 2010 16:35:12 -0700
Peter, thanks for bringing this up. I think a discussion about this might
be worth the email landslide because I think it is, and will remain, one of
the biggest challenges Psychology is facing to keep the field vibrant and
valued in the VA. A couple of general thoughts ..
- It's hard to imagine any one metric that will be able to
accurately reflect workload across the large variety of activities
psychologists (& every other VA provider) engage in. A hybrid (or multiple
indictor) system might be the most useful, even though it's the most
complicated.
- I think your point 5 is very important. These non-patient
activities seem to be ones that psychologists are heavily involved in and
for which there is no clear metric to capture the work involved. I've had
the most luck pointing this out when there were discussions about filling a
particular position and I've been able to make a list of all the activities
that the previous staff member was doing and would have to be tasked to
multiple other people if a psychologist isn't selected to fill the position.
Making the case in a more general way seems to be very much harder.
I'm personally very interested in hearing how others have attempted to keep
management aware of the value of psychologists on staff, especially during
times of economic stress.
Steve
Steven Lovett, Ph.D.
Chief, Psychology, VAPAHCS
650-493-5000 ext 67106
Fax: 650-496-2597
Email: <mailto:Steven.Lovett@xxxxxx> Steven.Lovett@xxxxxx
From: avaplmembers-bounce@xxxxxxxxxxxxx
[mailto:avaplmembers-bounce@xxxxxxxxxxxxx] On Behalf Of Graves, Peter K
Sent: Friday, August 27, 2010 3:48 PM
To: members1@xxxxxxxxx; Graves, Peter K
Cc: Wolfe, Gary R
Subject: [AVAPL Members] Data and "Model of Care" for Psychology and MH?
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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