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Role & Fiscal Sustainability of PMHNPs within Primary Care
Susan Marie, PMHNP PhDMedical Director for Behavioral HealthOld Town Clinic, Central City Concern
Success =Clear Roles & ProcessesPreventing Cultural PitfallsSustainable Revenue
Roles
BehavioristWho: various flavors- social workers,
counselors, psychologists, unlicensed mh staff- check licensing/revenue
What Crisis intervention/suicide intervention Diffusing hostility Brief cognitive-behavioral treatment anxiety IMPACT problem solving intervention Linking to resources Teaching skills: relaxation, trauma management
RolesPsychiatric Expertise
WHO Psychiatric nurse practitioner or psychiatrist
WHAT Just-in- time consultation to primary care providers Focused psychiatric assessments Psychiatric medication management “weave in & out” Crisis/suicide support PCP psychopharmacology support and training
Preventing Cultural Clash
Specialty Mental Health
Caseload of clients- “full”
Values confidentialityIndependenceNever interrupt
Integrated Primary Care
Serve PCP panelsValues collaborationTeamEncourages
interruptions
MENTAL HEALTH
“Therapist”“Sacred 50 min hour”Full evaluation before treatmentEpisodic
PRIMARY CARE
Varied RolesShorter appointmentsDevelop assessment as you goOngoing, as needed
Sustainable Revenue
OHP Health Plan (medical)E&M CodesHealth & Behavior Codes
Mental Health Plan “Mental Health” codes
FCHP pays E & M codes Operationally defined “primary care
behavioral health”Assessing, diagnosing, and treating mental
illnesses What the primary care provider would be doing if psychiatric provider was not there
Provided in same physical and temporal space of primary care
E & M Codes
1) Less cost2) Less stigma3) Increased access 4) Better outcomes
E&M Codes: The Rationale
Similar charting requirements as PCPSimilar billing as PCP
No same day paymentNo coverage of non-medical BH staffOnly brief interventions covered (99212,
99213)
E&M Advantages/Disadvantages
Services to diagnose and treat mental illnessesExpectations inconsistent with primary care
modelClinical record keepingClinical supervision & reviewQuality improvement processes
Increased administrative burdenCredentialing/licensing
AuditingPrior authorization procedures
OHP Mental Health Plan
Same day with PCP visit Case management, counseling services Wider variety of providers
Requires state license as behavioral health provider
Requires contracting with MHO State expectations (eg CPMS)Differing expectations by MHO
Advantages/Disadvantages
Now It’s Your Turn. Questions??
