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Mental Health Providers Plead for Meaningful Use Payments

POLITICO; Arthur Allen, 7/22/2014

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Mental health care providers pleaded Tuesday for Congress to pass a law that extends meaningful use incentive payments to their work, which they said was underfunded and suffering from faulty connections to other health care providers.

Five bills, two in the Senate and three in the House, were introduced in 2013 to extend the meaningful use program to behavioral health providers, who held a briefing on the Hill to gin up support for passage.

“It was a mistake to leave us out of meaningful use,” said Alfonso Guida of the Behavioral Health IT Coalition. “Now we’re trying to correct that.”

About 70 percent of patients with mental illnesses such as schizophrenia and bipolar disorder have other chronic conditions such as diabetes, asthma, high blood pressure or cancer. The cost of treating these diseases among the mentally ill is two to four times higher than in other populations, frequently because the mentally ill fail to adhere to drug prescriptions.

Coordination of their care is vital, providers at the event said, and it can’t be done without health IT.

“If you aren’t caring for the whole person, you get tremendous expenses and bad outcomes,” said Chris Wolf of ViaQuest, a private community health provider in Dublin, Ohio.

Historically, mental health services have been underfunded. According to the National Council for Behavioral Health, they typically recover only 70 percent of their costs from Medicaid, for example. And they were left out of meaningful use when it launched in 2011.

“We need to get that dime,” said Joseph Cvitkovic, director of behavioral health care at Jefferson Hospital in Pittsburgh. His hospital is part of the Allegheny Health Network, which is building “health malls” where specialty services are linked to primary care.

Allegheny is switching to an Epic Systems EHR, but Epic’s behavioral health software is in an elementary stage, Cvitkovic said.

“How can I have psychiatric care in that primary care complex if I don’t have health IT?” he asked.

The problems of working with a mostly paper system are enormous, he said. It is time consuming, he loses insurance and Medicare payments because of illegible physician handwriting, and when his patients are in emergency care the doctors have trouble finding out about their behavioral medications.

Closure of some state hospital systems in Pennsylvania has placed strains on inpatient acute care clinics, Cvitkovic said, and “we care for some of the most violent, acting-out people. Units like ours are going to close if we’re kept out of the modern era, which we are.”

Health IT requirements are complex for mental health because information about substance abuse must be sequestered from other health information in a patient’s record under federal law.

That requires special EHR modules. Since behavioral health is low on cash and left out of meaningful use, there’s been no incentive to EHR vendors to develop that software, said Ginger Bandeen of the Columbia Community Mental Health Center in St. Helen, Ore.

“You need health IT that can lock things down — and break the glass,” she said. For example, systems such as Kaiser-Permanente have systems that keep the information separate but allow physicians in an emergency room, for example, to get the relevant information on a patient who has substance-abuse issues.

The technology includes sophisticated audit tracking capacity that makes sure the wrong people aren’t looking at sensitive information, Bandeen said.

“The good stuff is in our records,” said Badeen. “We want to be able to share it because it will create better outcomes for our patients.”

Changes in regulations that loosen privacy restrictions might be required to make strides forward in health IT, said Cvitkovic.

“While we keep some privacy, the issue is to find out what’s in the interest of the patient, the family and, in the case of violent individuals, the community,” he said.

The providers urged senators to support bills that would enable meaningful use for behavioral health providers.

“We need co-sponsors,” said Guida. “If we can get them, we can show that to [Finance Committee leaders Ron] Wyden and [Orrin] Hatch and make progress in the next Congress.”

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