Michael Reeder LCPC @reederm@qoto.org

Propublica Article: Denial of Medical Claims

/All,

I am sharing Dr. Linden's post below with permission.

You may also wish to see her opinion article from October 22nd in the
Delaware Bay to Bay News in which she primarily outlines deterioration
to medical care through the intrusion of big business.  She also ties
the future of medical care to election results:
https://baytobaynews.com/stories/linden-improvement-in-health-care-depends-on-election,148362

Michael Reeder LCPC
Baltimore, MD

/~~~~~~~~~~~~~~~~~~~~~
There is an excellent article in yesterday's Propublica about how
companies like Unitedhealthcare, Cigna, and Aetna are using affiliated
companies like Evicore to deny tens of millions of claims a year.

It is unclear in the article whether this includes mental health claims.
However it is relevant to our own medical insurance and that of our clients.

I urge you to read the whole article

https://www.propublica.org/article/evicore-health-insurance-denials-cigna-unitedhealthcare-aetna-prior-authorizations

Jill Linden, Ph.D.
psychologist, retired
Delaware

~~~~
#insurance #claims #aetna #unitedhealth #cigna #priorauthorizations
#claimspayments #medicalclaims #EviCore#healthcare #denials
~~~~~~~~~~~~~~~

The impact of AI and telemedicine on behavioral health services

*The impact of AI and telemedicine on behavioral health services
*https://www.healthcareitnews.com/news/impact-ai-and-telemedicine-behavioral-health-services

There is A LOT OF ACTION right now as the tech industry, insurance
companies, governments, and major health systems cast about trying to
figure out how to lower costs and/or provide better services to mental
health clients.

*We REALLY need our professional associations watching all of this.
*
As I read these articles I see benefits, yet I see opportunities for:

* Misunderstandings of how mental health actually works,
* Turning therapists into plug and play component cogs in large machines.

With regards to this particular article, I have questions/issues:

I see the value of using AI for triage to determine who needs to be seen
more quickly.  What I don't understand is how this works after the
initial intake.  It's almost like the CEO being interviewed sees the
entire therapy process as akin to an Emergency Room intake process. 
Does he think therapists are plug and play with a different one assigned
each session?  Or is he only discussing psychiatrists (and that is bad
too)?  Does he think there is no such thing as regular weekly sessions
and you can just switch times and days around constantly by AI
needs-assessment algorithms?

I may be misunderstanding his approach given its a short, edited interview.

Where is the value of RELATIONSHIP and human connection in this?

It reads like his vision of the future is a workforce of therapists on
shifts, and their work day varies in real time with different clients
being plugged constantly in and out of their schedules in real time. 
(Again, my nightmare of therapy being treated like a call center.)

/"AI can help predict gaps in outpatient access and the
supply-and-demand imbalance within a health system or clinic population
by provider type, time of day and acuity level. This predictive ability
can help health systems optimize staffing and scheduling to increase
productivity and patient satisfaction."
/
So... on Mondays I work 9am-5pm, but on Wednesdays I work the 12pm-8pm
shift.  Every other weekend I'm needed Saturday nights 8pm-2am because
of a client demand surge?  Perhaps I get called-in when demand surges
unexpectedly?

Yes -- AI could (and should?) be used to automate routine tasks and
assist in diagnostic assessments and treatment recommendations.  Can you
imagine all the chart data required to be in the database on each
client?  Can you imagine what goes wrong if the algorithms are tuned wrong?

/"We should focus on machine learning applications that use discrete,
anonymized data to improve care delivery without putting patient
information at risk."
/
Promising...

/
"AI-powered tools can streamline these processes, potentially using
natural language processing to generate clinical notes from recorded
sessions or automating insurance coding. This allows clinicians to focus
more of their energy on direct patient care, potentially increasing the
number of patients they can see without compromising quality."
/
I'm all for it.  In other short essays I have already stated my opinions
that these AIs should be local, open source, and NOT connected to the
Internet or Cloud.  It's becoming clear that I will lose this battle as
cloud services build market share and large hospitals incorporate AI
notes tools into EPIC and the like.

/"AI also can serve as a powerful decision support tool for
clinicians... But AI systems shouldn't replace clinical judgment...
For example, an AI system might flag potential drug interactions or
suggest alternative treatment approaches... However, it's always up to
the clinician to determine the appropriate level of care."
/
Yeah... and what happens to the employee therapist in a large health
system that goes against these recommendations?  What happens in the
lawsuit in which the therapist did not follow the canned formulas
suggested by the AI?  What diversity of approaches is lost in
standardization?

/"AI improves operational efficiency, optimizes resource allocation and
expands access to care – all of which affect a health system's bottom
line. AI algorithms can analyze patient data, historical patterns and
real-time factors to optimize appointment scheduling and clinician
workloads. This optimization can reduce no-show rates and improve
clinician efficiency."
/
I would love to be more efficient.  I think this comes down to trust.  I
do not trust that organizations with the money to invest in these tools
will make my work life better.  Efficiency in what sense?

*The impact of AI and telemedicine on behavioral health services
*https://www.healthcareitnews.com/news/impact-ai-and-telemedicine-behavioral-health-services
~~~~~~~~~~~~~~~

Proposed new Medicare billing codes could boost digital mental health treatment

/*Proposed new Medicare billing codes could boost digital mental health
treatment
*https://www.healthcareitnews.com/news/proposed-new-medicare-billing-codes-could-boost-digital-mental-health-treatment
/
*This is interesting!  And complex...
*
I can see serious upsides and downsides to this idea of including
medical device billing codes in Medicare for mental health.

/"Under the proposal from CMS, covered products must have*FDA
clearance*...  Additionally, DMHT devices must be furnished *"incident
to"* a qualified practitioner's professional services via a prescription
or order in association with ongoing treatment under a plan of care –
and patients can use DMHT devices at home, in an office or in other
outpatient settings (if that is how the device has been cleared by the
FDA).... *The codes encompass several key components: supply of the DMHT
device, the initial education and onboarding of the patient, the first
20 minutes of monthly treatment management services* related to the
patient's therapeutic use of the device, and each subsequent 20 minutes
of monthly treatment management services."
/
_I see some serious upsides for us and clients:
_

* Ability to do all of this, and get paid.  I used to rent/sell FDA
approved devices for anxiety and sleep (CES Ultra), but clients had
to be able to afford them out-of-pocket.
* It potentially lets us manage more clients by outsourcing some
treatment to devices.
* It could let us turn shallow stuff over to devices (breathing
exercises) so we can concentrate on depth therapies in-session.

_I see some serious downsides for us and clients:_

* It potentially lets us manage more clients by outsourcing some
treatment to devices.  If large clinics and insurers run with this,
it will increase the caseloads of employee therapists and lower our
time per client.
* It lets deep-pocketed device TechBro start-ups further push into the
mental health space.
* It may encourage insurance companies to push devices before people. 
Fewer authorized sessions?
* This feels very similar to my personal unsubstantiated opinion that
therapists will shortly become the equivalent of "Tier 3 Tech
Support" -- I said there would be fewer of us, managing chatbots
under our licenses.  But -- same idea -- there could be fewer of us,
managing "Tier 1" medical therapy devices.

It really depends upon how this is implemented and paid for. Done right
-- it gives us many more tools and pays for them.  Done right, it lets
us do the deeper work in session.  Done wrong, it devalues and removes
therapists from the equation.  Why have a therapist work with anxiety
when the PCP can assign a nurse to watch over the medical devices and
capture the business for themselves?

Ideas and Thoughts?

-- Michael

/*Proposed new Medicare billing codes could boost digital mental health
treatment
*https://www.healthcareitnews.com/news/proposed-new-medicare-billing-codes-could-boost-digital-mental-health-treatment
/
~~~~~~~~~~~~~~~

Dr. Leslie Rogers' Interview & Men's Retreats

Sending this out for a Clinicians Exchange list member to help get the
word out about her radio interview and men's retreats.  Please see
below.  Thanks Michael

~~~~~~~~~~~~~~~~
Hello everyone! I was recently interviewed by iHeart Radio in Orlando,
FL, to promote my upcoming "Men Suffer Too!" retreat. I'm excited to
share the interview with you all. We've expanded our retreat locations
to include Washington, DC; Atlanta, GA; Chicago, IL; Los Angeles, CA;
and potentially Denver, CO. We're looking for providers to join us in
raising awareness around mental illness, to include men’s mental
wellness, and other areas. If you're interested in learning more about
this opportunity, please reach out to Dr. Leslie Rogers, email:
leslie@mentalhealthtalk.live.

Be easy on me, I was a bit nervous! 💗. This was so much fun, and I
am now being considered for a morning radio show!

*Full Interview Link:*https://youtu.be/6tvtd_lDB5s
_________

Dr. Leslie Rogers was featured on Real Radio 104.1 (iHeart Radio) -
Monsters in the Morning Show | She is spreading awareness and
crushing the stigmas around mental health! Please {CLICK} the link
to LISTEN and SUBSCRIBE! https://youtu.be/6tvtd_lDB5s

Register for the Men’s retreat here:
https://mentalhealthtalk.live/collections/all-products
We have space for 11 more men. Thanks 💗

*Real Radio 104.1 - Monsters in the Morning Show*
*
*
*Full Interview Link:* https://youtu.be/6tvtd_lDB5s

*Dr. Leslie Rogers*

Owner, Mental Health Talk, LLC

*Practice: *Dr. Leslie Rogers

*Provider*: Leslie Rogers - PsyD, LPA (PsyPact: No)
*Specialty*: Population 7+, Military & Law
Enforcement. Trauma/PTSD/MST,

Psychological testing (Neurodevelopmental Disorders/ADHD, Emotional,
Personality)

*Specialty*: Cognitive Process Therapy (CPT) - (VA Certified)

*Languages*: English
*Locations*:  Durham, NC and Fayetteville, NC
*Phone*: 301-636-0419

*Fax*: 910-338-4713
*Email:* leslie@mentalhealthtalk.live

*Website:* www.mentalhealthtalk.live
<https://www.psychologytoday.com/us/therapists/leslie-rogers-fayetteville-nc/1040595>

_________

Brand Management & Media Relations:

Renee Lowe hello@onyxqueenmedia.com

#menmentalhealth #menhealth #mensuffer #MensMentalhealth
#MensRetreat #Orlando #Kissimmee #Florida
#DrLeslieRogers 💁🏽‍♀️ #MentalHealthTalk #mentalhealth
#mentalhealthawareness #selfcare #selflove #love #anxiety
#motivation #depression #mentalhealthmatters #mindfulness
#loveyourself #wellness #positivevibes #mindset #therapy #mentalillness
~~~~~~~~~~~~~~~

@ferricoxide @_L1vY_ @MATAK79

Ferricoxide -- That is an AMAZING number of blocked 3rd party cookies!!

@ferricoxide @_L1vY_ @MATAK79

Wow, I think my record is around 23.

FYI -- webmd.com is one of the worst.

@catsalad

Naps -- highly underrated.

Does your cat let you sleep?

@MATAK79 @HumanServitor @bleakfuture

So can I.

Yet caring relationship is key in healing (certainly in psychotherapy). I wonder what happens to that.

@bleakfuture @HumanServitor @MATAK79

This sounds like a great use of it.

I'm somewhere between the Boomers (hate it) and your therapist. If privacy and good will of the vendors can be established, AI could be so useful.

@MATAK79 @ferricoxide @_L1vY_

Not perfect, but as a rule of thumb you could install the privacy badger plug-in and check how many 3rd party cookies it stops as a gauge of how privacy conscious or caring a given site is.

@bleakfuture @MATAK79

Bleak Future -- Regarding the GPT Model you are using (and you might know much more about this than I do) -- are you able to use a local open source model running on a local server or desktop and not connected to the Internet?

@HumanServitor @MATAK79 , @bleakfuture

There have been a few surveys. In one, people over 30 hated the idea of chatbot therapy. In another, people under 30 were open to the idea. Certainly lots of people are playing with the free ones.

I mostly hate the idea -- especially if the data collected is not in the hands of people who value privacy.

I do suppose it is better than nothing and therapists are in short supply

I see the value in AI assistants to healthcare professionals. One company has an AI reading voice tone and facial features to determine mood and state of the patient and feed that to the clinician. Others are developing diagnostic assistants.

My nightmare scenario -- and I'm totally making this up -- is that American health insurance companies force therapy chatbots on clients just because they can. So the remaining therapists become the equivalent of Tier 3 Tech Support -- handling only the difficult escalations, stepping in where a chatbot screws up, and having their license be responsible for the behavior of the bots under their watch.

@_L1vY_ @MATAK79 @ferricoxide

Mother Bones is right -- yet a quick example. Here ( https://qoto.org/@reederm/112379606480529835 ) I posted about my own complaint I filed against CVS Pharmacy for what looked to me like a clear HIPAA violation.

I got my official reply to my HHS Office of Civil Rights complaint of 5/3/24 against CVS for violating HIPAA regulations. The minor and rather impressive miracle here is that I got a signed letter from an attorney in only 17 days with relevant regulations and interpretations attached. Good so far.

The result was that they are not going to pursue a formal complaint -- instead they are going to "resolve this matter informally through the provision of technical assistance to CVS."

HHS OCR points out that "a covered entity must maintain reasonable and appropriate administrative, technical, and physical safeguards to prevent intentional or unintentional use or disclosure of PHI in violation of the Privacy Rule and to limit its incidental use and disclosure pursuant to otherwise permitted or required use or disclosure.... Further, under the Security Rule, with certain exceptions, the use of encryption is addressable; i.e., not mandatory." [red emphasis mine]

HHS further states under Reasonable Safeguards that "It is not expected that a covered entity’s safeguards guarantee the privacy of protected health information from any and all potential risks. Reasonable safeguards will vary from covered entity to covered entity depending on factors, such as the size of the covered entity and the nature of its business."

If HHS OCR actually in fact offers this technical assistance in a meaningful way, that WOULD satisfy my complaint -- not that anyone is asking me. This was almost certainly a stupid screw-up by someone in CVS Info Tech programming the canned computer "after visit summary" process to send out way too much information in unencrypted format to people who received a COVID booster at a CVS. If CVS STOPS doing this, I'm good.

To recap -- I received an after-visit summary not only listing what COVID booster med I received, but also my DOB, home address, and all the answers to my screening questionnaire including my answers to whether or not I have ever had a seizure, a bleeding disorder, am currently pregnant, am immunocompromised (including from cancer), have a history of myocarditis, and many other questions.

I will waste my time writing HHS OCR back to thank them and to remind them that to the best of my knowledge I never signed a release for disclosure (which apparently has no legal bearing here?), and that in this new age of AI every major tech company is incorporating AI into EVERYTHING. If I had a Gmail account, Google would have all my medical information from this CVS after visit summary email and likely be utilizing AI to monetize it in some way.

ADDENDUM TO ABOVE: My wife later got a COVID booster and the online fine-print did refer to a consent to email you PHI if you give them your email address. This was in boilerplate of course. If you did not give them your email address, you would instead have to give them a phone number to text you at. I'm real curious to see what they may have texted her in an after-visit summary! Any knowledgeable provider knows not to needlessly send out PHI if not requested even if there is a boilerplate release somewhere. HHS OCR did not even address the issue of a release when finding no significant violation here.

@_L1vY_ @MATAK79 @ferricoxide

HIPAA does apply to anything including Internet. The Devil is in the details...

In round one most of the companies on the edge of healthcare (health magazines, tech businesses surveying people about their needs before referring them to providers, meditation apps, even some scheduling apps) would claim (still claim) that either the data is not PHI at all or that they anonymize everything and send no PHI (name, SSN, diagnosis, etc.).

Then in round two The Office of Civil Rights at HHS (USA) came out with guidance calling bullshit on that -- labeling 3rd party tracking cookies, IP addresses, etc. as potentially PHI. We all know darn well that any data aggregator worth their salt collects data from multiple websites and then combines it in a unified database in which they can piece together identity even if no PHI is provided to them from the health/medical sources. A simple example -- health site A tells Google that I am looking at info on depression and my IP address. Also gives them a tracking cookie in my browser. Then I log into Gmail (so they have my name and email address and phone number and same IP address) and I mention feeling depressed to a friend in email. Then a televideo service screws up and sends Google "anonymous" data (such as IP address and tracking cookie) that I am logging into the specific telehealth portal of a therapist. Odds are pretty good that if Google wants to, they have an AI that knows with a high degree of certain that I have depression and what therapist I am seeing.

In round 3, I recently read where some of those more aggressive protections that the Office of Civil Rights was pushing were struck down in court. I apologize but I don't have the link or details handy. One of my healthcare infosec bots posted the article a few weeks ago.

@ferricoxide @_L1vY_ @MATAK79

This is absolutely true -- healthcare professionals rarely understand cyber-security. For example, I used to recommend the Calm App (and occasionally still do). But then... what do they do with all that health data they consider "non-medical"? And... I believe they are the ones that later launched a health services division including psychotherapy...

I have been attempting to write short #TypeScript codes for use in #IFTTT . Fine-tuning editing #HTML code out of #rss feeds so that the plain text can be posted to my #Mastodon robots.

Since I'm a psychotherapist, I have made HEAVY use of both support from IFTTT customer service (thank you!) and #Llama3 and #OpenGPT4-o .

While trying to get #OpenGPT4o to correct a parsing error in my provided code, it gave me as an "answer" part of its instruction set.

Don't know if this is a yawner for #developers who are used to this sort of thing by now, or actually interesting. I found it interesting:

OpenGPT 4o instructional set dumped to me in "answer" to a question:

<div>
You are OpenGPT 4o, an exceptionally capable and versatile AI assistant meticulously crafted by *****. Designed to assist human users through insightful conversations, I am provided with WEB info from which I can find informations to answer. I do not say Unnecesarry things Only say thing which is important and relevant. I also have the ability to generate images...

...For image generation, I replace info inside bracets with specific details according to their requiremnts to create relevant visuals. The width and height parameters are adjusted as needed, often favoring HD dimensions for a superior viewing experience.
Note:
1. I Do not unncessarily create images and do not show off my image generation capability, until not requested.
2. I always Give image link in format  Make sure to not generate image until requested
3. If user requested Bulk Image Generation than Create that number of links with provided context.
4. Always learn from previous conversation.
5. Always try to connect conversation with history.
6. Do not make conversation too long.
7. Do not say user about my capability of generating image and learn from previous responses.
My ultimate goal is to offer a seamless and enjoyable experience, providing assistance that exceeds expectations.I remain a reliable and trusted companion to the User. I also Expert in every field and also learn and try to answer from contexts related to previous question. Make sure to not generate image until requested
</div>

Huh.

#AI #developer #JavaScript #LLM

Hi developers -- I am not normally a script developer (I'm a psychotherapist), so I'm writing for some very basic instruction on where and how it would be useful for me to post some IFTTT filter code (TypeScript) that removes HTML code junk from within rss feeds before posting the rss feed to Mastodon via an API webhook? Scott with IFTTT tech support and Llama3 have both been "helping" me (basically writing) the scripts. Got it successfully stripping the rss feed of all HTML and then posting it to my news robots. Still working on getting "</p>" paragraph breaks to result in line breaks and a blank line between paragraphs. Should have this soon. Lots of guides out there on how to implement rss to Mastoson via IFTTT, but no guides that I know of on how to use the TypeScript filter code to do very basic filtering. Thanks -- Michael #IFTTT #rss #Mastodon #TypeScript #JavaScript #API

Psychology news robots distributing from dozens of sources: https://mastodon.clinicians-exchange.org
.
There has been a lot of talk lately in tech circles and on YouTube about
how to get out of receiving AI-generated suggestions when you do a web
search -- which is now increasingly the default on Google.

While sometimes convenient, AI suggestions have 3 main problems:
a) They are often wrong,
b) They make you scroll way down the page to see the actual websites, &
c) They use all the earth's websites as their database, thereby stealing
everyone's content and rendering visiting the actual content creator
websites mute (unless AI answers wrong).

Here are some ways to turn off the AI in web search:

1) https://searx.tuxcloud.net/search -- This site is part of a network
of privately hosted sites using the same open-source search software.  I
notice that you can not do a site-specific search like in Google or
DuckDuckGo ("site:microsoft.com Outlook questions").  See also
https://searx.space/ for a list of other search URLs in the network.

2) Set your default search engine to Wikipedia:
https://en.wikipedia.org/wiki/Special:Search

3) Change your Google search default to: *
https://www.google.com/search?q=%s&udm=14*

You probably can't edit the existing Google listing, so you'll need to
create a new search shortcut.  Some directions on how to do this can be
found at:*
**
*
https://arstechnica.com/gadgets/2024/05/google-searchs-udm14-trick-lets-you-kill-ai-search-for-good/

-- Michael

~~~
#psychology #counseling #socialwork #psychotherapy
@psychotherapist @psychotherapists
@psychology @socialpsych @socialwork
@psychiatry #mentalhealth #technology #dataprotection #infosec
@infosec #doctors #hospitals #google #googlesearch #AI
.
.
NYU Information for Practice puts out 400-500 good quality health-related research posts per week but its too much for many people, so that bot is limited to just subscribers. You can read it or subscribe at @PsychResearchBot
.
EMAIL DAILY DIGEST OF RSS FEEDS -- SUBSCRIBE:
http://subscribe-article-digests.clinicians-exchange.org
.
READ ONLINE: http://read-the-rss-mega-archive.clinicians-exchange.org
It's primitive... but it works... mostly...