6 MPS Bulletin - September 2016 www.-mps.org 11 apy as well as medication due to the median 200 days LOS. Work Taunton, MA 02780 or email to:[email protected]. with an excellent and personable group of . EOE Telepsychiatry: Importance, Opportunities and Challenges of Remote Care Steven E. Locke, MD, Chief Medical Officer, iHope Network, Inc. 2. Salary: $213,000 same as above with no overnight/weekend The Massachusetts General Hospital (MGH) Charlestown on call. HealthCare Center is recruiting board-eligible/certified psychiatrists Contact Anthony Vagnucci, MD, Chief of Psychiatry, Tewksbury who are committed to community health and mental health, integrated PART TWO Behavioral Health, or Optum Behavioral Health. Optum will re- Hospital, 978-851-7321 x2863, [email protected] psychiatric/substance abuse/medical models of care, and residency Continued from July/August Newsletter imburse for telemedicine. However, Optum-credentialed provid- training. The positions involve psychiatric clinical assessment, ers must apply for authorization to be able to submit claims for Tewksbury Hospital consultation and treatment, working in collaboration with a Reimbursement Issues telemedicine practice. https://www.providerexpress.com/content/ Half-time (20 hours per week) multidisciplinary mental health team of psychiatrists, psychologists, Telemedicine cannot get significant traction without third-party ope-provexpr/us/en/clinical-resources/tmh.html Excellent salary and fringe benefits, signing bonus and generous advance practice nurses and social workers. We also work closely with reimbursement and CPT codes and fee schedules or active adop- For further information, contact UBH/Optum Provider Relations. leave time for half-time psychiatrists. Positions available on the adult and pediatric primary care providers of the health center and are involved in outreach services to the residents of the Charlestown tion by ACOs. Many payers, including MassHealth, have no stra- In May of this year, members of the MPS Healthcare Systems and a DMH intermediate care unit working with a wide variety of patients with severe and persistent mental illness are available. No neighborhood of Boston. tegic plans to create or enable CPT codes for telecare. Instead they Finance Committee met with Steven Kozak, LICSW, Director of prefer to shift the treatment innovation options to value-based managed care or after hours on-call. Median LOS about 200 days. The successful candidates will have staff appointments at MGH Behavioral Services at Tufts Health Plan. We learned that THP is Work with an excellent and personable group of psychiatrists. payment and alternative payment contracts with networks of pro- currently reviewing the issue of telemedicine reimbursement in through the Department of Psychiatry. Massachusetts General Hospital viders. How that will impact the few remaining solo practitioners Contact Anthony Vagnucci, MD, Chief of Psychiatry, Tewksbury is a major teaching hospital of Harvard Medical School and Partners MA but no timeline for a decision is currently known. Tufts does Hospital, 978-851-7321 x2863, [email protected] (mostly psychiatrists) remains unclear but could be problematic. currently reimburse for telemedicine in NH in their Tufts Health HealthCare System, Inc. and a major teaching site for Harvard Medical These reimbursement deficiencies threaten to exacerbate the Freedom Plan. School. The positions include opportunities for teaching residents problems contributing to unacceptable disparities in access to and BROCKTON MULTI-SERVICE CENTER (BMSC) and fellows. Women and underrepresented minorities, especially quality of care in at-risk populations. Although MassHealth has no current plans to reimburse for BROCKTON, MA those who speak Spanish, are encouraged to apply. Harvard Medical telemedicine, the Group Insurance Commission which provides ATTENDING PSYCHIATRIST - (Full or Part-Time) The telemedicine reimbursement landscape is extremely complex School appointments at the level of Instructor or Assistant Professor health insurance for MA state employees is monitoring a new in- Hospital Practice Psychiatry seeks BC/BE Psychiatrist in a Joint are available, commensurate with experience. Both full and half-time and dynamic and the only way to get an up-to-date snapshot is to novation initiative of the Health Policy Commission, the Telemed- Commission Accredited CMHC with comprehensive outpatient, positions are available. Please contact Lorenzo Lewis, M.D., Director/ review the monthly updates provided by the Center for Connected icine Pilot Initiative. This month eligible carriers and health care PACT, case management and a supportive interdisciplinary work Medical Director of MGH Charlestown HealthCare Center by email Health Policy http://cchpca.org/ and the website of the American providers submitted proposals for initiatives intended to imple- environment. BMSC is part of the MA DMH Southeastern Area. [email protected] , including a statement of interest and CV. Telemedicine Association http://www.americantelemed.org/. ment telemedicine-based services to enhance access to behavioral Academic affiliations and involvement in training of residents’ Some private payers are beginning to reimburse for telemedicine health care for any of the following populations in Massachusetts available if interested. Responsibilities include; outpatient Gould Farm is seeking a Consulting Psychiatrist for their and because of federal and state parity legislation, they must also with unmet behavioral health needs: 1) children and adolescents; psychiatric evaluations, psychopharm, management, treatment Monterey location in the Berkshires of Western MA, to work 1 reimburse for telemental health as well. The first payer in Mas- 2) older adults aging in place; 3) individuals with substance use planning and consultation to treatment teams. Competitive salary, day each week, 9am to 5:30pm. Office provided on site. This is an sachusetts to begin reimbursement for telemedicine is BCBS of disorders. outstanding benefits, daytime, flex schedule and no nightcall. annual contract position. Full job description: http://www.gouldfarm. Massachusetts (BCBSMA). They created a telemedicine modifier Board certification required (can accept BE only if plan in place org/employment.htm. Please send resume and letter of interest to: GT which when used with select CPT codes could be submitted Platforms for board certification exams). Transitional age, youth or forensic [email protected] or mail to: Gould Farm, Attn: Director of Human for reimbursement. Providers need to register their practice with • The Telemental Health Institute (San Diego, CA) has a experience and/or bi-lingual would be desirable. Please send CVs Resources/Consulting Psychiatrist, P.O. Box 157, Monterey, MA BCBSMA as offering telemedicine using a Practice Status Update comprehensive list of the various potential providers of to: William Pariseau, Polaris Healthcare Services, PO Box 4007, 01245. Website: www.gouldfarm.org form available on the Provider Central website. secure videoconferencing solutions for telemedicine and On January 1, 2016 codes were turned on for psychiatrists as well telepsychiatry. See: http://telehealth.org/video/ as social workers, psychologists and licensed mental health coun- • Some vendors who have offered free programs in the selors (LMHCs). As of July 1, these permitted codes have been past now provide a subscription service along with a expanded and are listed in Table 1. As a matter of policy, the level BAA for HIPAA-compliant, secure videoconferencing associate medical director of reimbursement has been set at 10% lower for face-to-face tele- (e.g., Skype for Business). I use VSee because my usage medicine treatment than for in-person treatment. BCBSMA ex- level is low enough that I fall within the free subscription The Whittier Pavilion, a free standing in Haverhill, MA, plains that this is to take into account lower projected operating allowance. I have signed a BAA with VSee. VSee is also is seeking a physician-leader to help innovate and lead the hospital’s costs for providers of telemedicine. the videoconferencing engine for a vendor called Secure BCBSMA members are being advised of how they can access Video which is a subscription service, uses a BAA, and transformation towards accountable, team-based care. telemedicine. On their website it says that members and their fam- offers some nice features like a “waiting room” where ilies who have benefits can see doctors and therapists in the patient can log in and “park” while awaiting for you •Competitive Salary the Blue Cross Blue Shield of Massachusetts network who choose to log in and start the session. iHope Network, for which •Flexible Hours I am the CMO, uses SecureVideo. to offer the service. •Teaching Opportunities Here are several popular HIPAA-compliant video- “To see if you are covered for Telehealth, log in to Mem- conferencing platforms: ber Central at www.bluecrossma.com/membercentral to Contact: review your plan benefits. Depending upon your plan de- 1. Zoom https://zoom.us/plan/healthcare Jameson Pinette, Administrator sign, you may be billed your cost share after your visit. 2. Vidyo http://www.vidyo.com/solutions/health- care/ [email protected] If you are having trouble finding a doctor who offers 3. VSee https://vsee.com/hipaa/ (Free*) (978) 556-6233 Telehealth, you can try one of the following options: 4. SecureVideo https://www.securevideo.com/ 5. Doxy.me https://doxy.me/ (Free*) Ask your local doctor if he or she offers Telehealth. Find a local provider who offers Telehealth through the • Support: You and/or the patient may need some technical Telehealth providers tab above. support when things don’t go according to plan. What Visit now with one of our national providers through our if the video keeps freezing, or the program crashes? Or partner, American Well, an independent company. First- there is not enough bandwidth for full video and audio? You need to discuss these issues with your vendor and time users, enter Service Key: BCBSMA when register- a MeMber of the Whittier health NetWork: ing to make sure you receive coverage.” know what your support options are. Consider purchas- dedicated to your Well-beiNg ing a subscription support option if needed, either from Harvard Pilgrim Health Care has carved out their mental health the vendor or from a technology support vendor like the Geek Squad (BestBuy) or similar service. benefit to a managed behavioral healthcare organization, United 76 Summer Street, Haverhill, MA 01830 | www.whittierhealth.com (continued on page 7) Massachusetts Psychiatric Society PO Box 549154 Waltham, MA 02454-9154 Massachusetts Psychiatric Society PO Box 549154 Waltham, MA 02454-9154 781-237-8100 Fax: 781-464-4896 Email: [email protected] www.psychiatry-mps.org 781-237-8100 Fax: 781-464-4896 Email: [email protected] www.psychiatry-mps.org MPS Bulletinwww.psychiatry-mps.org - September 2016 9 www.psychiatry-mps.org 7 10 (continued from page 6) Office space available; desirable BUSINESS SERVICES • Informed consent: The standard of care has not been es- fusing, expensive and time consuming. Legislation and BUSINESS SERVICES Derby OFFICESt. Hingham SPACE location . tablished with regard to informed consent for the use of regulation governing telemedicine practice are very dy- Established multi-disciplinary South telemedicine. Unfortunately, it may ultimately be deter- namic. The shifting environment imposes a burden on Shore practice.Call SSPPA 781-741- LEGAL ADVICE SPECIALIZED CREDENTIALINGHea SERVICES mined by case law, rather than by statute or regulations. the individual practitioner. Therefore, membership in 9991Brookline: or email at stevenallison@ MEDICAL CREDENTIALING SPECIALISTS Attractive, comfortable, quiet, reasonably priced Patients do have the right to be informed of the risks and organizations such as the American Telemedicine As- FOR PSYCHIATRISTS comcast.net 3 suite office near Coolidge Corner has opening benefits of a treatment and both are present for telepsy- sociation, the American Association for Technology and Milton L. 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Attorney James Hilliard, who represents the MPS, try and for those anticipating and preparing for modern Mr. Hyams, former General Counsel to the Bd. • HEALTH PLAN ENROLLMENT AND PsychotherapyJim Harburger Building.rent MD, 617-232-3822 Includes or LINKAGE email [email protected] has a sample informed consent for use in telemedicine. practice. of Reg. in Medicine, and Mr. Kerstein provide Providing Billing Services to the Mental Health Community All Utilities, Furnished Reception legal services to psychiatrists and other health • NPI AND PROVIDER NUMBERS Rooms.office Cleaning + Receptionist. • Training: As you have been learning, there are some Risk Management Issues • NATIONAL AND MULTI-STATE Oct.occupncy 617-416-8777 Or professionals in the following areas: Billing. . . unique aspects to providing telecare, especially for Treating patients remotely involves both legal and clinical risks. SERVICES [email protected] • Licensing Board Complaints and Applications telemental health. There are training resources that First you must determine if an additional medical license is re- • CAQH REGISTRYIt’s what MAINTENANCEwe do. you should consider. The San-Diego based Telemental quired if you are treating an out-of-state patient. Some states (e.g., • /Medicaid Audits • STATE OF THE ART SOFTWARE Winchester Center: Part-time Health Institute (Marlene Maheu, PhD, founding direc- Washington, Ohio) do not require a clinician licensed in another Every mental health furnishedTewksbury psychotherapy Hospital is looking office for a fullwith time • Patient Confidentiality inpatient psychiatrist. The position is on a DMH tor) offers an extensive online training curriculum. See: state to obtain a license to practice telemedicine in their state as Please callprofessional us to discuss needs fee a greatarrangements. views of Winchester Common. Single http://telehealth.org/ long as the out of state clinician does not have an office in their • Provider and Employer Contracts officeintermediate with careseparate unit workingclient waitingwith a wide area. varie- Credentialingbilling Services service. are For priced over 15 either by ty of patients with severe and persistent mental state. I am currently treating two patients using telemedicine who • 4-hour weekly block sublets @ $150/ The William James College (http://www.williamjames. Civil/Criminal Litigation application or on a monthly flat fee basis illness. No managed care or after-hours on-call. have moved to states where this is the case. I have another pa- depending years,on the Healthcarescope of services Billing requested. month (minimum rental of two weekly edu/), formerly Massachusetts School of Professional As a service to Bulletin readers, we offer one Median LOS about 200 days. Competitive com- tient moving to California, where I am licensed and she prefers blocks). Contact backbayalliance@ Psychology, is preparing to offer training in telemen- free 15-minute consultation to discuss any gen- Specialists has been pensation. Work with an excellent and persona- to continue in treatment with me rather than change to a new psy- IN ADDITION TO OUR CREDENTIALING gmail.com / 617-230-3002 tal health. WJC is planning a symposium, Telemental eral legal concerns. ble group of psychiatrists. chiatrist. I will establish a collaborative care relationship with her SERVICES,providing WE OFFER exceptional MEDICAL BILLING Health: Expanding the Frontier at the Newton Marriott Back Bay Office Sublet available new PCP. 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AS PART OF [email protected] Several additional barriers to telemedicine adoption have been are rendered where the patient is physically located, so you will THAT PACKAGE. - minimum 16 hours required (48 identified. need to check with the patient’s state medical board, as well as Office: (781) 784-4123 hours per week possible). Fore more  1) Rapport Building and Adherence Challenges: Some your own medical board, to determine what is required for you to PRACTICE Fax:MEDICINE, (781) 784-0996 WE DO THE REST. detailsSTAFF call PSYCHIATRIST 617-784-3307 POSTIONS. or email Full mental health clinicians have expressed concern that tele- legally treat the out of state patient. 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Massachusetts Psychiatric Society ♦ 40 Washington Street, SuiteMassachusetts 201 ♦ Wellesley, Psychiatric MA 02481-1802 Society PO Box 549154 Waltham, MA 02454-9154 Massachusetts Psychiatric Society PO Box 549154 Waltham, MA 02454-9154 781-237-8100 ♦ Fax: 781-237-7625 ♦ Email: [email protected] ♦ Fax: [email protected] 781-464-4896 Email: [email protected] www.psychiatry-mps.org 781-237-8100 Fax: 781-464-4896 Email: [email protected] www.psychiatry-mps.org 8 MPS Bulletin - September 2016 www.psychiatry-mps.org 9 (continued from page 7) APA News & Notes Conclusion: RESOURCES Telehealth, including telepsychiatry and telemental health, is Blue Cross Blue Shield of Massachusetts Fee Schedule for Tele- Monthly Free CME growing rapidly. While it is still a wild frontier, with all the op- medicine – Effective July 1, 2016. To view the BCBSMA Fee Each month, APA members have access to a free CME course on the APA Learning Center. Less than 30 minutes in length, these courses can help portunity and danger associated with new worlds, there is broad Schedule, please log on to the MPS website at www.psychiatry- you brush up on a trending topic over lunch - http://education.psychiatry.org agreement that telemedicine is an important part of the future mps.org and click the Newsletters tab, Featured Columns. of healthcare. And that includes the future of psychiatry. If inte- • September: Advances in Therapeutic Interventions in : Neuromodulation in the Treatment of Geriatric Psychiatric grated, collaborative care is where psychiatry ought to be headed, Ternullo JL, Locke SE. Tackling changes in mental health prac- Disorders tice: the impact of information age health care. In: Maheu MM, • October: Advances in Medications Development to Treat Alcohol Use and Psychiatric Disorders: Assessing the Efficacy of Varenicline technology is what will transport us to that future. That is how we Tartrate for Alcohol Dependence go from treating a small portion of the population suffering from Drude K, Wright S, editors. Career Paths in Telemental Health. • November: Advances in Therapeutic Interventions in Geriatric Psychiatry: Diagnosis and Treatment of Geriatric Depression mental illness to embracing a population health approach capable New York: Springer, 2016. • December: Childhood Precursors of Borderline Personality Disorder: Why are Childhood Precursors Important? of addressing the 80% of persons with mental disorders who never Locke SE, Gorrindo T. Technology in treatment and physician- seek treatment. Hopefully this article provides a guide to encour- patient communication. In: Greenberg DB, Fogel B, editors. What’s New at the APA age you to explore this new world. Psychiatric Care of the Medical Patient. 3rd edition. New York: • APA applauded the House of Representatives for passing the Helping Families in Mental Health Crisis Act, aka H.R. 2646. In light of the Oxford University Press, 2016. overwhelming support that H.R. 2646 received in the House vote, APA and 29 allied organizations sent a letter urging Senate leadership to take up the bill and pass it before the end of the year. You can read about the specific provisions of H.R. 2646 and the full text of the letter sent to Risks Associated With Specific Internet Activities: A Guide For Sens. Mitch McConnell and Harry Reid at www.psychiatry.org/newsroom/news-releases Psychiatrists. http://medcomclassifieds.com/prms/assets/TTP_ InternetBook_16Update.pdf. Accessed: June 4, 2016. • APA applauded the Senate’s overwhelming vote in favor of the Comprehensive Addiction and Recovery Act. The bill, which includes a range of measures to address the growing addiction problem, received broad bipartisan support in the Senate and is expected to be signed into law by President Obama. You can read about the specific provisions of the Comprehensive Addiction and Recovery Act at https://psychiatry.org/ newsroom/news-releases/apa-applauds-congressional-passage-comprehensive-addiction-and-recovery-act John MacIver, MD November 18, 1923 – June 8, 2016 • The Centers for Medicare & Medicaid Services (CMS) announced plans to begin coverage and reimbursement for “Psychiatric Collaborative Care Management Services” as part of its proposed Medicare Physician Fee Schedule rule starting in 2017. APA President Maria A. Oquendo, John MacIver, MD, aged 92, died of pulmonary fibrosis on June 8 at Broad Reach Rehabilitation Center in North Chatham. M.D. wrote a blog applauding this news as a “huge win for psychiatry and collaborative care.” APA plans to continue to offer comments to CMS until the new rule comes into effect in 2017. You can read Dr. Oquendo’s blog about the CMS announcement at https://www.psychiatry.org/ Dr. MacIver was born in Irvine, Scotland in 1923 and emigrated, the youngest of four children, with his family in 1927, and grew news-room/apa-blogs/apa-blog/2016/07/new-payment-codes-represent-a-big-win-for-psychiatry-collaborative-care up in Dorchester. Dr. MacIver attended Boston Latin School for middle and high school and matriculated at Harvard College, Class of 1945, study- • In light of the wave of gun that has recently taken place across the nation, APA President Maria A. Oquendo, M.D. released a statement ing Philosophy. He was then drafted in 1943 into the 8th Armored Division at Fort Polk, La. After scoring at the top of his Bat- expressing sympathy and support for the victims of such events, while also highlighting resources for coping with such tragedies that are talion in a medical/dental school aptitude test, he was sent to Columbia University College of Physicians and Surgeons where he available for psychiatrists, patients and their families. Those resources can be accessed at https://www.psychiatry.org/news-room/apa-blogs/ earned an MD in 1949. apa-blog/2016/07/apa-president-responds-to-wave-of-shootings After medical school, he specialized in Psychiatry in a residency at Yale University, where he also earned a Master’s Degree in Public Health in 1953, and pursued a fruitful and innovative career in corporate medicine, most lately at the Steel Corporation. In 1972, Dr. MacIver opened a private practice in Hyannis, taking up residence at the family home in North Chatham. He found great fulfillment in the variety of clinical work he experienced on staff at Cape Cod Hospital as well as his leadership roles with the Massachusetts Medical Society and the Southeastern Massachusetts Psychiatric Society. Husband of the late Shirley MacIver, MD, who he shared a happy and fulfilling marriage for 57 years until her death in 2007 from Alzheimer’s disease. Dr. MacIver is survived by two sons, John Robertson (Rob) and Janet Riggs of Voorhees, N.J.; Mathew and Geriatric Psychiatry Division Diane of Hingham; four grandchildren, Andrew, Megan, Anne and Gregory; and many nieces and nephews. He is also survived by his companion Janice Wilson of Newmarket, N.H., with whom for the past 7 years he had enjoyed a devoted and fulfilled relation- Inpatient Position ship, extended by her loving care. McLean Hospital is inviting applications for the inpatient position of Psychiatrist in Charge of SB II in our Geriatric Psychiatry Division. This is 1.0 FTE position. Duties will include the provision of direct clinical services to inpatients, participation in the program’s educational activities, program development, and quality improvement process. Attending Psychiatrists Applicants must have an M.D. and board certification in Psychiatry. Added qualification in Geriatric Psychiatry is preferred. Applicants Hospital Practice Psychiatry, Inc (HPP), a division of Polaris Healthcare Services, Inc., and in conjunction with the Southeast must be licensed or eligible for licensure in the Commonwealth of Area of the Massachusetts Department of Mental Health (DMH), seeks Board Certified or Board Eligible psychiatrists for full MA. The ideal candidate has expertise in diagnosing and treating -time Attending Psychiatrist positions in general adult care psychiatric facilities. These facilities provide acute and continuing care psychiatric disorders in older adults, comfort with managed care, treatment for DMH-eligible patients. Candidates should have a commitment to a recovery-based model and community first. All and one or more years of post-training clinical experience. The unit is a teaching rotation site for the Massachusetts General Hospital- facilities are Joint Commission Accredited (JCAHO) and are located in Brockton, Fall River, Pocasset and Taunton, Massachusetts. McLean Hospital Adult Psychiatry Residents and Partners Geriatric Psychiatry Fellow. Co-Investigator participation in clinical research As public sector acute and intermediate care facilities, HPP/Polaris psychiatrists do not experience the pressures of managed care. This is also available. Qualified women and minority candidates are provides a unique opportunity for psychiatrists interested in providing treatment to a diverse population of psychiatric patients with encouraged to apply. severe and persistent mental illness in an acute and continuing care environments. The psychiatrist is the leader of a multidisciplinary Salary, recruitment package, and academic rank will be team, and a wide range of treatment modalities are valued, including psychopharmacology, group therapy emphasizing skill-building, commensurate with qualifications and experience. insight-oriented and cognitive behavioral psychotherapy, family interventions, and Dialectical Behavior Therapy. Applicants should submit a curriculum vitae along with the names and addresses of three references to the search committee chair: The psychiatrist group is energetic, well trained, welcoming and very collegial. Most have trained in Boston-area psychiatric residency Brent Forester MD, MSc, Chief, Division of Geriatric Psychiatry programs, including the Harvard/Cambridge Hospital, the Harvard/Longwood programs, Tufts University School of Medicine, and Email: [email protected] Boston University School of Medicine. Review of applications will begin immediately and will continue until the position is filled. These outstanding opportunities offer competitive compensation packages and include an attractive employee benefit program. As an equal opportunity employer, McLean Hospital seeks qualified candidates for all posted Night/weekend call is not required but is available for additional compensation if desired. employment opportunities without regard to race, color, age, religion, gender, national origin, disability or veteran status. Interested candidates should send a Letter of lnterest and CV to William Pariseau at: [email protected]. A member of the PARTNERS HealthCare System.

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