Understanding the Mental Healthcare Regulatory Environment

Posted on October 5, 2022 by Dr. David Edward Marcinko MBA MEd CMP™

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Appreciating the Rules

[By Carol Miller; RN, MBA]

Carol S. MillerLocal counties and municipalities are the primary providers of state mental healthcare for patients who lack private insurance coverage for such care.

Both children and adults may be eligible to receive assistance.

These counties provide a wide range of psychiatric and counseling services to the residents in their community as well as other types of assistance such as:

  • treatment services related to substance abuse;
  • housing;
  • employment services;
  • information and education service;
  • referrals;
  • consultative services to schools, courts and other agencies;
  • after-care services; and other related activities.

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Rules and Regulations

Accordingly, regulations from federal, state, and county governments have an impact on the day-to-day operations, procedures and processes of a county mental health center. Traditionally, there are three main types of regulations.

Federal Regulations — The United States healthcare system is guided by programs such as those established under the Centers for Medicare and Medicaid (in the case of county mental health programs, Medicaid is especially important), Americans with Disabilities Act (ADA), Occupational Safety and Health Administration (OSHA), Health Insurance Portability and Accountability Act (HIPAA), and others.

State Regulations — These include general legislative guidelines, state management of benefits and reimbursement of the Medicaid program, and state allocations of budgets, which impact the centers’ operations.

County Regulations — Each county defines its own County Mental Health Program and decides which services will be provided or excluded.

Assessment

County facilities generally include outpatient clinics, county mental health programs, short-term psychiatric facilities, day-care centers, de-toxification centers, residential rehabilitation centers for substance abuse, long-term care psychiatric facilities, and Veterans Affairs (VA) psychiatric centers. The county centers may be co-located with other county services such as social services, occupational rehabilitation services, information technology services, human resources, maintenance services, and others or may be independently located.

Conclusion

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Ray Dalio SPEAKS

Posted on October 5, 2022 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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  • Ray Dalio no longer believes “cash is trash” in light of tighter monetary policy.
  • He’s warmed to the greenback due to higher interest rates and the Fed shrinking its balance sheet.
  • However, Dalio is still only neutral on the dollar, likely because of stubborn inflation.

Ray Dalio, after repeatedly proclaiming “cash is trash” in recent years, has warmed to the US dollar and now views it as a passable investment.

“The facts have changed and I’ve changed my mind about cash as an asset: I no longer think cash is trash,” Dalio just tweeted.

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A Review of Mental Healthcare Provider Types

Posted on October 5, 2022 by Dr. David Edward Marcinko MBA MEd CMP™

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Implications for Staffing Modern Mental Health Facilities

[By Carol Miller RN MBA]

Carol S. MillerCommunity Mental Health Centers are also referred to as County Mental Health Centers and treat patients usually with no or limited insurance in a domiciliary setting versus an inpatient state or community facility.

And, both children and adults are eligible to receive such assistance.

These programs provide a wide range of psychiatric and counseling services to the residents in their community as well
as other types of assistance. But, what type of mental healthcare staff, and providers, are involved with these facilities?

Staffing

Staffing levels at community mental health facilities depend on the size and funding of each clinic, and vary in number, qualifications, and mix. Many personnel hold or are working on Master’s degrees and various professional certifications.

Typical staffing would include:

  • Administrative or Mental Health Director ¾ This individual, working under general policy directives, is responsible for planning, organizing, coordinating, and directing delivery of a community’s comprehensive mental health programs and services. This would include the development and implementation of goals, objectives, policies, procedures, budget, standard compliance, and work standards for mental health services. The Director is responsible not only for the services offered under the program, but also for extensive coordination with other county departments, public and private organizations, citizen groups, and the Board of Supervisors.
  • Case management staff ¾ These personnel are responsible for compiling all the services related to the treatment program.
  • Psychiatrists ¾ These individuals may work for a mental health center full or part time, and be Board-eligible or Board-certified in Psychiatry.
  • Psychologists ¾ These individuals will hold Ph.D., Psy.D. or Ed.D. qualifications and be licensed as clinical psychologists in the state.
  • Licensed Independent Social Worker (LISW) ¾ These individuals will have expertise in such services as family counseling, child psychology, geriatric dementia, psychological testing, and so on.
  • Licensed Marriage and Family Therapist (LMFT) — These individuals are specialized in various fields and provide an array of counseling services to patients, dependent on the nature of their problem.
  • Clinical Nurse Specialists ¾ These personnel are certified in psychiatric nursing by a national nursing organization such as the American Nurses Association to practice within the scope of these services and are licensed in the state.
  • Support staff ¾ These staff members would include an administrative assistant to the Director, medical billers, transcriptionist, and possibly a receptionist.
  • Substance Abuse Counselor or Licensed Professional Clinical Mental Health Counselor (LPC or LPCC) — An individual who takes a holistic approach where they exam a person’s external environmental and societal influences while also monitoring inner emotion, physical and behavioral health.

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Counselor Qualifications

A licensed mental health counselor has met or exceeded the following professional qualifications:

  • earned a Master’s degree in counseling or a closely related mental health discipline;
  • completed a minimum of two years post-Master’s clinical work under the supervision of a licensed or certified mental health professional; and
  • passed a state-developed or national licensure or certification examination.

Assessment

Conclusion

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UPDATE: Domestic Markets Soar as United Kingdom Scraps Taxation

Posted on October 5, 2022 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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The Dow surged 825 points, or 2.8%. The Dow has soared more than 1,500 points in the past two days. It is now back above the key 30,000 milestone and is about 18% off its most recent record high, meaning that is no longer in a bear market.

The S&P 500 and Nasdaq gained 3.1% and 3.3%, respectively. But both of those indexes remain in bear territory, at more than 20% off their all-time highs.

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The UK is scrapping its plan to remove the 45% top rate of income tax, calling it a huge distraction from other priorities. The plan, which the government defended just recently, caused a mini-financial meltdown before the Bank of England stepped in with emergency measures.

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FINANCE: https://www.routledge.com/Comprehensive-Financial-Planning-Strategies-for-Doctors-and-Advisors-Best/Marcinko-Hetico/p/book/9781482240283

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Three Fundamental Criteria All Physicians Should Consider before Investing

Posted on October 5, 2022 by Dr. David Edward Marcinko MBA MEd CMP™

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Re-Appreciating the Basic Three Rs …

By Guy P. Jones CFP® www.guypjones.com

Guy P. Jones

Physician-investors are often confronted with a myriad of decisions concerning any potential investment not the least of which is:

“When or how should I change my investment strategy?”

Given the choice of investment options, there are three criteria by which any investment you make should be evaluated: Risk, Reward and Liquidity.

  • Risk, in a financial context, is defined as: The probability that the actual return on an investment will be lower than the expected return.  For our purposes and for most people, it equates to whether there is the potential to lose money on an investment and how much of a risk you are willing to take in order to achieve an acceptable return.

One measurement of the risk or volatility of market-based investments can be quantified by the beta of an investment.  Beta is a measurement of volatility of an investment and is measured against how volatile an investment is relative to the market.  The beta of the market is always 1.00, so any investment that has a beta of less than 1.00 is less volatile and conversely, one with a beta greater than 1.00 is more volatile.   The desired result is low beta (low volatility) investments that have higher returns vs. the market.  Each of our institutional-class money managers utilize investments that collectively have a beta that is lower than the market while generating results that avoided the steep losses of the stock market in 2000-02 and 2008.*

  • Reward, in a financial context, is the positive return on your investment.  The rule of thumb is that the reward – or return on investment – is directly proportional to the amount of risk that one is willing to assume- i.e. – the higher the risk, the higherreturn on investment.

In addition, traditional thinking says in order to reap stock market-like returns, you have to invest in the stock market.  In our managed portfolios, that is not necessarily the case.  Two of our investment managers, who do not invest in the stock market, have generated average returns over the past 7 and 10 years that are equal to or better than returns of the stock market over similar timeframes with 76-84% less risk as measured by the beta of each manager*

  • Liquidity, in a financial context, means how quickly you can get your hands on your cash or is the ability to get your money whenever you need it.  One of the first things I advise anyone to have is a liquid emergency fund of readily available cash.  By having available cash, you don’t have to convert another asset to cash and create a transaction that could result in potentially adverse tax consequences or worse, trigger losses.  I often see clients sacrifice higher returns that they could be earning on idle cash because of their perceived need for absolute liquidity of their money.  But what if there was a way to have both?  Wouldn’t you want higher returns in low risk, low-volatility assets as well as the ability to get at those assets quickly?

With our multi-manager investment platform, investors have the ability to have a portion of their assets held in a safe, liquid money market account while also having their remaining assets diversified in a variety of low risk, low-volatility investments.

financial risk

More:

Assessment

*Past performance is not a guarantee or indicator of future performance

Conclusion

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COVID-19’s Impact on Mental Health and Workplace Well-being

Posted on October 5, 2022 by Dr. David Edward Marcinko MBA MEd CMP™

Pandemic Mental Health

By NIHCM

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READ: https://nihcm.org/publications/covid-19s-impact-on-mental-health-and-workplace-well-being?utm_source=NIHCM+Foundation&utm_campaign=a03fb2164b-EMAIL_CAMPAIGN_2020_12_03_03_17&utm_medium=email&utm_term=0_6f88de9846-a03fb2164b-167744768

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PODCAST: Doctors Split from Hospital

Posted on October 5, 2022 by Dr. David Edward Marcinko MBA MEd CMP™

By Eric Bricker MD

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The Story of Tryon Medical Partners shows us that if doctors don’t like the way a hospital is running their practice, they can leave and be successful.

Specifically, the 88 mostly primary care doctors of Tryon Medical Partners sued Atrium Health, the hospital system that owned them, in order to leave and become independent in 2018.

Some of their grievances against the hospital system were:
1. The hospital replaced the nurses in their clinics with medical assistants.
2. The hospital increased the number of patients they needed to see per day and decreased their visit times.

Atrium agreed to let the doctors separate in exchange for dropping the lawsuit.

Just one year later Tryon Medical Partners began to offer Direct Primary Care to local employers and have signed up 30 companies.

The program has been a huge success because an independent primary care practice can work to provide better care at lower costs. Conversely, physicians associated with a hospital system are incentivized to increase healthcare costs.

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HEALTH INSURANCE: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

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Medicare Customers Say Mental Health Benefits Are Very Important

Posted on October 5, 2022 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

AN eHEALTH SURVEY

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A eHealth survey of 3,800 Medicare customers aged 65 and older asked “When choosing health coverage, how important are mental health benefits?” The survey found: 
•  38% say mental health benefits are “very important” to them when choosing health insurance.
 •  34% say it’s “somewhat important” to them.
 •  22% say mental health benefits are “not so important” to them.
 •  Only 5% say it’s “not at all important.”
Source: eHealth, “Seniors Speak Out On Mental Health,” March 2022

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MANAGED CARE: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

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