So, how much time do you spend doing paperwork? Assessments, progress notes, treatment plans, billing, updates, etc.–the lot?
When I asked the director of the agency I was working at last week, it took him no time to respond. “Fifty percent,” he said, then added without the slightest bit of irony, “It’s a clinic-wide goal, keeping it to 50% of work time.”
Truth is, it’s not the first time I’ve heard this figure. Wherever I travel–whether in the U.S. or abroad–practitioners are spending more and more time “feeding the bureaucratic beast.” Each state or federal agency, regulatory body, and payer wants a form of some kind. Unchecked, regulation has lost touch with reality.
Just a few short years ago, the figure commonly cited was 30%. In the last edition of The Heart and Soul of Change, published in 2009, we pointed out that in one state, “The forms needed to obtain a marriage certificate, buy a new home, lease an automobile, apply for a passport, open a bank account, and die of natural causes were assembled … altogether weighed 1.4 ounces. By contrast, the paperwork required for enrolling a single mother in counseling to talk about difficulties her child was experiencing at school came in at 1.25 pounds” (p. 300).
Research shows that a high documentation to clinical service ratio leads to higher rates of:
- Burnout and job dissatisfaction among clinical staff;
- Fewer scheduled treatment appointments;
- No shows, cancellations, and disengagement among consumers.
Some potential solutions have emerged. “Concurrent ,” a.k.a., “collaborative documentation.” It’s a great idea: completing assessments, treatment plans, and progress notes together with clients during rather than after the session. We started doing this to improve transparency and engagement at the Brief Family Therapy Center in Milwaukee, Wisconsin back in the late 1980’s. At the same time, it’s chief benefit to date seems to be that it saves time on documentation–as though filling out paperwork is an end in and of itself!
Ostensibly, the goal of paperwork and oversight procedures is to improve accountability. In these evidence-based times, that leads me to say, “show me the data.” Consider the wide-spread practice–mandate, in most instances–of treatment planning. Simply put, it is less science than science fiction. Perhaps this practice improves outcomes in a galaxy far, far away but on planet Earth, supporting evidence is spare to non-existent. Where is the evidence that any of the other documentation improves accountability, benefits consumers, or results in better outcomes?
Put bluntly, the field needs an alternative. What practice not only insures accountability but simultaneously improves the quality and outcome of behavioral health services? Routinely and formally seeking feedback from consumers about how they are treated and their progress.
Soliciting feedback need not be time consuming nor difficult. Last year, two brief, easy-to-use scales were deemed “evidence-based” by the Substance Abuse and Mental Health Services Administration (SAMHSA). The International Center for Clinical Excellence received perfect scores for the materials, training, and quality assurance procedures it makes available for implementing the measures into routine clinical practice:
Then again, these two forms add to the paperwork already burdening clinicians. The main difference? Unlike everything else, numerous RCT’s document that using these forms increases effectiveness and efficiency while decreasing both cost and risk of deterioration.
Learn more at the official website: www.whatispcoms.com. Better yet, join us in Chicago for our upcoming intensives in Feedback Informed Treatment and Supervision:
In the meantime, would you please let me know your thoughts? To paraphrase Goldilocks, is the amount of documentation you are required to complete, “Too much,” Too little,” or “Just about Right!” Type in your reply below!
First time in my life have not been able to contain work.
Am in private practice.
Am starting seriously to think through how to re-arrange.
I love the article, I am a therapist in Florida and in all honesty. I can’t stand Medicaid at all. I say at least for me working in clinics the paperwork is more 75% of my time. It’s really stinks when the time should be focused on clients. Stats in mental health is rising, I wonder why? Something needs to be done on National level to cut down the tedious, ridiculous paper. I never understood why a bio for a 5 year child needs to be 15 pages or repetive questions.
I completely agree. The ridiculous loads of paperwork detract from psychotherapy and place unnecessary burdens on the therapists and clients. Paperwork has become more important than healing in practice. This really needs to change.
Take a look at page 4 of the above-referenced document for details regarding how paperwork is handled at local walk in clinics.
http://www.brieftherapynetwork.com/documents/Walk-in.pdf
Hi Scott,
Yes, I definitely spend more time on paperwork than 5 years ago and yes, it definitely takes time away from work with my clients.
Hi Scott. Being in private practice and doing mostly EAP contract work doesn’t make me a good responder for this particular question. However, I would say that I have very minimal amounts of paperwork to interrupt the process. Usually, I just have to do enough to keep up with patient progress (session notes) and some contract billing. I don’t do any Medicare or Medicaid or insurance work anymore. But I do remember in the 1980-90s, insurance billing was pretty complicated and not always very rewarding. I imagine that is more difficult now but I am not billing at all for those funding sources. Most of my clients are covered by EAP contracts with their company or workplace. I would be interested in what others have to say on the topic.
I am clinical supervisor of 6 clinicians in CYMH clinic and for all of us I can definitely say TOO MUCH
Thank you for raising this isse.
I work in a correctional institution. More than 75% of my time is spent on paperwork. Some of my coworkers disagree with me. They believe the actual number is closer to 85%, and I am not surprised. One reasons, in my opinion, for this high level of waste on “clinical” hours is that the state agency I work for is being monitored for compliance with the court orders to provide care to the mentally ill offenders at various levels. There is no need for the actual care and there’s no accountability for the quality of care. Although I am a very computer-savvy clinician and can utilize technology to maximize my face-to-face contact with the patients, I am forced to do a lot of paperwork. Regretfully, the agency is using the technology to create more paperwork. Alas! The agency utilizes computers to create neat forms and requires clinicians to type their notes, etc. and awkwardly considers this an efficient use of technology. I want o scream…
Thank you for your excellent article!!
I am a Mental Health Therapist who was recently hired at a counseling center. I can relate to most of the comments. So far it seems like they cram as many clients as you can in one day, but then expect soooooo much paperwork to be done by each client, that there aren’t encough hours in the day to do it all! Realistically to properly get the amount of paperwork they want done, it would take an hour per client. There are not enough hours in the day! So what happens is, you come in early and stay late (Im on salary) and still not get it all done!!! There are very few people who have worked there more than a year!!!! The burnout and turn over rate is sooo High! (of course, I didn’t know when I got hired). I am praying to just get through my first 90 days! Help!
Hi Scott
I have been practicing psychology for over 40 years, during that time I have noticed increasing requirements for documentation, especially in the public sector. I work in Sydney Australia, in the late 70’s community health services were new and we were treated with suspicion by the hospital administrators. Part of this suspicion translated into an emphasis on writing up our notes, they had to be problem oriented, and contain specific information. No one except maybe clinicians taking over a case read them, and often that was not the case. I remember the family therapist Michael White saying he used to weigh medical records, that was the only information he needed. In the early 90’s I did a locum at the local inpatient mental health unit. All I was required to do was date and sign, a card or medical record, we psychologists could keep our own notes, but there was no accountability and the Medical Records Librarian did not want to be bothered storing them. Neither seemed to make sense.
I have worked in private practice for the last 20 years and can please myself. If I worked in the public sector my colleagues tell me they spend up to 1 day a week on recording. Uneconomic in private practice.
With increasing subsidy of private practitioners has come increasing accountability in terms of paperwork. However I am finding that requirements also are concerned not to present too much work to the reader, so whilst I did not like the 6 session plans I need to do for many of my clients, I now find them useful in keeping me focused and can be a helpful review to share/co-collaborate with the clients.
With free rein to write how I like I see the importance of notes as documenting what a client considers important, especially if it relates to compensable cases such as workers compensation, or MVA, but I have to very mindful that they are likely to be subpoena’d. I also need them to remind me of homework.
Another area I have found notes to be a useful tool is if I am seeing a young child which is the subject of a custody battle. I will take detailed notes of everything I am told by all parties and provide copies to both parties straight after.
a couple of years ago I was asked if I would like to see the notes from an assessment done by our local adult mental health team, it was offered by an eager new grad. There was about 20 pages of a structured interview given to clients presenting in crisis, which was all about what the system wanted to know not what the client needed to say. Not surprisingly the client had no wish to return to that system. I have also found my adolescent clients say that “they just didn’t get me”
I do what I am asked to do by organisations who pay me, for the rest of my personally paying clients I muddle along with something that means something to me, but is probably not useful to anyone coming after.
Too Much.
We’re not alone in this – see “The Atlantic” Nov14 “Doctors Tell All” – a review of books by disillusioned physicians showing that the problem is becoming ubiquitous.
Way too much! 50% is for routine documentation. That percentage increases with unusual requests or circumstances. That combined with declining reimbursement is making private practice almost impossible. I work much longer hours today, seeing approximately the same number of patients and doing the same kind of work that I did 10 to 20 years ago but getting paid less. And work under the constant threat of insurance audits that require people to repay monies earned for services already provided.
Too much by a long shot.
The staff at my workplace are required to meet productivity levels that make it impossible to complete the notes during normal work hours. Thus, we work during our personal time on evenings and weekends in order to complete progress notes and intakes, in addition to working on notes during the work day. Staff believe that our detailed, 2-3 page progress notes are required by the Joint Commission. I have not heard of any complaints by the Joint Commission about our notes, so I wonder if that’s accurate or if it’s lawyers being overly cautious. We have had additional paperwork added to our task list, all of it well-intentioned and meaningful, but there has been no commensurate reduction in productivity requirements, so these added documents will require greater use of personal time to complete. For professionals who promote the mental health of clients, you’d think we’d look after our own mental health, too.
Although it goes against my ethics of wishing to serve those in need, I recently had to stop accepting Medicaid patients in my private practice because of the amount of behavioral mumbo jumbo required in their treatment plans and the frequency of need to write another plan to request additional services. The details requested have no relation to factors that determine effective treatment and as a psychologist with a spinal cord injury and limited time available to see clients, I’ve had to turn my back on these clients.
I first met you when you started working with Insoo and Steve in Milwaukee ,Wisconsin. I was doing some work with them in New Mexico..
In reference to your question, it is obvious that paperwork has increased only it’s now on the computer and the clinician does all their own paperwork. intake assessments are required before any counseling which includes a two hour block requiring that the treatment plan B completed the same time. There is no or little time involved in rapport building the families or even getting to know the client through developing therapeutic rapport. I sincerely hope we can join together to address legislative sessions throughout the country as prevent the demise of mental health therapeutic rapport replaced by a business model
far too much paperwork. Bevan & Hood (2006) is the paper to read on ‘targets and terror’ and ‘gaming’ of health statistics – the form of management that crashed the Soviet economy – where there is now a whole industry of health target measurers where people cook the statistics for them, and they don’t check because if they are getting the figures they want they are happy. This industry deliberately excludes FIT – see for example Sasiak et al (2012) Measuring outcome in child and adolescent mental health services: …’ Clinical Child Psychology and Psychiatry, 18, 4: 519-535. (A NZ study – no mention of FITS despite now in use in numerous hospitals).
Yes the amount of paperwork has increased. In my opinion, some of the forms are just not well designed and the same i formations is repeated in several forms inside the same file. I believe that several forms could be combined into one easily.
I work for the federal government and for every 30 mins of direct patient contact I am spending 30 mins to document that encounter that includes all the risk assessments and SOAP notes that I am mandated to complete. Talk about redundancy I also have to literally document all of this into two separate military records systems. I am forced to make the choice between providing “world class” (which is in the mission statement) patient care versus closing out records to meet unrealistic demands. Of course I choose to provide my patients with “world-class” care, that is why I choose to work with the military, and therefore face being perceived by my superiors as not being effective with “time management”. Rediculous !!!!
Yes, I am spending more time on paperwork and than I was 5 years ago. Usually 30%, and sometimes 40%.
It isn’t taking time away from my work with clients, it’s help me in my work with my clients.
Best regards,
Doina
Too much paperwork!
Absolutely too much!
The paperwork problem is a longstanding problem. I’ve worked in the field for 40 years, mostly in substance abuse treatment agencies, some private for profit and some non-profits. Back in the seventies we did an informal time steady at one place we worked, an inpatient drug program, where we added up the hours spent face to face with clients as opposed to doing paperwork, it was 20% with clients and 80% paperwork and other stuff like training, supervision, staff meetings, case management, etc. In a recent mental health center we had a therapist productivity standard of 65%of time face to face and 35% for paperwork plus the other non-direct services. Sounds way better but it’s rare that the clinicians get their paperwork done with thin that time frame so they work overtime to get it done, for which they do not get paid. I believe the paperwork problem is even more burdensome in the substance abuse field because we have so many regulations. Having said that I worked in a Mental Health agency a few years back that required 67 pages of documents to be done before you could even see the client the first time. Quite ridiculous of course but they answered to State, Local and Federal authorities and various 3rd party payers. Much of this is CYA to avoid law suits and to get paid. For that reason I say it’s not going away anytime soon.
Far too much in the State of MN!!!!
We do too much paperwork. A vast portion of it is to justify our existence ie. for contractual obligations to the government, not for client care. The rationale is not justified. Less paperwork obligations and more opportunities for direct client care would be optimal.
I pay a colleague who runs a billing service $40 an hour to do data entry for me. My private practice is nearly all insurance clients and I still have to provide my billing person with raw data that I have to complete at night and on weekends. Notes are also done at night and on weekends, but If I didn’t pay my friend and have her do some of the work I wouldn’t have any time for myself. Calls to the insurance companies to “trouble shoot” is have to be done during what would be the time I do housework so forget that! I think that’s what’s gone in the way of the dodo bird – housework!
Paperwork is hindering mental health care, substantially so. Truthfully, there are few clinical challenges that I feel stronger about than this one because I feel it is such a barrier, at least a CMHC’s. Accountability is incredibly important, oversight is important…but it should not be so intense that it harms delivery of care. It is truly maddening that the powers that be (Medicaid in particular, but other insurance companies too), in insisting upon good clinical care through documentation, put the barriers to this very care right in front of our faces. It is the most maddening catch-22 ever…needing to complete paperwork to ensure access to more services but in doing so, eroding the therapeutic relationship through distraction in multiple ways. Once you’ve ensured more services…you get to do the same thing all over again. It is a miracle that people show improvement at all in some cases. I used “maddening” twice, because that is how all of this makes me feel! That, and utterly, and completely powerless. All that we know about how people improve in mental health care can be distilled down to one single, golden thread–the therapeutic relationship. This is tied to attendance, engagement, motivation, willingness to take life-saving medications, and so much more. If insurance is so evidence-based, why can they not apply this information? Why is this information not reaching the top tiers of these healthcare giants? That is my biggest question. We KNOW what works. Why, oh why, can folks at the top not see this? I do believe that insurance companies want all of their members to be well and healthy and also want to reduce costs…so why is this not part of their plan in delivering care? Great progress with the ORS being approved as an evidence-based practice. However, when I have shared it with others, some have scoffed.
It is frustrating just thinking of all of the times in the past that I have been trying to concentrate on a client’s story while mentally tabulating all of the forms that I needed to complete while I still had the client in my office so that I would not receive negative feedback from supervisors for a variety of reasons. I was deeply, deeply offended when the idea of concurrent documentation came along. I was always left doing my notes late into the evening, but I never wanted to put this additional physical barrier in between clients and myself. Needless to say, this made me burn out. It is so ironic that that in trying to ensure good client care, Medicaid/insurance are orchestrating it’s destruction. Nonetheless…I remain hopeful.
Yes paperwork has increased, and it depends on who you are serving just how extensive it is. They range from the legal/ethical license requirements to the insurance carrier that is data intensive. My biggest complaint is that the paperwork requires the clinician to think in terms of case development in the way the paperwork requires it, which sometimes is not a match.
My answer to your question is to say that as a private practitioner in the UK I still have a very light paperwork load. Long may it continue – but the forces of darkness are spreading. National registration is coming.
On another note, you might enjoy this – my homage to you Scott.
In my NHS practice there is alot of extra documentation I need to check is complete prior to inspection by the Care Quality Commission (CQC). This important government agency are focused on what documentation looks like rather than quality of improved experience for patients. I will have to allocate about one week in which I am not seeing patients.
I think the culture associated with documentation can make some clinicians aversive to risk and less likely to take on work. I tend to take on more as the risk averse clinician takes on less. I had been advised to find ways to offload or pass work to someone else. I feel I unable to do this in our small team.
To find the delicate balance of paper justification to satisfy federal, state, and insurance providers and actually do therapy is an exercise in patience.
Having worked in community behavioral health the load is enormous…
Now in a private setting I’m loving doing therapy again and using spoken dictation technology to assist in my documentation.
I have heard many arguments for concurrent documentation and I believe there is power in presence, focus, eye contact, and human connection….all of those subtle gifts seem diminished when a piece of hardware is included in the therapeutic relationship.
I absolutely spend more time in the electronic medical record world on documentation. I work at a local mental health center that no longer has maintained full time salaried positions in the outpatient program. We are all now FFS employees and have been moved to the 45 minute block where we see more people in a day and are expected to do “concurrent billing” It is daunting to clients to complete the “hoops” for such needs as JCAHO accreditation and insurance standards and feel that they have gotten their copayment’s worth of “talk time.” . Many, many clinicians leave to enter private practice and we have have fewer and fewer staff with clients feeling the abandonment issue with each departure.
Hello Scott.
Too much!
Working as a clinical psychologist in public health care in Norway, we have at present a national debate regarding the amount of paperwork in the field. In focusing on the clinical staff, and the time consuming documentation routines, leaving less time to direct clinical work, I have introduced the term “non- completion fatigue” to describe the possible negative consequences for staff members/ clinical workers that almost never get the time or feedback to perform “good” enough work…..
AndersD, ph.d
Scott,
Paper is our client in many setting that I consult and in my own experience in the public sector. We did two time studies, one in last 1999 with 17 clinicians and determined that, at that time, the ave. for typical documentation was 27 percent of the clinician’s time. This did not include meetings and sundry other ‘demands’ on the their time. The last official look was in 2008 at a large community mental health facility. With 20 professionals doing a time-study, the time spent was 32 percent on routine paper work. This was also using a state mandated on-line computer program. An interesting insight was that although the bulk of the documentation was upfront, a significant portion was trying to continue authorization with Medicaid and QA folks within the state.
More anecdotally, in numerous agencies where I have clinically consulted, the numbers typically cited are a third of their time. This has launched a lot of concurrent documentation schemes and processes. Finally, I believe that much of the documentation quality (meaningfulness, accuracy, conceptualization, and insightfulness) has been eroded by the demand for quantity and fixed data points. With this in mind, it is not surprising that most clinicians that I work with and know are working between 47- 52 hours weekly and being paid for forty because of productivity quotients and demands…………
Hi Scott,
Being in private practice i’m very lucky to be able to avoid the huge amount of paperwork which weighs down many of my colleagues. I’ve used the CDOI paper forms & then MyOutcomes since 2006. I do this to:
1. assist my clients to engage more fully in the process of therapy
2. to give them a clearer voice in letting me know what works or not for them
3. to keep me growing in competence and accountability
4. to provide simple & clear feedback on outcomes to EAP providers & referral sources at the push of a button. It really streamlines any reporting that I do.
Many thanks,
Vivian Baruch, M. Couns, Sydney, Australia.
Scott,
I am so busy that I can’t take time to do this properly! This speaks volumes. I work in the schools and there is so much paperwork for special education that it certainly impinges upon not only my job as a licensed school psychologist but special education teachers as well. I have known many a early special educators with master’s degrees working 12 to 14 hour days plus weekends to get the paperwork completed. Many whom don’t have families or are married! Having said that, many are looking to exit this field by getting into a doctorate programing and looking to become college/university professors. Little do they know that most of the time only adjuncts are hired!
Be well and Happy Thanksgiving!
Bill Hosmer, Ph.D.
Hello Scott,
I work for a CMHC in Washington state. The agency has introduced concurrent documentation for the clinician’s due to several factors. One is the mandate from the state to get 1080 face to face hours per month. Another is the mandate to have all notes done within 72 hours. Another one is the extraordinary amount of paperwork that needs to be done in a timely manner. I was hoping that with the advent of our E.H.R. that paperwork would be reduced. However, when we had paper charts you had to do one form to reauthorize a client for additional services. Now not only do you have to complete that form but you also have to do three other online forms for the process. So one form turned into four forms! TOO MUCH!
Hello Scott!
I am still doing clinical work, group-, family- and individual therapy. And a lot of supervision. And I enjoy doing that! (At the age of 69.) The Norwegian government demand me to report how many patients, diagnoses, hours and so forth, three times every year and that has gone from once a year to three times a year! But when it comes to the rest of the paperwork, it is more or less the same as five years ago! So thats all. I am now in France, and write you more personal when I return to my computer in Norway.
Peter Rongved
Sendt fra min iphone
I work in a community mental health and substance abuse agency where documentation demands occupy more and more time and where every document is scrutinized for perfection. While I realize the importance of documentation (in mental health as well as medical fields), the process has come to serve itself and results in decreased quality of patient care and increased cost while compensation decreases. After many years of practice, I look forward to leaving the profession in the next 2 to 5 years and doing something more rewarding.
I work for a New York State Office of Mental Health agency and am dismayed that I am required to spend my first three visits with a client completing forms on a computer when the client has come to receive therapy for, often, urgent issues. Clients often become exasperated by the requirements and I apologize repeatedly that I cannot give full attention to the client’s therapy until the forms are complete. Some clients become quite angry and indignant that they cannot talk about the issues that brought them into therapy. I do try to do some therapy as we complete the forms, as best I can.
I am appalled that I am not treated by the state as a professional but instead as if I’m an irresponsible person who cannot be trusted to behave appropriately without documenting every second of my day. In fact, the “documentation” does nothing to ensure that I am doing my job effectively as I could well make up what ever I please to put in the forms and no one would know the difference. In reality good therapy only occurs during the few visits we have where I do not have to complete the regular and repetitive forms that distract us from the therapeutic process.
I consider therapy to be an art that requires mindful and compassionate attention to the nuances of a client’s tone of voice, body language, facial expression, and other more subtle avenues of communication. When I pay careful attention to a person, the individual feels supported and heard and this fosters the level of trust that is required for him or her to share in a manner that enables healing to occur. The endless electronic forms are harsh and coarse in comparison and interfere with my ability to create a therapeutic connection with clients. Instead of engaging fully with someone I am staring at a computer screen while I direct questions at a client who may be pleading for help, sometimes crying, sometimes shutting down. Of course I stop the forms if the client is in distress, but I am always distracted at these times because I know I’ll pay a price if my forms aren’t completed on time. So I do not give the kind of attention I would like to in these situations.
I feel that I am a good therapist when I’m allowed to conduct therapy in my own way but when I use these forms it is as if I am following the method of someone who has no sensitivity. It’s as if I’m locked into playing the role of a poor therapist.
Like other therapists, I do plan to go into private practice to get away from these constraints which diminish my effectiveness and cheat my clients out of quality therapy. I feel badly about this because I do want to work with those most in need but these folks cannot afford private care. So, once again the needy are left with sub par service. I do feel this is also a social justice issue.
I work both in private practice and a clinic that is governed mostly by the state guidelines. We treat a heavy population of Medicaid clients which usually translates as “paperwork until you’re blind”. We have to give a minimum of 4 rating scales in the intake session, 2 of which I feel are degrading to clinicians because they make you justify the need for services. I think we have enough knowledge to call that decision. Our assessments at about 15-17 pages, depending on the presenting problem. As the above have mentioned, the need for data has only increased over the last few years. I also notice a significant difference since I first started 9 years ago.
I’ve always shared my frustration and disappointment about this with my colleagues who all agree it takes away from the enjoyment of being a therapist and working with your clients. It’s always in the back of my head that if my treatment plan gets audited and it’s not exactly how “they” like it then my clinic gets fined or I get fined.
Unfortunately, I have considered leaving the profession the longer I work in clinics because I’m either pushed to up a quota in billing, work 60-70 hours to get all of the notes and paperwork completed, or be concerned about grant funding being cut. Again, it takes away from the reason I wanted to enter the field in the first place.
Private pay sounds great right now…but that even has it’s pitfalls.
I am in private practice. I quit being on insurance panels because of paper work and now things are fine. I do not do workmans comp either for that reason. I bill for patients and keep my notes and that is about it. I do ask your scaling questions almost every session and find them very helpful but I do not document them.
Good evening,
for me, in the past 5 years ago I was working only in private practice and I have no rapports to make for statal agency, so
· I’m not spending more time on paperwork than the last place of work, 6 years ago
· I’m not taking time away from my work with my clients.
Best regards,
Dr. Josephina NEAGU-SLOBOZEANU
PsyMotion – Clinica de psihiatrie, psihoterapie si dezvoltare personala
Str. Mihail Sebastian, nr. 203, sect. 5, Bucuresti
Tel./Fax: 021.781.22.59
From: Reg Reynolds
Date: Mon, Nov 24, 2014 at 10:34 AM
Subject: Re: Can I ask your opinion?
To: enda.madden@acehealth.co
Reg Reynolds
I am in independent practice, so I can’t answer your question directly. However, I used to manage a psychology department and, when the institution that I worked for demanded that the psychology staff sign in and out, the hours that they put in dropped from 54 per week to slightly under 36 per week.
Scott: I am entering my 34th year in the field and every time there has been an initiative to reduce paperwork it seems to increase it – most are state/accreditation requirements and most of these add very little if anything to the clinical picture the client presents – we have to have certain things in assessments that don’t fit what the client is here for. I believe it can and does take away from time we have with our clients and can frustrate therapist and it is hard to catch up when you get behind in paperwork. Two areas frustrate clinicians the most in every place I have been in: 1) paperwork and 2) productivity – I understand the productivity but at times the paperwork gets in the way of what we are trying to do and serve the amount of people that come through our doors. All my work experience has been in Community Mental Health/Addiction Agencies so we always need to comply with State requirements for paperwork as well as at present we are CARF accredited.
Michael Ruffin, MS, LPCC, LICDC
Director of Clinical Services
Miami County Recovery Council
1059 North Market Street
Troy, Ohio 45373
40-50% of time spent on paperwork!
I have seen the reimbursement rates remain the same -or lower, during the past sixteen years. Concurrently, the time spent -even in private practice, involving billing, collecting, and keeping up to date with required changes (HIPPA, new 2013 CPT codes, etc.), has significantly increased.
The above is only the case of Commercial Insurance Companies. If we include Federal Programs in the conversation, such as Medicaid, the numbers are much worse. Those reimbursement rates have decreased to an insulting level for any professional with Master’s degree or higher, and the paperwork has tripled!
As a private practitioner, it has pained me to arrive at the decision of not accepting Medicaid assignments. However, the alternative would have been closing the doors soon after due to the practice becoming financially unsustainable.
The end result? Private practices with much fewer clients, and people with limited resources not receiving needed services….
Paperwork is more demanding now than 5 years ago. About 7 years ago is was even better (paper files).
It is taking time away that I used to spend on client contact.
First of all when I read the heroic client, the first thing that came to my mind was, this is a possibility to tackle bureaucracy. Because I think then and now that bureaucracy is one of the greatest threats for healthcare, it will squeeze our throats and we will never be able to breathe again, if we don’t find an answer to this problem.
At the moment because of the financial transition that is taking place here in Holland bureaucracy is winning. I am having a hard struggle to persuade politicians to look at alternatives.Almost always they say that they don’t want bureaucracy they don’t want it for sure, but somewhere along the line there is someone who wants to have it, and who benefits. In the trainings I give, this is one of the strong arguments to persuade people or organizations to use FIT. I will keep talking to people who are the decision-makers, and the workers in the field in the coming years, because the transition is also a great chance in changing things.
The tail IS wagging the dog!!!!! Way too much paperwork simply to CYA!
I just started a new job for a county MH program and I think it’s about 40% and rising. We don’t get productivity credit for most of it, either. One main culprit, frankly, is the CANS, which DHS is requiring. The state of Oregon loves it. I find it incredibly counterproductive as we don’t use is as a clinical instrument, for which it isn’t designed, but as a means for DHS to determine stipends for foster parents. I will spare you my rant, but believe me, I have one. We do concurrent documentation, but it can’t all be finished during the session, especially if you see clients in homes and schools, which I do.
Throughout my 20 year career as a child and adolescent therapis I have seen the productivity and documentation demands increase to the extent that it is now standard practice for an outpatient therapist to see over 34 patients a week while an access worker will perform 28 initial or diagnostic evaluations per week. Salaries have not gone up accordingly, documentation standards are more stringent, and a therapists worth (whether you stay or are fired) depends not on patient satisfaction and positive outcome measures but solely on documentation. This is a sorry state of affairs as I know many “iffy” therapists who receive glowing scores.
As someone relatively new to the field, and with extensive experience in quality and efficiency in other contexts, I have very quickly become disillusioned and burned out. The client experience and clinical skills receive little emphasis or appreciation. I long to interact with professionals who emphasize and value clinical skills over paper pushing.
I feel exactly the same
I work in substance abuse. The amount of documentation is absurd and takes away from time that could be spent on providing excellent client care, instead of distracted, rushed sessions which seems only to serve the documentation, not the other way around.
We need mental health lobbying of insurance companies who are the ones driving this. It ultimately costs them more in recidivism.
This is what happens when profits and incompetence are running the show.
It stems from managed care – which itself has become obsessed with profits and is filled with incompetence. Managed care is destroying the entire economy on a grand scale and wrecking all healthcare fields that use it in any way.
If it is Erik, then MC is in a Folie a Deux with the professional organizations, especially the two APA’s. In the press releases, building a better relationship with them was a chief objective of the committee.
Some documentation is good, but i was taught it should be concise and able to be easily read by another professional with the gist in under 60 seconds. Many people write entirely too much and many agencies are bound to insurance companies, who do not have any real professional understanding and believe that somehow writing the same thing repeatedly over and over again in different words makes it more qualified or better done work, when often just the opposite is the case.
A good counselor works with people. Insurance companies are systemically destroying and weakening genuine healthcare in a quite calculated manner from people who see the dollar signs and make the rules (and do not provide any services). Their greed increases stress on professionals and results in a decline of patient/client care.
– Working as a counselor in several settings since 2009.
Well I know this is old but I just walked out of a psychologists office because she handed me about 35 forms to fill out. I have chronic pain and the injury I sustaining happened in 1989. I am having a internal stimulator put in next week and the doc asked if I wanted to sit down and talk to someone? I said sure why not. 30 years of history on my injury? I would have been there filling paperwork out for a year. I thanked her and walked out. So, question to you docs, aside from the court-ordered referrals, how do you get any patients? No way am I filling all this out. I just wanted someone to TALK to. If I wanted to write my memoirs over the last 30 years, I would do just that. Crazy!
thanks for sharing this it’s really helpful for me.