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MSDP Training

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MSDP Training May 5, 2009 Day One * Presented by MHSACM, DMH, DPH/BSAS * * * * * * * * * * * * * * * * * The 3 points we want to make over and over and over Examples ... – PowerPoint PPT presentation

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Title: MSDP Training


1
MSDP Training
  • May 5, 2009
  • Day One

1
Presented by MHSACM, DMH, DPH/BSAS
2
Welcome and Introductions
Presented by MHSACM, DMH, DPH/BSAS
2
3
Presenters
  • Jordan Oshlag, LICSW, Vice President of
    Operations, Community Healthlink, Inc.
  • Vic DiGravio, CEO, MHSACM
  • David Lloyd, President, M.T.M. Services Senior
    National Council Consultant
  • Stephanie Sladen, LICSW, Asst. Vice President
    Outpatient Mental Health Substance Abuse
    Services, Health Education Services, Inc.
  • Bill Schmelter, Ph.D., M.T.M. Services National
    Council Consultant
  • Kathleen Janssen, BSN, RN, MS, Director of
    Quality Management, Riverside Community Care
  • Joe Passeneau, LMHC, Director of Health Record
    Review and Audit, MBHP
  • Marcia Webster, Consultant to The Transformation
    Center
  • Susan Schneider, Member of MOAR

4
Thank you!
  • DMH
  • DPH/BSAS
  • MHSACM
  • MBHP
  • CHD
  • Presenters
  • Countless volunteers

5
Morning Agenda
6
MSDP - Overview
  • Terms -

7
Terms
8
More terms
9
Paradigm Shift
10
New Language
11
MSDP Initiative Overview A New Direction
Leading the Way!
  • Vic DiGravio, CEO, MHSACM

12
Purpose of the MSDP Initiative
  • Conceived as part of MHSACM e-Health Initiative
  • Sub-committee process in Fall 2006 identified
    need to bring order/structure to how providers
    document care
  • Essential interim step in transition from paper
    to electronic based records- e-Health Readiness

12
12
13
Goals of MSDP
  • Develop standardized set of clinical forms that
    will lead to
  • Improved quality of patient care
  • Increased compliance
  • More efficient business practices

13
13
14
MSDP Initiative Stakeholders
  • Mental Health and Substance Abuse Corporations of
    Massachusetts (MHSACM)
  • Executive Office of Health and Human Services
    (EOHHS)
  • Department of Mental Health (DMH)
  • MassHealth
  • Department of Public Health Bureau of Substance
    Abuse Services DPH/BSAS
  • Massachusetts Behavioral Health Partnership
    (MBHP) Medicaid Carve Out
  • Medicaid Managed Care Organizations (MMCOs)
  • BMC HealthNet,
  • Neighborhood Health Plan,
  • Fallon Community Health Plan
  • Network Health.
  • Consumer/Families and Advocate Organizations
  • National Alliance for the Mentally Ill of
    Massachusetts (NAMI)
  • The Consumer Quality Initiative (CQI)
  • Massachusetts Organization for Addiction Recovery
    (MOAR)
  • Massachusetts People/Patients Organized for
    Wellness, Empowerment and Rights (M-Power)

14
14
15
MSDP Initiative Operational Structure
15
15
16
Why Would You Not Want to Use the MSDP Processes?
Benefits at the Local Program Level
  • Presented by
  • David Lloyd, President
  • M.T.M. Services

17
Benefits of Participating
  • Quality of Care Benefits
  • Promotes consistent assessment, planning
    service documentation
  • Person-Centered and Strengths focus
  • Recovery/Resiliency focus
  • Promotes Information Sharing
  • Promotes effective collaboration with other
    providers shared terminology for use by
    different disciplines
  • Less room for error Decision support

17
Presented by David Lloyd, MTM Services
17
18
Benefits of Participating
  • Business Benefits
  • Compliant with Federal Mandate for Electronic
    Health Records by 2014 a wide variety of
    regulatory and payer requirements
  • Protection against federal audits
  • Wide array of funders/payers support this
    initiative
  • Enhances Measurement Outcomes Focus

18
18
19
Benefits of Participating
  • Financial Benefits
  • Free training and forms
  • Compliant with a wide variety of regulatory and
    payer requirements
  • Some protection against federal audits
  • Saves time and money
  • Reduces redundancy in collecting information
  • Concurrent documentation possible
  • Standardized revisions and updates in future

19
19
20
Statewide MSDP Pilot Study Completed
  • Twenty-six MHSACM member provider agencies
    submitted a request to participate in the MSDP
    Pilot Study in March and April 2008.
  • A total of 70 different local programs at these
    member agencies representing twenty-six different
    statewide funded program types participated

20
21
Evaluation Levels and Tools
  • Program Level Evaluations
  • Completed after local pilot trainings
  • Assessed Local Program Pilot Training and
    Kickoff
  • Evaluate quality of training and supports
    received
  • Evaluate success of agency training
  • One evaluation per program participating in the
    pilot

21
21
22
Evaluations Levels and Tools
  • Direct Staff Form Mark-up Process
  • Completed during pilot study
  • Evaluation of pilot forms
  • Notations made directly on blank forms by
    participating program staff
  • Each participating staff member required to mark
    up one form for each mandatory type piloted
  • Direct staff members chance to influence the
    final product
  • Commented on form layout, data elements, spacing
    issues, etc.

22
22
23
Program Evaluation Focus Areas
  • Identified of how many times each pilot
    form/process was used by direct care staff during
    the pilot study.
  • Evaluated to what extent each pilot form used
    collected the data elements direct care staff
    need to do their job well
  • Evaluated to what extent each pilot form used
    contained unnecessary data elements
  • Evaluated to what extent each pilot form
    supported compliance with regulations and payer
    requirements (DMH, MBHP, Medicare, MCOs, CMS,
    etc)

23
23
24
Program Evaluation Focus Areas
  • Evaluated to what extent each pilot form used
    supported compliance with accrediting body
    standards (CARF, JCAHO, COA, NCQA, etc)
  • Evaluated to what extent each pilot form used
    supported a Person Centered, Recovery Oriented
    approach to services
  • Evaluated the overall clinical flow/ clinical
    content of the MSDP forms/documentation processes
  • Compared each new pilot form used with the
    equivalent form being used just prior to the
    pilot in terms of support for quality clinical/
    recovery focused services
  • Evaluated to what extent the pilot forms used
    unnecessarily collected information more than
    once

24
24
25
Ongoing Support for the MSDP Process
  • EHR Vendor Certification Process to help ensure
    that the EHR product you purchase is compliant
    with the MSDP data elements
  • Data mapping for all forms/processes has been
    completed and will be used to develop gap
    analysis between the EHR vendors data elements
    and the data elements identified as required in
    the MSDP process for each form type

25
26
Presented by David Lloyd, MTM Services
26
27
Ongoing Support for the MSDP Process
  • Ongoing Annual Review of the MSDP processes and
    manuals to ensure continued compliance with
    revised standards
  • Eliminates local costly efforts to revise and
    maintain forms/training manuals

27
28
MSDP Data Elements and Forms Processes How Did
We Get From There to Here?
  • Presented by
  • David Lloyd, President
  • M.T.M. Services

29
MSDP Scope of Work
  • The identified scope of work for the MSDP
    includes documentation requirements for services
    identified below
  • All Department of Mental Health community
    services
  • Medicaid Mental Health acute services, regardless
    of health plan, carve out or Fee For Service
    status
  • Services purchased by the Bureau of Substance
    Abuse Services
  • Substance Abuse services purchased by Medicaid
  • EATS, CBATS and Supported Education and
    Employment Services are included in the scope of
    work for the project.
  • Programs that do not have an individual record
    will not be included in the scope of work (i.e.,
    Disaster Response, Training, Trauma Response,
    Consultation Programs, etc.)

29
30
MSDP Project Management Model
  • The Project Management Model used in the MSDP
    Initiative includes
  • Empowered Project Teams
  • 70 Super Majority Decision Making
  • Compliance Grid Development
  • Statewide Pilot Study of all developed
    processes/data elements
  • Three levels of evaluation
  • Training Manual Development
  • Implementation Training Plan Development

30
31
MSDP Project Management Scope of Work
  • Develop the data elements necessary in each
    clinical form type to support an integrated
    standardize documentation approach statewide
    based on Ohios SOQIC standardized documentation
    initiative refocused to Massachusetts
    requirements
  • 2. Develop a data element dictionary and cross
    walk for all data elements in each form type
  • 3. Provide compliance review to ensure the
    created form processes meet applicable state,
    federal and national accreditation
    requirements/standards
  • Develop a statewide documentation training manual
    based on the model used in the SOQIC initiative
    in Ohio
  • Use the MH/SA providers technical assessment
    level survey completed by MHSACM to develop
    interim documentation solutions for community
    providers based on possible paper processes,
    electronic forms and/or EHR specifications
  • 6. Provide technical assistance for the
    development of an RFP to select a vendor to
    create EHR specifications for application
    statewide with all vendor types (i.e., XML code
    model, etc.)
  • 7. Provide training to support the
    documentation model and data elements developed
    to facilitate an understanding of how to use the
    new processes to support
  • Medical Necessity linkage requirements
  • Recovery/Rehabilitation service delivery focus
  • Move to more fidelity between what we do, versus
    what we write

31
32
MSDP Documentation Processes Within the Scope of
Work
32
33
MSDP Development Timeline
33
34
Decision-Making Process to Support Core
Organizational Principles
  • The following decision-making process that was
    utilized for the MSDP Initiative
  • Primary emphasis will be placed on gaining
    consensus and support from all stakeholders
  • Preliminary straw votes will be taken to
    determine the position of QMC, Compliance Review
    and Project Team members on specific
    issues/initiatives
  • If consensus cannot be reached in a reasonable
    time frame, then a final vote will be taken with
    a super majority (70 of members attending the
    meeting) being required to act on any
    issues/initiative that needs leadership.
  • The minutes will accurately reflect the vote of
    members.

34
35
Empowered Team Membership and Scope of Work
  • Quality Management Council Membership on the QMC
    consists of
  • Eight representatives from MHSACM, two
    representatives from EOHHS, two representatives
    from DMH, two representatives from MassHealth,
    two representatives DPH/BSAS, two representatives
    of consumers, family members, and/or advocates
    and two at large members will be selected and
    empowered to represent stakeholders.
  • A MHSACM Senior Administrator will serve as the
    Chair of the QMC to facilitate the business
    activities of the Council. A consultation team
    member will serve as facilitator consultant to
    the QMC.
  • Guides the project and is charged with ensuring
    data element development and implementation
    occurs

35
36
Quality Management Council
36
36
37
Quality Management Council (Contd)
37
37
38
Empowered Team Membership and Scope of Work
  • Compliance Review Team Membership on the CRT
    consists of fourteen members and be comprised of
    representatives each from
  • MHSACM, EOHHS, DMH, MassHealth, DPH/BSAS, MMCOs
    and MBHP who have experience and expertise with
    HIPAA, CMS Corporate Compliance, state and
    federal standards, and JCAHO, CARF and COA
    Accreditation compliance.
  • The CRT will be required to provide a full review
    all data element recommendations developed by the
    Project Teams to confirm full compliance with all
    HIPAA, CMS Corporate Compliance, state/federal
    requirements and Accreditation standards.

38
39
Compliance Review Team
39
39
40
Five MSDP Compliance Areas
40
Presented by David Lloyd, MTM Services
41
MSDP Compliance Grid
41
Presented by David Lloyd, MTM Services
42
Empowered Team Membership and Scope of Work
  • Standardized Documentation Team Membership on
    the SDT consists of fourteen members comprised of
    representatives each from
  • MHSACM, EOHHS, DMH, MassHealth, DPH/BSAS, MMCOs
    and MBHP who have experience and expertise with
    clinical documentation for all levels of MH/SA
    services contained in the scope of work
  • The SDT will develop new documentation models,
    protocols and processes, pilot the newly
    developed models, send recommendations to the CRT
    for compliance review and submit reviewed
    recommendations to the QMC for approval and
    implementation.

42
43
Standardized Documentation Team
43
43
44
Standardized Documentation Team
44
44
45
Standardized Documentation Team
45
45
46
Empowered Team Membership and Scope of Work
  • Consumers, Families, and Advocates Advisory
    Committee Membership on CFAAC consists of ten
    representatives from statewide consumer and
    advocacy agencies/groups/individuals.
  • CFAAC is to provide feedback to the SDT regarding
    documentation needs of consumers/families and
    review all documentation processes developed by
    SDT prior to piloting.

46
47
CFAAC Membership
47
47
48
MSDP Leadership Team
48
48
49
Break
50
MSDP Training Manual, Resources and User Website
  • Presented by
  • Stephanie Sladen
  • MSDP Leadership Team
  • David Lloyd, President
  • M.T.M. Services

51
Access to Forms/Manuals
  • Each Provider Program will be provided all of the
    following files electronically via the MSDP
    Website
  • MSDP User Training Manual
  • Electronic Version of each MSDP Form type
  • PDF Version of each MSDP Form Type
  • MSDP Compliance Grids
  • MSDP Training PowerPoint Slides

51
51
52
MSDP User Training Manual
  • Section 1 Simplifying and Standardizing the
    Mental Health/Substance Abuse Treatment Process.
    Contains background information about the MSDP
    effort, the forms development process, and the
    benefits MSDP documentation processes provide.
    Also, this section provides specific information
    regarding Medical Necessity, payer, signature and
    compliance requirements and a discussion of a
    person-centered Recovery/ Resiliency approach to
    services.
  • Section 2 Using the MSDP Assessment Group
    Documentation Processes/Forms.
  • This section provides a sample of each
    Assessment form type, guidelines for the use of
    each form, and instructions for completion of the
    forms, including definitions for each data field.
  • Section 3 Using the MSDP Individualized Action
    Plan (IAP) Group Documentation Processes/Forms.
    This section provides a sample of each Action
    Plan Group form type, guidelines for the use of
    each form, and instructions for completion of the
    forms, including definitions for each data field.
  • Section 4 Using the MSDP Progress Note Group
    Documentation Processes/Forms. This section
    provides a sample of each Progress Note form
    type, guidelines for the use of each form, and
    instructions for completion of the forms,
    including definitions for each data field.
  • Section 5 Appendix This section contains
    supporting reference information.

52
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53
Case Studies
  • Adolescent
  • Adult
  • Where located MSDP Web site
  • http//www.mtmservices.org/MSDP/2009forms.html

54
Presented by David Lloyd, MTM Services
54
54
55
Presented by David Lloyd, MTM Services
55
55
56
Presented by David Lloyd, MTM Services
56
56
57
57
58
Stakeholder Information Provided via E-Mailed
UPDATES
58
Presented by Vic DiGravio and David Lloyd
59
MSDP Forms and Manual Website
  • Each of the MSDP 2009 version of the paper forms,
    e-forms and manuals can be downloaded by program
    type at the website
  • http//www.mtmservices.org/MSDP/2009forms.html  
  • MSDP UPDATE Website http//www.mtmservices.org/MS
    DP-Update.html
  • Technical Assistance will be provided by the MSDP
    Leadership Team. Email at MSDPHelp_at_Earthlink.net

59
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60
Medical Necessity SupportDocumentation Linkage
Capabilities
  • Bill Schmelter PhD

60
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61
Medical Necessity
The type, intensity and duration of an
intervention as provided by a qualified
practitioner and ordered by a qualified
practitioner in the current action plan is
needed to prevent worsening and/or produce
improvement of symptoms, behaviors and/or
functioning level related to an approved
diagnosis and assessed needs
61
61
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Medical Necessity Auditor View
  • Provided Service
  • Appropriately Qualified Practitioner
  • Clinically Appropriate and Allowed Services
  • At appropriate Intensity and Duration
  • As Prescribed in
  • Individualized Action Plan
  • Designed to
  • To improve functioning, symptoms and/or
    behaviors or prevent their worsening

62
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63
Documentation Linkage The Golden Thread
Assessment Data
Diagnoses - Assessed Needs Service
Recommendations
Individual Action Plan Goals
Individual Action Plan Objectives
Interventions and Services
Progress Notes
63
63
64
64
Presented by David Lloyd, MSDP Project Manager
64
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65
Presented by David Lloyd, MSDP Project Manager
65
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66
Presented by David Lloyd, MSDP Project Manager
66
67
67
Presented by David Lloyd, MSDP Project Manager
67
68
MSDP Implementation Strategies
  • Presented by
  • David Lloyd, President
  • M.T.M. Services

69
The Change Rules Have Changed
  • Behavioral healthcare community providers are
    facing an increased emphasis on delivering
    services that support rehabilitation/recovery,
    outcome based quality services, compliance,
    performance based funding, and change management
    requirements like no other time in our industrys
    history.
  • The MSDP Documentation Process is a SOLUTION

69
70
Change Challenges That Require Active Leadership
  • Quality Improvement Process Focus (QI)
    Typically Supports Lack of Forward Movement/
    Attainment Process based discussions of the
    need to change
  • Vs.
  • Continuous Quality Improvement Solution Focus
    (CQI) Implies Movement Forward/Action Has
    Happened to Provide Continuous Improvement

70
71
Key CQI Pre-Implementation Evaluation Areas
  • How many styles/processes of Diagnostic
    Assessments, Service/Action Plans, Progress
    Notes, etc. are currently being used by staff in
    the Organization?
  • What is the level of ownership in the current
    processes/documentation models?
  • Emotional response level from staff when faced
    with change needs
  • Willingness/support of Senior Managers to move
    forward

71
72
Key CQI Pre-Implementation Evaluation Areas
  • 5. Assess core competency levels of direct care
    staff regarding
  • Ability for staff to provide a more
    focused/objective information gathering/recording
    model/clinical formulation.
  • Level of narrative intensity in current
    documentation model versus focused check
    off/short narrative is critical through
    structured MSDP Clinical Tools
  • EHR Conversion Computer hardware and software
    skills for electronic recording of documentation

72
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Top Eight MSDP Implementation Challenges
  • 1. Change Itself
  • Change is hard
  • Weve always done it another way.
  • I like my way better.
  • Individualized documentation perspectives and
    professional pride
  • Lack of understanding of WHY we should change
  • Big changes might affect competencies of some
    staff
  • Concern that the MSDP forms will not keep up with
    accreditation changes

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Top Eight MSDP Implementation Challenges
  • 2. Training costs/Learning curve/Productivity
    issues
  • Initially it takes more time to use new forms
  • Dont know where to find info or where to put
    info in the forms
  • New forms might alter some internal processes
  • Training is needed to adapt to new forms system

74
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Top Eight MSDP Implementation Challenges
  • 3. Lack of commitment by top management
  • Perception that this is something we have to do,
    that this is being done to us, rather than
    looking for how it helps us.
  • Focus on rules, requirements and mandates
  • Lack of recognition of the changing business
    climate (increased scrutiny)
  • Focus on the perception that this will cost us
    money to implement, not seeing the potential for
    saving

75
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Top Eight MSDP Implementation Challenges
  • 4. Forms dont accommodate everyones current way
    of doing business
  • Asking clinicians to code billing strips on
    Progress Notes
  • Person Served name and at the top of page, not
    the bottom
  • Some info on CA weve always put on Demographic
    form or Health History form, etc.
  • At first, clinical staff disagreed with the CA

76
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Top Eight MSDP Implementation Challenges
  • 5. New processes
  • Lack of understanding of important linkages
    necessary in the documentation
  • A CA Update and IAP Review/Revision processes are
    not understood
  • Lack of recognition that new forms will require
    some processes to be changed or reinvented
  • Need to look at whole system of documentation
    rather than just pieces and focus on integration
    of services and documentation

77
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Top Eight MSDP Implementation Challenges
  • 6. Technology issues
  • Investments in current systems
  • Costs to make changes in current systems
  • Forms dont accommodate our existing business
    model need to be integrated into how we do
    business

78
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Top Eight MSDP Implementation Challenges
  • 7. Issues with the forms themselves
  • Not enough space to write on the forms
  • No lines in the text boxes
  • We cant change the forms
  • They are not in our local software which I know
    and love (They are in WORD!)

79
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Top Eight MSDP Implementation Challenges
  • 8. Incorporating a recovery culture
  • Shifting from a culture of doing for clients to a
    culture of empowering persons served
  • Lack of understanding what recovery/ resiliency
    is
  • Lack of understanding the Medicaid rehabilitation
    option

80
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Acceptance Levels of Change Process
  • Keep in mind the stages of acceptance of change
    staff typically go through with this process
  • Denial
  • Negotiation
  • Anger (Blaming)
  • Drop Out
  • Acceptance of the need to change

81
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82
Key Challenges To Address before Implementation
of MSDP Forms Begins
  • The trainer needs to believe in the MSDP
    documentation process and come across to the
    staff that way Select Trainers that really
    believe MSDP process is a positive change.
  • Be aware of individualized documentation
    perspectives and professional pride
  • Be aware big change may affect the competency of
    some staff Plan ahead to provide core
    competency training (i.e., Motivational
    Interviewing, Objective Recording Using
    Structured Form Process, etc.)

82
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Key Challenges To Address before Implementation
of MSDP Begins
  • Change is hard for some to accept may need to
    provide an enhanced Coaching/Mentoring
    Supervision Model during implementation
  • Management of an agency needs to feel confident
    and support the documentation processes if the
    agency is going to implement need buy in of top
    management
  • Initially will need to do a closer review of
    quality of notes and clinical forms

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Some Identified Solution Focus Areas to Assist
  • Focus on MSDP Forms are a Tool not a rule. As
    a tool it can address compliance and audit
    concerns.
  • Focus on what MSDP documentation can do FOR staff
    instead of what it will do TO staff. Look for the
    potential benefits. Talk about the benefits.
    Continue to remind staff that MSDP documentation
  • Meets all three national accreditation standards
    (JCAHO, CARF and COA)
  • Provides available documentation solution without
    having to develop local form design efforts
  • Prepares us to move towards electronic medical
    records
  • Senior management/leadership need to be visibly
    proactive about the MSDP forms. Communicate,
    communicate, communicate. Share learnings,
    ahas and success stories

84
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Some Identified Solution Focus Areas to Assist in
Implementation of MSDP Forms
  • Be proactive about training and re-training needs
    (i.e., schedule additional core competency
    support). Provide coaching sessions on
    documentation.
  • Develop and provide to staff a written
    implementation plan including a change management
    strategy. Whether you decide to implement one
    form at a time or a group of forms (i.e. Progress
    notes), or all the forms at once, be planful
    about the approach. Provide training and support.
  • Develop post implementation monitoring and
    coaching plans. Tie monitoring to CQI efforts.

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Some Identified Solution Focus Areas to Assist in
Implementation of MSDP Forms
  • With staff, look at processes that could be
    improved and how the transition to MSDP forms can
    help improve them. View MSDP implementation as an
    opportunity to take a look at the things that are
    problematic in your system and perhaps make
    changes. Use MSDP data for internal process
    Improvements.
  • Try the MSDP e-forms. Talk to your software
    vendor about integrating the forms into your
    systems (Several vendors are in the process).
  • Try each form at least 7 times and then keep
    track of issues, problems, suggestions for
    improvement.

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Implementation Timeframes and Supports
  • Establish a completion date before the initiative
    begins.
  • Develop a full implementation plan with action
    work plans to ensure operational readiness.
  • Recommend a pre-announced evaluation process to
    ensure all feedback regarding implementation
    process is given consideration

87
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MSDP
88
89
89
90
Lunch
  • Questions on Index Cards

91
Afternoon Agenda
92
Afternoon Agenda - Continued
93
  • How do We Know that these Forms Meet All the
    Requirements of our Funders/Licensures and
    Accrediting Bodies?
  • Presenter Kathleen Janssen, BSN, RN, MS,
    Director of Quality Management, Riverside
    Community Care

94
Compliance Review Team
  • Beason, Grace Department of Mental Health
  • Becker, Madeline Vinfen
  • Boardman, Judith Health Education Services,
    Inc.
  • Gaudette, Craig Advocates
  • Haughey, Jim Behavioral Health Network
  • Eckert, Jane MSPCC
  • Janssen, Kathy Riverside Community Care
  • Kress, Carol MBHP
  • Markle, Fran High Point Treatment Center
  • Morgenbesser, Marcy Network Health
  • Paschal, Christine Wayside Youth Family
  • Savage, Michele Baycove Human Services
  • Thompson, Doug Beacon Health
  • Wagner, Michael North Suffolk Mental Health

94
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List of Programs in MSDP
Child Day Services  Community Based Acute
Treatment (CBAT)  Community Rehabilitation
Services (CRS)  Community Support Program
(CSP)  Crisis Stabilization Unity (CSU)  Day
Rehabilitation  Detox Enhanced Acute Treatment
Services (EATS)   Detox Level III (Inpatient
Pregnant Women) Detox Level III.7
(Inpatient)  Detox Level III.5 (Inpatient
Residential/Dual Diagnosis)  Detox Level III.5
(Short Term Intensive Inpatient Treatment)  Detox
Level IV (Inpatient All Inclusive Detox
Adult/Adolescents)  
95
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96
List of Programs in MSDP (cont)
Detox Outpatient Detox Adolescent Dual
Diagnosis Acute Residential Treatment
(DDART)  Emergency Service Program (ESP) Family
Stabilization Team (FST) Flex Support
Program Intensive Outpatient Program Substance
Abuse (IOP) Intensive Residential Treatment
Program Intensive Community Based Acute Treatment
(ICBAT) Opiate Treatment Program Outpatient
Mental Health Outpatient Substance Use Disorder  
96
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97
List of Programs in MSDP (cont)
Partial Hospitalization Program (PHP) Program of
Assertive Community Treatment (PACT) Psychiatric
Day Treatment Rehabilitative Treatment in the
Community (RTC) Residential Services Adult
DMH Residential Services Adult DPH Residential
Services Child/Adolescent DMH Residential
Services Child/Adolescent DPH Respite Structured
Outpatient Addiction Program (SOAP) Transitional
Support Services (TSS) 
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List of Regulators / Licensers / Accrediting
Bodies - MSDP
  • Beacon Health
  • Documentation Review Tool
  • BHS FCHP Manual
  • BHS NHP Manual
  • DHHS Regs
  • DHHS Program Memo AB03037 MH
  • DHHS SMD Letter Rehab Option
  • DMA Regs
  • DMA 130CMR429.400 MH Center Manual
  • 130450-275 Resident Regs
  • 130CMR433-428 Docs
  • 130CMR418-400
  • 130CMR417 Day Tx
  • 130CMR450.100

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List of Regulators / Licensers / Accrediting
Bodies - MSDP
  • DMH Regs
  • DMH 104CMR28.00 Licensing and Operations for
    Community Programs
  • 104CMR29.00 Service Planning
  • Risk Management Policies Informed Consent for
    Psychotropic Medications/ECT Therapy
  • Comprehensive Assessment Requirements
  • DPH Regs
  • DPH 104CMR27
  • 105CMR140.000
  • 105CMR160 Detox
  • 105CMR161 STIIT
  • 105CMR162 SA/OT/PT
  • 105CMR750 Drug Tx Programs

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List of Regulators / Licensers / Accrediting
Bodies - MSDP
  • DMH Regs (cont)
  • 105CMR165 Halfway House
  • Family Substance Abuse Shelter Guidelines
  • Transitional Support
  • MBHP
  • MBHP Audit Tool
  • OT/PT Perf Specs
  • SOAP Documentation Requirements
  • CBATICBAT Performance Specs
  • Inpatient Acute Mental Health Performance Specs
  • Level 4 Detox for Co-occuring Disorders
    Performance Specs
  • Medically Monitored Detox ATS Performance Specs

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List of Regulators / Licensers / Accrediting
Bodies - MSDP
  • Network Health Regs
  • Network Health Chart Review Tool
  • NHIC Regs
  • NHIC (L13492) Health Behav Ass Tx
  • L3159 Diag Assess
  • L3162 Psycho Pharm
  • L3187 ECT
  • L3203 Neuro Psy Test
  • L3220 Group Tx
  • L3239 Ind Tx
  • L3242 Interactive Ind Tx
  • Article 90862
  • Transmit Psychotherapy Notes
  • Transmit Psych Tests

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List of Regulators / Licensers / Accrediting
Bodies - MSDP
  • Federal Medicaid Regs
  • Federal States Medicaid Manual 2500A Doc
  • States Medicaid Manual 4221 Psych OTPT
  • States Medicaid Manual 4320 Clinic
  • Federal Opiod Regs
  • 42CFR812 Opiod Tx
  • 42 CFR8.1221CFR291 Opiod Tx
  • JCAHO
  • CARF
  • COA
  • NCQA

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Compliance Grids
  • Compliance Girds
  • SDT Form Creation
  • CRT Form Review

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Compliance Reviews
  • MHSACM Compliance Committee

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The Compliance Challenge in Massachusetts and
the Potential of the MSDP Standardized Forms and
Processes
  • Joseph Passeneau, EdM, LMHC
  • Director of Health Record Review and Audit
  • Massachusetts Behavioral Health Partnership

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In 2001, MBHP Began Quality Initiative Statewide
Record Review
  • Since then
  • Over 29,000 records reviewed
  • More than 1,900 MA site visits
  • Recovered more than 950,000.

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State of Behavioral Health Recordsin
Massachusetts 2001
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In 2001, we found isolated examples of superior
documentation.
  • Generally, however, record keeping
  • Low Priority
  • Poor Quality
  • Confusing Forms / Terminology
  • Multiplicity of Forms.

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Recovery of Payment Administrative Issues
  • Missing Records / Notes
  • Notes Do Not Match Paid Claims
  • Exceed Authorization Parameters
  • Illegible.

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Recovery of Payment Medical Necessity Issues
  • As found in a record
  • played tiddly-winks, he got a score of 2600,
    told him it was the highest I ever saw. He was
    happy and I was happy. Plan return next week.

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When Clinical Forms are Not Standardized
  • Labor-Intensive Form Revision Process
  • Staff Training
  • Difficulty Reconciling Payer Requirements
  • Existence Of Multiple Forms, Same Facility
  • Frustration

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Is it an exaggeration
  • to say that across the state, there are at least
    1,000 versions of each sheet of paper, for each
    form?

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Lack of Standardization, At What Cost?
  • 8 most common clinical forms per OP record
  • Personal Info. Assess. (1p)
  • Comp. Assessment (4pp)
  • Individ. Action Plan (1p)
  • Progress Note therapy (1p)
  • Progress Note group (1p)
  • MDT Review (2pp)
  • Discharge Summary (1p)
  • Psychopharm. Eval. (2pp)
  • TOTALS
  • 8 forms 13 pages _at_ 1,000 versions 13,000
    pages 26 reams 2.6 cases of paper
  • 8 MSDP Forms 1 version, 23 pages

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Advice from The Joint Commission
  • When the problems/need statements are well
    written, the development of care goals and
    objectives is easy. If problems/need statements
    are vague and unclear, the development of
    observable care goals and objectives is laborious
    or impossible. Staff attitudes about the
    wastefulness of documentation then become
    self-reinforcing.
  • A Practical Guide to Documentation in Behavioral
    Health Care, 2nd Edition, The Joint Commission,
    2002, p. 64

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MSDP Forms are Tools
  • All tools take time to learn.
  • They are not substitutes for professional
    judgment and are not perfect.
  • Designed to
  • Clearly Identify Assessed Needs
  • Decrease Confusion
  • Fix Documentation Problems
  • Address Risk Management
  • Document Quality of Services

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The Potential of MSDP Forms
  • Designed to bring clarity to roles of
  • Person Served,
  • Provider,
  • Payer,
  • in the documentation of behavioral health
    services.

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Compliance and Clinical QualityIs There a
Relationship?
  • Bill Schmelter PhD

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Compliance and Quality
  • Is Compliance Related to Quality?
  • Strongly
  • Moderately
  • Poorly

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Compliance and Quality
  • Is compliance effort and cost proportional to the
    clinical benefit?
  • Yes
  • No

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Compliance and Quality
  • Lets throw out the paper!

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Compliance and Quality
Where is The Real Golden Thread?
Person Centered Process
Paperwork Process
A. Assessing with the Person
A. Completing Assessment Form
B. Planning with the Person
B. Completing the Service Plan
C. Working with the Person
C. Writing Progress Notes
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Compliance and Quality
Golden Thread
Assessing with The Person
Planning with The Person
Working with The Person
Writing Progress Notes
Completing the Assessment Form
Completing the Individualized Action Plan
Documentation Linkage Shadow of Golden Thread
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Compliance and Quality
  • Assumption ??
  • We do good work
  • We just dont document well.

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Compliance and Quality
  • How much of the Behavioral Health Systems
    problem with compliance audits is due to
    documentation?

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Compliance and Quality
  • Summary of Findings
  • OIG Audit of Medicare Part B Outpatient MH
    Services
  • 41 billed inaccurately wrong code, non-covered
    services, excessive billing
  • 11 unqualified providers
  • 65 poor documentation
  • 23 medically unnecessary
  • 22 receiving more services than necessary
  • 8 not receiving enough services

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Compliance and Quality
  • Is Our Documentation Worthwhile?
  • Worthwhile Documentation Models Should Support
  • Quality Person Centered Services and Positive
    Outcomes
  • Compliance
  • Efficiency

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Compliance and Quality
  • If our documentation was Worthwhile
  • we would not resent doing it!

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Compliance and Quality
  • Do we miss the point?
  • Examples
  • Strengths of person served
  • Relationship between assessment information,
    planned services and services provided
  • Misplaced person centeredness

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Compliance and Quality
  • Documentation should just be an accurate account
    of what we do
  • The goal is effective and compliant interventions
    (positive outcomes)
  • We should not need to Bend our documentation to
    meet compliance standards
  • Our documentation forms and processes should help
    guide quality services

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Compliance and Quality
  • Independence of Clinical Process and Paper
    Processes

Clinical Process World
Paperwork World
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Compliance and Quality
  • Integration of Clinical Process and Paper
    Processes

Paperwork World
Clinical Process World
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Compliance and Quality
  • Integration of Clinical Process and Paper
    Processes

Clinical Process/ Documentation
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Compliance and Quality
  • The MSDP Forms and Processes Provide a High Level
    of Support for Worthwhile Documentation
  • Support for Quality - Person Centered Services
    and Positive Outcomes
  • Compliance
  • Efficiency
  • As long as we dont miss the point !

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Break
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How New Therapeutic Issues Are Documented ..Use
of the Assessment Update Processes..
  • Bill Schmelter PhD

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How New Therapeutic Issues Are Documented
  • What do we do when new therapeutic issues are
    identified?

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How New Therapeutic Issues Are Documented
  • Cannot document new information in progress notes
    only if it has implications for services!
  • Cannot wait until scheduled Assessment Update or
    Action Plan Review/Update!

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How New Therapeutic Issues Are Documented

New Information Presented
Implication for change in service ?
No
Yes
Record only in Progress Note
Update Assessment Data
New Identified Need(s)?
No
Record in Assessment Update Only
Yes
Identify New Need(s) and Update Individual Action
Plan
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Presented by David Lloyd, MSDP Project Manager
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Presented by David Lloyd, MSDP Project Manager
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Presented by David Lloyd, MSDP Project Manager
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Presented by David Lloyd, MSDP Project Manager
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Presented by David Lloyd, MSDP Project Manager
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144
  • Person Centered Planning and the Importance of
    Documentation Support Using the MSDP Processes
  • Presenters Marcia Webster, CFAAC
  • Susan Schneider, MOAR

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Documentation that Supports People and their
Recovery
  • Standardized forms and processes can help
  • you do work that is
  • Increasingly, energized and driven by the person
    or family you want to support.
  • Oriented toward recovery.
  • Sustainable over time and with limited resources.

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Person-Centered, Person-Driven
  • Language, structures and decisions that are
    driven and fueled by the person using services,
    the whole of the person, are essential to
    effective care and support.
  • p. 28, MSDP Training Manual

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Concurrent Documentation The next frontier in
person-driven practice
  • Last month there was a huge reduction in
    my no show rating and to me, thats an
    indication that my clients like my attention and
    my approach... Ninety-five per cent of the time I
    leave work on time - I could never do that before
    I started completing notes in session.
  • Catherine A. Main, MSW, LCSW,
  • SOQIC (Ohio) Documentation Process
  • Implementation Manual p. 62

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Recovery-oriented Documentation
The concept of recovery emphasizes a persons
capacity to have hope and lead a meaningful life,
and suggests that treatment can be guided by
attention to life goals and ambitions. The
American Psychiatric Association, 2005
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Recovery and Peer Support Practitioners,
Researchers and Writers to explore...
  • Bill Anthony, Boston University, MA
  • Mary Ellen Copeland, VT
  • Pat Deegan, MA
  • Dan Fisher, The Empowerment Center, MA
  • Larry Fricks, GA
  • Ed Knight, Value Options, CO
  • Renee Kopache, OH
  • Shery Mead, NH
  • Mark Ragins, The Village, CA
  • Peggy Swarbrick, NJ-CSP

  • Nowhere
    near a complete list!

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Sustainable Documentation
  • Establishing a goal and pursuing a purpose over
    time and in the context of local community.
  • Answers the question what happened? instead of
    what is wrong?.
  • Affirms the individuals power, control and
    connections in the present and future.

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Role Play!
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Documentation that Supports People and their
Recovery
  • Marcia Webster, The Transformation Center
  • marciaw_at_transformation-center.org
  • 413-626-6968
  • Susan Schneider
  • susan.shr_at_gmail.com
  • 617-429-7398

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Recap and Next Steps
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Questions / Comments
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Adjournment
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