Are mental health clinic audits asking the wrong questions?

Mental health clinics of all types, especially large publicly supported facilities, are subject to considerable oversight and regulation by various organizations. These include state health and mental health departments, insurance companies or coordinated care organizations (CCOs), federal agencies such as the Centers for Medicare and Medicaid, and other groups. Representatives from these regulatory agencies typically come on-site to periodically audit clinic operations by reviewing medical records, interviewing staff and customers, and writing reports specifying “findings” that need to be addressed and corrected.

I have experienced many of these myself on both sides of the evaluation process. These audits require significant resources from all involved. Can be time consuming and a lot of work stressful Because these evaluations can have real-world implications for things like accreditation and funding.

These reviews also help identify and fix issues while providing external information. motivation In order for clinics to remain compliant with many administrative regulations and policies. We tend to think we follow all the rules anyway, but honest self-reflection reveals that having someone looking over our shoulders on a regular basis is more important than we’d like to admit.

At the same time, it’s hard not to notice that these quality reviews often focus on relatively small matters while ignoring much larger quality issues, in typical “missing the forest for the trees” fashion. Forms, documents, and deadlines often go through a lot of scrutiny and are rarely checked. Note Paid for big-ticket items.

What do these audits tend to investigate?

• Whether the patient’s treatment plan is written and signed on time. (And these are often fairly unhelpful goals that clinicians are charged with. Clients use coping skills 70% of the time they are under stress.)
• Is it documented that new staff have undergone various employment-related forms and required training within a certain period of time?
• Ensure you have updated and approved policy statements on various required topics.
• Forms such as consent to treatment or disclosure of information (ROI) have expired.

Sure, there may be some value in making sure this type of work is completed and updated, but here are the types of questions that are rarely asked in the clinic:

• Is your patient or client getting better (how do you know that)?
• Can patients who need medical attention be seen immediately?
• Are drugs prescribed with appropriate informed consent?
• Does your clinician have the time and skills to make an accurate diagnosis?
• What evidence-based treatments does your clinic offer? What is missing?
• To what extent does your clinic adhere to published best practices for various conditions (early stages)? mental illnesseating disorders, substance use treatment, etc.)?

It is a real mystery why these important areas are not addressed by regulatory review. People may believe the question is too abstract, or they may believe that someone else is providing this monitoring (and no one is).

Part of the reason for this omission may have to do with who actually performs these audits and what their expertise is. Auditors are often enlightened public servants who may or may not have previous clinical experience, but are familiar with relevant policies and regulations. Practicing clinicians are rare, and those with medical training such as psychiatrists are even rarer. So it’s very easy to argue that evaluators aren’t really qualified to consider some of these larger, more complex issues, and no one else will.

In my opinion, this is a missed opportunity. When policy makers worry about mental health “system” issues, they tend to focus on: access. This is certainly an important component, but quality The treatment was established by assuming that people would get better if they saw some kind of mental health clinician. Unfortunately, this assumption is simply not true.

I don’t know why things don’t change. In fact, it may not be that difficult. When I worked as a medical director for another state’s Department of Mental Health, one of my jobs was to ensure quality and compliance at publicly funded clinics. When I learned that there was actually nothing stopping me from participating in state clinic audits, I decided to start going to clinics myself. While I was interviewing some of the clinic leaders and asking the big-picture questions I mentioned above, my assigned staff member was reviewing things that needed to be reviewed.

This was an eye-opening experience, and I think it got the attention of clinics in our state and started thinking more about these larger quality issues. If we need to “teach to the test” anyway to prepare for the next audit, why shouldn’t we teach about the most important issues? By contrast, my current home state (which has 10 times the population of my previous state) have Medical Director within the Department of Behavioral Health.

The end result of all of this is that you miss important opportunities for improvement because you can’t even assess the problem. If regulators are going to spend time and resources assessing the quality of mental health services anyway, they would be better off carrying out these audits in a way that can have the greatest impact on care.