eNewsletter - March 2016

Behavioral Health Partners


The Subtle Art of Insurance Authorization: How to view insurance companies
By Kelly Grill-Cooper, MS, LCPC

I don’t know about any of you but I did not even have one graduate school class that imparted any skills or wisdom for dealing with insurance in the real world of behavioral health.   

Sure, I learned symptomology, diagnostics and theory, and I scrutinized endless amounts of behavioral health case studies.  However, not once did anyone alert my fresh-faced-save-the-world-self that if I wanted to actually see a client (while simultaneously healing the world and graduating from a life of eating Ramen noodles), I would first have to find a means to get payment from the client.    

Once out in the public sector, I became quickly versed in documenting.  I did so, not so much to meticulously record the interactions with the patients, but for the governing bodies that could, at a moment’s notice, swoop in and dissect every document in the patient's file and check my compliance with the standards set forth by various national entities. 

The dissection was not as much of a surprise as, at times, the daily dance I would do with managed care. As I balanced my daily workload of seeing patients, mediating crises, completing the paperwork, complying with the standards of care (ex: treatment planning, reminder calls, mental health assessments, etc) and doing all this within a reasonable work week, I felt satisfied with all of my efforts until managed care questioned it all. 

Their endless list of questions included:

  • How much longer do you expect to treat?
  • What evidence-based treatment modalities are you using?
  • Are they working?
  • When do you expect them to work?
  • Are they linked to the treatment plan you wrote with the patient? 

And the list goes on… 

All these questions were being hurled at me from a reviewer I imagined was sitting in a plush, well ventilated living room in front of a roaring fire, laughing diabolically while typing my answers with one hand, and twisting an ever heinous mustache with the other. 

Why are they out to get me, I wondered? Don’t they know what I am doing each and every day to contribute to the betterment of a person's life? Heck…the betterment of the planet? 

As time went on, I went from a meek, fearful green therapist to a more confident, skilled clinician and started to use my new found wisdom in my interactions with various insurance companies. 

It was then that I truly came to understand what all the questions amounted to and how to view these inquires: insurance companies are not the enemy, but rather a wily adversary that serves to keep my skills sharp and my pursuit of greater mental health at the forefront of every encounter with the patient. 

I made it my focus to interact with the patients in such a manner that promoted me always asking myself these questions:
  • Are we plateauing in therapy?
  • What can I do different with the patient to petition better results?
  • Am I structuring this time frame with this patient to get the best outcomes from what my training taught me?  

I aspired to be better so I could do better, and report the merits of my passion as it spilled out in all its evidence-based glory.  I did so via lengthy dialogue with reviewers from major insurance companies and I learned to spell out the merits of the case.  I would throw every ounce of evidence-based goodness I could at the patient to get the results we both sought. 

Yes, it’s true, sometimes I would lose.  But, what I learned most was that if I could find a way to show the insurance company the human story in the case file of evidenced based practice, I would have a better chance at getting more treatment days.  This realization ultimately lead me to what I wanted which was more time to work with the patients who sought the “healing light” of treatment that I had promised to keep on for them.  

Kelly Grill-Cooper, MS, LCPC

Kelly graduated from Iowa State University with her Bachelor’s degree in Child and Family Services and her Master’s in Clinical Psychology from Benedictine University in Lisle. She has worked in a variety of clinical positions with various populations including multiple roles in the treatment of sex offenders and working in the chemical dependency field. In addition to this, Kelly has worked in the corrections field, with the homeless population and with wards of the state. In her spare time, she teaches and practices self-care by means of oil on canvas painting.  




Promoting Excellence in Psychiatric Mental Health Nursing:
How Linden Oaks Nurses are Leading the Way
By: Kelly Bryant, MS, BSN, RN-BC, NEA-BC, CNE, Director, Clinical Excellence/Magnet Program Director, Linden Oaks Behavioral Health


Nurses are recognized as key members of the interdisciplinary healthcare team, vital to redesigning health care in the United States (IOM, 2010).  As the complexity of healthcare increases, higher levels of education and training are required to assure provision of high standards of safe, effective, quality care for patients and families. 

National board certification for nurses and sharing best practices through professional nursing organizations are ways in which nurses can demonstrate their knowledge, skills and abilities to improve care. Certification exemplifies a commitment to nursing excellence and better patient outcomes through attainment of the highest credentials in a specialty area.

In 2014, Linden Oaks Behavioral Health embarked on a journey to foster a culture that encouraged higher certification for our nurses.  As part of this initiative, we focused on best practice sharing in designated specialty areas including psychiatric nursing, gerontological nursing, addictions nursing, nursing professional development, and nursing administration. At the end of 2014, we had 29 nurses who had attained specialty certification.  


Beginning in 2015, Linden Oaks implemented a formalized plan to increase the number of certified nurses on staff.  Our overall goal was to acknowledge the specialty expertise of our nurses, validate their competency, enhance patient safety, and recognize their professional commitment to lifelong learning.   

We did this, in part, through participation in the Success Pays Program sponsored by the American Nurse Credentialing Center (ANCC), a program which helps hospitals facilitate the provision of onsite certification review courses.  In 2015, an additional 33 nurses earned their specialty certification through ANCC.   

In 2016, we are continuing our participation in this program and through February we have had another six nurses who have obtained certification.   

As part of our goal to recognize higher education, this year we are holding a special celebration event on March 17 to recognize the extra efforts of the certified nurses and their dedication to achieving higher credentials.  This celebration is a part of the nationally recognized Certified Nurses Day celebration endorsed by ANCC.  

This past weekend, Linden Oaks sponsored the 15th Annual Illinois State Meeting for Psychiatric Nursing at the Northwestern Memorial Hospital Prentice Conference Center in Chicago, IL. In addition to our nurse representation at the conference, we were accepted to give three poster presentations disseminating behavioral health best practice information.  

Linden Oaks has been a major supporter of the Illinois Chapter of the American Psychiatric Nurses Association (APNA) and this year we also presented at the APNA’s 29th Annual Conference in Orlando, FL.  These presentation opportunities are, in part, due to the increased dedication of our staff and organization to attain higher certification over the past few years.    

We are proud of each of our nurses and the exceptional care they provide to our patients and families and their dedication to excellence in psychiatric mental health nursing. 


References

Biography

Kelly Bryant is a nurse leader and educator with over 34 years of experience.  She currently oversees quality, education, research, and practice initiatives at Linden Oaks Behavioral Health. In addition, she serves as the Magnet Program Director and Crisis Prevention Institute (CPI) Coordinator.  Kelly holds several specialty nursing certifications.  She belongs to a number of professional nursing organizations including APNA, where she regularly provides professional presentations to share best practices in behavioral health care.