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PubMed1980

Liability and electroshock therapy.

The malpractice status of the use of electroshock therapy (electroencephalotherapy) has been reviewed. In about 40 years, there have been relatively few reported cases dealing with EST (EET) and professional liability. Few cases have been won, and those generally for modest amount. However, future successful claims are expected to reflect current inflation. Certainly the limited volume of litigation would seem to raise a question as to the justification for the extent of the surcharges charged for psychiatric malpractice insurance for the administration of EST. Potential liability for EST continues to be a significant threat to the psychiatric practitioner, although drug matters, suicide, and conformance with legal standards seem a more significant area for current litigation. Those who use EST (EET) can minimize liability exposure by (1) obtaining an informed consent from the patient, (2) describing the method of treatment and possible complications to the family or patient and so noting, (3) ensuring legal authority to treat the patient who is incompetent to give consent or for whom special procedures are required, (4) treating in accordance with accepted procedures, (5) avoiding outpatient EST, if possible, (6) paying close attention to patient complaints, (7) keeping good records, and (8) not promising perfection.

Electroconvulsive Therapy↗
PubMed1977

Psychiatric peer review: the Washington, D.C., experience, 1972-1975.

The authors describe the method by which claims review for psychiatric practice is carried out by an APA district branch peer review committee in the Washington, D.C., metropolitan area and analyze the claims reviews handled by the committee from 1972 through 1975. On the basis of their findings they conclude that peer review of psychiatric treatment can be carried out in a medical framework, that it can have some effect in diminishing costs incurred by improper utilization or by abuses, and that it can improve the quality of psychiatric practice.

Ambulatory Care↗
PubMed1987

Psychiatry before the year 2000: the long view.

The author assesses psychiatry's accomplishments during the past quarter century and the challenges the profession faces in a changing political, economic, and medical environment. He believes that several of the policy decisions of the early 1960s, particularly the deinstitutionalization movement, were based on faulty premises and that their consequences hold valuable lessons for future policy planning. Among psychiatry's major challenges are advancing its knowledge base through intensive research; increasing the accessibility and quality of existing therapeutic services despite constrained resources; and enhancing confidence of the voting and paying public, including other physicians, in the field's unique capabilities. Such confidence will be conditioned on a rigorous redefinition of the boundaries of psychiatry, acknowledging both the field's limitations and its responsibilities to other than the "traditional" psychiatric patient.

Deinstitutionalization↗
PubMed1992

Case-based reimbursement for psychiatric hospital care.

A fixed-prepayment system (case-based reimbursement) for patients initially requiring hospital-level care was evaluated for one year through an arrangement between a private nonprofit psychiatric hospital and a self-insured company desiring to provide psychiatric services to its employees. This clinical and financial experiment offered a means of containing costs while monitoring quality of care. A two-group, case-control study was undertaken of treatment outcomes at discharge, patient satisfaction with hospital care, and service use and costs during the program's first year. Compared with costs for patients in the control group, costs for those in the program were lower per patient and per admission; cumulative costs for patients requiring rehospitalization were also lower. However, costs for outpatient services for patients in the program were not calculated. Treatment outcomes and patients' satisfaction with hospital care were comparable for the two groups.

Adolescent↗
PubMed2004

Use of health care services and costs of psychiatric disorders among National Health Insurance enrollees in Taiwan.

The National Health Insurance (NHI) database in Taiwan was used to detect the use of health care services and the costs of psychiatric disorders among NHI enrollees. Data were analyzed for 126,146 enrollees. Four categories were used for enrollees: no psychiatric disorder, a minor psychiatric disorder, a major psychiatric disorder without catastrophic illness registration, and a major psychiatric disorder with catastrophic illness registration (which eliminates copayments). Compared with enrollees with a minor psychiatric disorder, those with a major psychiatric disorder, either with or without catastrophic illness registration, had higher use and costs of mental health care services. Compared with enrollees without a psychiatric disorder, those with a minor psychiatric disorder or a major psychiatric disorder without catastrophic illness registration had higher use and costs of non-mental health care services. Both the mental and general health care of persons with psychiatric disorders are important.

Databases, Factual↗
PubMed1990

[Invalids due to psychiatric reasons].

A sample of 150 applicants for insurance indemnity for psychiatric disability discriminates from a general township population by older age and lesser education, and from an outpatient group by older age, only. In the sample of the insurance applicants, there were diagnosed more neuroses and less other non psychotic psychiatric disturbances and less oligophrenics than in the outpatient group. 22 insurance applicants proved to be able to work. Among the disabled no subgroup such as foreigners, females or single people proved to be more susceptible to disability than others. Neurosis was the most frequent diagnosis among the disabled. The depressive syndrome and, equally, personality disorder tended to lead to disability mainly in the more than 50 years old.

Aged↗
PubMed1977

Peer review and PSRO in American psychiatry.

The past 5 years have provided major pressures for and development in the varied areas of peer review of medical services. Organized psychiatry's activities on the national and local levels have been vigorous and responsive. The author traces the development of the mandated, professional and third party payer forms of peer review and the mechanisms and requirements within these programs. The specific programs and projects within the American Psychiatric Association and it's district affilates are also reviewed.

Insurance, Psychiatric↗
PubMedDate not supplied

Billing for psychiatric evaluations: options for coding and reimbursement.

The complexity of the current practice environment challenges clinicians to master complicated billing and coding regulations. Failure to properly bill and code can result in reduced potential revenue for services providers and, if improperly done, could lead to paybacks or penalties for the clinician. The purpose of this article is to assist psychiatrists in choosing the optimal coding for new evaluations and to understand the documentation requirements. Comparisons are provided between the "psychiatry codes" and the "evaluation and management" series. Details of required history, examination, and medical decision-making are listed in order to provide the tailed knowledge necessary to appropriately utilize some higher paying evaluation and management coding options for psychiatric evaluations.

Decision Making↗