Dr. Bob Bluman, MD, CCFP, FCFP (biography and disclosures)
What I Did Before
As a family physician when I attended patients who presented with depression or other mental health concerns, I would try to determine the seriousness of their symptoms as well as uncover other factors that related to their mental state. I would then make a diagnosis and determine a therapeutic approach which might include referral to a psychiatrist, psychologist or other local mental health program if available or affordable. However, it was usually difficult to get my patients into these resources and due to my lack of tools and time to help these patients, I would often prescribe medications. My capacity to care for these patients was also limited in part due to a lack of adequate remuneration for my efforts and the amount of time it took to more fully help them. These limitations made this extremely important part of my clinical practice very frustrating.
What Changed My Practice
New GPSC supported fee codes for the development of a Mental Health Care Plan (fee code 14043), extra counseling visits (fee codes 14044, 14045, 14046, 14047 and 14048), supportive telephone/email patient contacts (fee code 14049) and Community Conferencing fees (fee code 14016) have encouraged me to spend more time caring for my patients with significant mental health problems (click to here to view fee codes). Further, after attending the Practice Support Program (PSP) Mental Health Module, I learned new tools to help me better assess and more confidently treat these patients (click here to view PSP Mental Health Tools).
What I Do Now
When I now attend a mentally distressed patient, I feel more appropriately compensated, empowered and confident to take the time to do a proper assessment and prescribe appropriate treatment. When indicated, I develop a Mental Health Care Plan using a variety of assessment tools. To support my care, I often resort to other readily available non-medication treatment options such as the Bounce Back Program, Anti-depressant Skills Workbook as well as the Cognitive Behavioural Interpersonal Skills Manual and the Family Physicians Guide which I learned to apply in the PSP Mental Health Module. Due to enhanced compensation related to the new fee codes above, I am able to spend more time interacting with these patients and I have the community resources to support my care. My MOA’s time to support these patients (with a billed Mental Health Care Plan), is also compensated (fee code 14049) as part of their planned follow up. I am also more open to share care with a psychiatrist or other Mental Health Care Professional since the Community Conferencing Fee can be billed for appropriate patients.
Overall, my practice satisfaction and success with these patients has significantly increased. I look forward to caring for my mentally distressed patients knowing that I have more to offer them and can afford the time to properly assess and treat them. My patient relationships have become more rewarding and I’ve become more excited about my medical practice. If you are interested in more information about the PSP or the Mental Health Module, please click here.
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The new suite of tools for Cognitive Behavioural Therapy and the associated billing codes have definitely improve my ability to care for patients with mental illness. I concur with Dr. Bluman’s comments in his article and hope that more physicians in our province and across Canada can be made aware of this supported approach with the associated tools from the Mental Health PSP.
I have also attending the practice support program and have found the tools which they have introduced me to very helpful. Using support handouts has given much better structure to my follow up visits for patients with depression and anxiety. I haven’t been taking advantage of the new fees up until now. I will begin to do so to allow more compensated time.
I’m glad to see that others feel strongly about this teaching module as I do. It probably was one of the most valuable continuing med education events that I’ve ever been part of and it has made the most impact on my practice.
There has to be some planning, though, to implementing and continuing to use this effectively in your practice. If you are paper based, the handouts/referrals need to be tracked and displayed in an easily accessed area of the chart. If you are on an EMR, there needs to be some effort in integrating the resources and skills into the EMR. Accessing the electronic algorithm as a pdf file on your desktop is ok but much more usable in a “real” patient visit when everything is instantly accessible.
PITO and PSP have supported “EMRizing” this into one vendor’s product and it works extremely well!