In an earlier post I criticized my state's Medical Quality Assurance Commission for faulting a physician for not requiring more frequent visits with a patient who appeared to need monitoring of suicide risk.
The official CPT code for Psychiatric Medication Management (the infamous med check) is 90862. As far as I know a code for Suicide Risk Monitoring does not exist. Yet responsibility falls on the shoulders of mental health professionals simply to "see" patients who might be at risk of suicide often enough that somehow sufficient frequency will prevent a suicide attempt. This means presumed suicide risk dictates frequency of visits not otherwise needed for treatment.
Regardless of whether increased frequency of patient encounters can actually prevent suicide, I argue that, particularly in light of shortages of psychiatrists in many areas of the country, a nonphysician could more cost-effectively carry out this function which amounts to little more than behavior control. Here's how it would work: a given clinic or professional or even a family member could require any patient deemed at risk of suicide to purchase suicide risk monitoring services separately. Such a company would regularly contact the client to assess risk of self harm, independent of treatment of any mental disorder, using a tally of risk factors and standardized rating scales. This would free treating professionals to focus on treatment, possibly increasing its cost effectiveness and leaving behavior control to SRM, Inc. In fact, since suicide frequently occurs in the absence of any mental disorder, such individuals might not need mental health treatment at all.
Increased risk would lead to increased monitoring or even incarceration. SRM, Inc. behavior control teams (BHT) could follow clients into hospitals.
Who would pay for suicide risk monitoring? Should medical insurance pay even in the absence of a diagnosed mental disorder? Should society bear this cost? the individual? a family member? Would the cost be offset by reduced number of suicide attempts and associated needs for treatment? Could such a service reduce the need for expensive psychiatric hospitalization?
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I think that it takes more than a checklist approach to adequately assess suicide risk. Every psychiatrist I know uses an assessment that goes past the usual monitoring and may not be accessible to nonpsychiatrists. A good example is severe character pathology that leads to high risk behavior in certain situations. Monitoring of risk is also not enough, and something should be actively done to reduce risk. To some extent suicide risk doesn't mean what it used to. In many cases it is the only way for a person to get into a hospital and in most of those cases the hospitalization is probably indicated.
ReplyDeleteI agree that it takes a lot more than frequent 90862s to prevent suicide and that visits for that purpose are no substitute for treatment. The state should be faulted for applying a managed care tactic for RATIONING psychiatric care and mistaking that for a treatment modality.
GD MD