Bureaucratic Paperwork 101
Some how I missed this class. It should be a requirement so I don't know how I failed to take it. Ah, perhaps it would mean scaring too many of us away from our chosen profession if they let us know the truth. Even an internship isn't going to provide you with a real understanding of the insanity of it. I admit I don't know if ALL social work jobs are as paper heavy as those in the Substance Use Disorder field but I pray they're not for the sake of those who may suffer.
With no exaggeration, I spend 80 per cent of my workday doing paperwork or in meetings about it. A 6th day of work would not relieve me enough to make up the time to actually work with patients. I suppose this is why we've been told that we no longer have to see patient's individually except when going over their treatment plan or doing their initial assessment or taking their urine (that would be fun in group, wouldn't it?) We're supposed to learn everything we need to know about them in group. This is a skill that is eluding me as well. Especially when you have a patient who goes into a panic attack if you so much as look like you might ask her a question directly. Of course this does free you up to get more time in to do more paper work or consult about paper work or make phone calls about what paper work you need to send to a coordinating agency.
I used to work in a teaching hospital. We had rounds every morning where we actually discussed the treatment of patients. Kind of like group supervision, or at least that's what I've been told. Occasionally, because I worked on a private pay unit we'd discuss those patients who thought universal heath care coverage had already begun. It was amazing how many times they could forget, or their spouse forget or their personal assistant forget to bring in their universal credit card to pay their bills. But as they say, that's how the rich get richer. Now, working in an outpatient facility primarily funded by Medicaid, we too have rounds twice a week and case conference once a week. Once a week (case conference) we discuss absenteeism and the importance of the patient's being at treatment. Makes sense to me. Can't treat a patient if they're not there. But apparently a more important reason for having good attendance is cash flow. We have someone in charge of finances on site. Her job is to see to it that clinicians discuss in group the importance of attendance so we can get our Medicaid funds. It's also important to bring it up in group for the few who pay out of pocket to be sure that they understand that they actually must pay and not just promise to do so as so many have been confused into thinking. I do so wish that just once the administration would pretend that it's important to have patients attend treatment for treatment sake. Seems to me Medicaid payments come along with the patient so if we pretend the really important reason for attending is to get better then the agency will get their funds! I know, it's silly thinking.
In five months I don't think I've heard the term transference or counter transference once. I've tried to slide it myself every once in a while given that 50% of my clients suffer (do they actually suffer or does everyone around them suffer?) from every type of personality disorder available. But I'm usually met with blank stares or "We don't have to worry about that. The auditing agencies never check to see if we mention that on any of our forms." Apparently they don't check to see if there's been any individual therapy either. But they do care if there are 16 people in your caseload group instead of 15. I don't know what they expect you to do with the five extra people they say you can have on your caseload when its time for a group, or why they won't pay you for a group of 45 to whom you try to bring some education on the "physical effects of alcohol and cocaine." YOU try keeping the attention of 45 addicted individuals in early recovery for 60 minutes. Payment and a bronze star seem about right to me!
But I digress. This was about paperwork. The last week of the month is REAL crunch time. Patient's I have in drug court, TASC, DTATI, or with cases involving CPS (equivalent of ACS in NYC), MPS, DSS (and if you have someone on Medicaid you have a DSS client, which means almost everyone), or in shelters(almost everyone) all require a monthly report on attendance and drug screens. Apparently most substance treatment agencies cannot afford healthcare software which might make such reporting somewhat easier (though each agency also seems to require their OWN style form, so the last week of the month is spent searching through charts looking for paper work to back up "excused" absences and hand written sign in sheets to be sure the patient was there all other times. I know in NYC there is something called "Stars" which I believe is allowing agencies to track such reports on line. I would have thought Obama's campaign for online medical reporting would have translated into some funding to allow such things to happen elsewhere, but I guess I'm just a foolish optimist.
Maybe universal healthcare ISN'T such a good idea, given what hoops we're given to jump through for Medicaid. With private insurance you barely have to prove anything. Of course every 3 sessions you do have to call them and explain why treatment hasn't cured the patient yet in order for them to pay 50% of the next 3 treatment days. At about treatment day 10 they tell YOU the patient isn't going to improve anymore and they won't pay for any more days. Doesn't matter if you tell them they still have cravings to use and suicidal ideation--according to their book it doesn't matter because the actuarial odds show they won't recover now anyway. So simple, neat and quick. This is also helpful when it comes to backlogs of patients trying to get into treatment. No long-term, tedious, treatment. No reams of paperwork. They simply just say no. Hmmm I've heard that phrase before....