I am outraged more and more as time goes by due to the lack of meaningful change in the public mental health system upon which my son relies. Outraged by the fact that ethical consumer/family driven care is entirely unavailable in our community. The primary purpose for the so-called mental health transformation is to transform the system to be client centered and client/family driven. I see no evidence that this is actually part of the "mental health transformation" plan where we live. I see a consistent effort to control and direct this supposedly "Community Driven project" by the Washington State employees and contracted providers with a vested interest in maintaining the status quo. Changes that are made seem to be for appearances sake.
The Conflicts of Interest that have been permitted for virtually every member past and present on the Washington State's mental health planning and advisory council no doubt have something to do with the lack of real progress and lack of meaningful systemic change. I do not see the fundamental changes being made to prevent other children from experiencing what my son did. I do not see treatments and services being made available to aid in real recovery. I do not see something other than neurotoxic drugs that cause iatrogenic injuries and illnesses being recommended as an alternative for those who do not wish to risk disabiltiy and death to "medically treat" their depression, anxiety, biopolar disorder, ADHD, or schizophrenia. these psychotropic drugs are the "first-line" and in many instances, the ONLY treatment made available to people with a psychiatric diagnosis. There is, in my opinion, not nearly enough effort being brought to bear on providing the tools and services which are known to help people effectively recover, and entirely too much effort spent on maintaining the status quo...
This post is about the high volume prescribers of neuroleptic drugs in Washington State which are being over-prescribed in spite of the overwhelming evidence of the grievous harm being done.
I wonder if this first prescriber is the one that Jeffrey Thompson, M.D. Medical Director for Washington State's Medicaid program refers to in his email posted on What's an emergency?
These are the from the Fee For Service Prescriber list
Lakewood Pierce RSN Kathleen Potter Hughes ARNP Family Practice (no longer a provider)
year presciptions Billed Reimbursed
2008 607 $223,480.46 $188,263.34 Geodon
2008 2149 $555,131.94 $473,035.08 Risperdal
1195 $421,639.60 $355,807.23 Seroquel
1150 $401,034.76 $343,665.07 Zyprexa average re $298.84 b$348.72
Totals 5101 $1,601,286.76 $1,360,770.72
465 $233,935.39 $138,307.69 Geodon
986 $419,052.14 $314,197.71 Risperdal
1195 $421,639.60 $355,807.23 Seroquel
1189 $714,132.02 $414,090.03 Zyprexa average re $348.27 b$600.62
Totals 3,835 $1,788,759.15 $1,222,402.66
Something totally fishy with this data. Seroquel data is identical for 2008 and 2009. The Zyprexa data shows that Ms. Hughes wrote 39 more prescriptions in 2009 than in 2008. The average amount billed in 2008 per prescription was $348.72, the average amount reimbursed $298.84. In 2009, the average amount billed per prescription was $600.62, while the reimbursement rate per prescription was $348.27---virtually the same amount that was billed per prescription in 2008. The total amount billed to Medicaid in 2009 increased by $313,097.26; using the 2009 average billing rate of $600.62, this represents an amount which would be billed for 521 prescriptions. Looking at the data from another angle, the increase in the billing amount divided by the number of additional prescriptions and the average cost of each of the 39 prescriptions amounts to $8,028.13.
By comparison here is the Zyprexa data for a psychiatrist in Spokane, Dr. William Bennet, M.D.
505 $205,810.11 $177,782.93 Average $407.54 $352.05
635 $435,508.19 $244,998.99 Average $685.84 $ 385.83
130 more prescriptions increased the amount billed by $229,698.08, the increase represents the average amount billed per prescription was $1766.91. Taking the amount of the increase in the reimbursement $67216.06, and dividing it by 130 the average amount reimbursed for 30 additional prescriptions is $517.05.
For further comparison here is another psychiatrist in Spokane, Dr. Hal G. Giliespie
482 $302,238.38 $263,728.85 Average $627.05 $547.16
516 $362,267.89 $242,902.92 Average $702.07 $470.74
Now this doctor has the highest per prescription billing rate of the three, and also the highest per prescription reimbursement rate--by a significant amount. In spite of his increased per prescription billing amount in 2009, his per prescription reimbursement rate is significantly lower in 2009 than it was in 2008. Despite this fact, this doctor’s reimbursement rate is significantly higher than either of the other two prescribers featured.
The real question is why are billing and reimbursement rates so disparate for different prescribers? All three prescribers were prescribing the same drug and two of them were in the same town. The two psychiatrists in Spokane are within the same mental health Regional Support Network, so the wide disparity in the billing and the reimbursement rates are particularly troubling, and very odd.
I want to thank Jim Stevenson from Washington State's Health Care Authority for his prompt response to my request for the data for this post.
Top Ten Fee for Service
Top Ten Managed Care