The GCBH RSN: the five prescribers who made the neuroleptic drug top ten prescriber list

3 out of 5 of the prescribers on the top ten neuroleptic drug prescribers list, work for CWCMH.

(no surprise here) 

Washington State' public mental health system has a "Regional Support Network" model or “RSN,” which acts as an intermediary between the State and Counties. It is a gate-keeper which distributes mental health funds to Counties, the Counties then contract for mental health services in the community. Densely populated counties, have their own RSN, such as King and Pierce Counties where Seattle and Tacoma are located.  

The RSN where we live is in the Greater Columbia Behavioral Health RSN which is a consortium of eleven counties. The region’s main industry is agriculture; with a lot of orchards, vineyards and hopps, crops which demand a lot of manual labor. Part of the Confederated Tribes and Bands of the Yakama Nation's tribal lands comprise roughly a third of the total area of Yakima County. Much of the tribal lands in Yakima County are not at all accessible for any purpose whatsoever; the Nation's land borders the Yakima Training Center, a military training ground.

Map found at Washington State Department of Ecology

The Confederated Tribes and Bands of the Yakama Nation, have been historically excluded from any meaningful participation in how mental health services and public policies affecting them are planned, provided, and/or administered by Yakima County government. As one can imagine, this situation has added insult to injury; to say the very least. For years and years, Yakima County has administered mental health funds which are distributed to the County to contract for mental health services for all of the citizens in Yakima County, including Tribal members.

The GCBH RSN had one of the worst offenders on Washington State's Top Ten Prescribers list compiled at the request of Iowa Republican Senator, Charles Grassley's Investigation into the illegal marketing of psychotropic drugs.  The list is comprised of the top ten prescribers for each drug; so there are more than 10 offenders, i.e. prescribers who prescribed neuroleptic, or "antipsychotic" drugs in extraordinarily high volumes. In any case, a psychiatrist who worked in Walla Walla and Benton Counties made the top ten list for four neuroleptic drugs. In 2009 he made the top ten list for both the Managed Care System, and in the fee for service system by writing a total of 1261 prescriptions for Abilify. In 2008 he wrote 2120 prescriptions for neuroleptic drugs, the following year he nearly doubled that amount.

Walla Walla, Walla Walla County and Richland, Benton County Jose Cardell, M.D.

2008      574)   $219,374.69  $189,049.13 Geodon
2008      1040  $357,963.10   $308,137.76 Risperdal
2008      1006  $235,977.13   $202,334.52 Seroquel
Totals    2120  $813,314.92    $699,521.41

2009     78        $33,604.94         $0          Abilify MCO
2009     1183    $612,219.58  $432,670.68 Abilify FFS
2009     662      $305,056.18  $218,710.57 Geodon  Average  $460.81  $330.38
2009     904      $456,102.36  $252,049.20 Risperdal
2009     1214    $383,517.94  $252,300.52 Seroquel
Totals:  4041 $1,756,896.06  $1,155,720.97

Theoretically, if this psychiatrist saw a total of 336 patients regularly once a month in 2009, and every one of them got a prescription every single month that would be a total of 4032 prescriptions---let's further suppose that he had a normal 5 day week with an average of 23 office days a month--he would have needed to see 14-15 patients every single day.

I was not surprised to find the psychiatrist who treated my son when he went to CWCMH on this list:
Yakima
Philip Rodenberger, M.D. Medical Director, Central Washington Comprehensive Mental Health, CWCMH.
2008       564 $155,700.98  $148,769.89 Risperdal
Nor was I surprised to find him on this list:
via ProPublica Dollars for Docs:
Payment Disclosure

Company AstraZeneca
Period 2010 Q1-Q4
Amount $15,300
Payee PHILIP RODENBERGER
Listed Practitioner Rodenberger, Philip
Location Yakima, Wash.
Service Speaking
Payment Disclosure

Company Eli Lilly
Period 2009 Q1-Q4
Amount $1,200
Payee PHILIP D. RODENBERGER, MD
Listed Practitioner RODENBERGER, PHILIP D.
Location YAKIMA, Wash.
Service Healthcare Professional Educational Programs
Number of activities 3


#prescriptions     Billed             Reimbursed
2009        293  $233,178.95 $213,696.19 KATHLEEN A MACK ARNP - FP Yakima
               235 $225,197.86 $190,843.84   ANGELO A BALLASIOTES PHARM  Yakima
        207 $127,953.72 $97,709.28 MICHELLE R WILLIAMS ARNP - FP Richland

No prescriber in the GCBH RSN made the Zyprexa top ten list. Three of the five prescribers from this RSN who made the list for Risperdal, work at the Yakima community mental health clinic run by Central Washington Comprehensive Mental Health under Medical Director, Philip Rodenberger, M.D.; who was my son's psychiatrist in 2008. The only other prescriber who is on the Risperdal list in the GCBH RSN practices in Benton County.  

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

3 of the top ten prescribers of neuroleptic drugs in Washington State

In my August 13th post, I promised an article on the top ten prescribers for Washington State. I had discovered that one of my son's former psychiatrists is on the list, he made the list during the time he was my son's doctor. I wasn't shocked---in truth, not much shocks me any more. The doctor I am referring to is a real piece of work. He actually told me that it didn't matter whether Isaac actually has schizophrenia or not--he was not going to discuss any change in his medication, period. However, this post will not feature my son's former doctor. Once I had examined the data the story that emerged did not include him.

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

2009     
               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