The PRMS Blog

Happy Holidays From PRMS


On behalf of everyone at PRMS, we wish you a wonderful holiday season and a new year full of good health and much happiness.

We appreciate the opportunity to be of service to you. In recognition of the commitment and care you provide your patients and to say “thank you,” we will once again make donations to charities that focus on mental healthcare. This year we will continue to support NAMI. We will also make donations to the Society for Suicide Prevention and, in recognition of the recent natural disasters here and elsewhere around the globe, to World Central Kitchen. 

1. National Alliance on Mental Illness (NAMI) – We so appreciate the advocacy and dedication of NAMI to ensure access to treatment for those affected by mental illness.

2. American Foundation for Suicide Prevention (AFSP) – This organization raises awareness, funds scientific research and provides resources and aid to those affected by suicide. 

3. World Central Kitchen – Established by Chef Jose Andres, this organization uses its network of chefs and volunteers to feed thousands of people in disaster areas but also works to empower people with a focus on health, education, jobs, and social enterprise. 
                                                                
Happy Holidays!

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The Life of PRMS: Ashley Quattlander, Marketing Assistant


Only a year and a half ago, I was graduating from the University of Richmond with a degree in marketing. Fast forward a few months and I was beginning my first ever full-time position with PRMS as the new Marketing Assistant.

I knew for my first job I wanted to be at a company where I could develop and grow as a marketer and I have found that with PRMS. I have had the opportunity to work with a highly talented team who I learn from on a daily basis. From day one, they have exemplified how friendly and hard-working everyone is at PRMS. Who wouldn’t enjoy working with a team who takes you trapezing to get the creative juices flowing?

One of the most admirable qualities of working for PRMS is how it cultivates its employees. Continuing your education is encouraged and over the past year I have taken classes on design and social media marketing, making me a more valuable member to my team. I am grateful to work for a company that values its employees so highly and I look forward to a lengthy career with PRMS.

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Guest Blog: Finding Novel Ways to Support Adults with ADHD


As a part of PRMS’ ongoing commitment to behavioral health, we invited Jacob Behrens, MD, in Milwaukee, WI to be featured as our guest blogger this month.

ADHD, or attention-deficit/hyperactivity disorder, often conjures images of rambunctious young boys running circles around a classroom. It is generally more difficult to spot in adults, many of whom have more subtle symptoms and suffer silently for years before they get a diagnosis.

Jacob Behrens, MD, CEO and medical director of Envision ADHD Clinic in Milwaukee, is passionate about changing that for adults with ADHD. Behrens said he sees ADHD as a “positive diagnosis and a potential gift” to hone via treatment rather that fight as a negative that should be eradicated.

“Having ADHD is like having a Ferrari engine but fiat brakes,” Behrens said recently. “I don’t want to turn down your horsepower. I just want to fine tune your brakes and put you in better control through all of life’s inevitable curves, road construction, traffic, etc.”

October is ADHD Awareness Month. An estimated 2.5 percent of U.S. adults have ADHD, and without treatment, they can struggle with motivation, staying organized, being on time, and impulsivity. Depression and anxiety are often related, particularly when someone is not performing at a level they know they can and getting constant negative feedback from coworkers and significant others.

In adults, documented risks of non-treatment or under-treatment of ADHD include the potential for increased rates of criminality, motor vehicle accidents, accidental death, substance abuse, obesity, divorce, being fired from a job, homelessness, earning less than colleagues, as well as numerous other psychiatric comorbidities.

Some providers balk at making an ADHD diagnosis, Behrens said, because of lack of time/resources to make a confident diagnosis and concerns/difficulty prescribing controlled substances. While there are certainly risks of misuse and abuse, thorough diagnoses and careful fine-tuning and monitoring are key. ADHD is one of the most readily-treatable conditions in psychiatry and the risks of not treating should be looked at as well, Behrens said.  

For more information about ADHD Awareness Month, visit https://add.org/adhd-awareness/

More about Dr. Behrens and Envision ADHD:

As an outpatient specialist and chief resident at his alma mater, the University of Wisconsin School of Medicine and Public Health, Behrens worked to find new and better ways to expand care to ADHD patients – many of whom were high-functioning professors, lawyers and project managers from the area. He began using technology to build tools for more thorough evaluation and outcome tracking, which included use of in-session ipads and web/phone based home solutions for patients to collect and monitor data.

Envision ADHD, which he founded in 2016, works to evolve with emerging technologies and research to tailor adults’ clinical experience. One significant way is by recognizing the conflict between demanding lifestyles and commuting to an office each month to pick up paper prescriptions or to have an in-person follow-up visit when the patient is stable.

Before founding Envision ADHD, Behrens already knew a lot about e-prescribing, telemedicine, health records systems and patient portals through years of policy involvement with the American Medical Association and American Psychiatric Association and advising technology start-ups. He studied various models and even contacted PRMS for regulatory and risk management advice. “PRMS has been a great resource. I don’t think I would have felt comfortable starting out on my own without their guidance,” Behrens said.  

Much of how the Envision ADHD Clinic is set up is similar to the direct primary care model, which offers an alternative to fee-for-service insurance typically by charging a monthly, quarterly, or annual fee that covers all or most primary care services. Patients, in turn, often have a greater access to, and time with, their providers.

Patients – limited for now to Wisconsin residents – can schedule initial visits on Behrens’ website. The relationship begins with a comprehensive two-hour, in-person evaluation that includes a clinical history, rating scales, and computerized testing to determine diagnosis followed by extensive education and review of a large menu of treatments, including medications, coaching/therapy, supplements, diet, exercise, and potential for further lab testing. Insurance is not accepted. Initial evaluation and testing are key to beginning treatment. Through the clinic’s monthly subscription model, patients have unlimited online video follow-up appointments access and direct messaging communication with Behrens. “My goal is for my patients to be more productive and enjoy their own lives, not take time away from work/relationships/home simply to travel to me.

“I want my patients to think of me like their Netflix subscription. Binge when in need and know that I am just a message away regardless. No need to think of copays, extra fees, surprise bills, or wondering if they should reach out,” Behrens explained. “I feel like these are ‘my patients.’ They chose it because they wanted to and not because their insurance offered them the next available slot. I want to be available to my patients and to help outside of simply old fashioned visits. I want to be an educator/guide/consultant/advocate for my patients and this model incentivizes this more than ever before.”

When going through conventional health insurance for an initial ADHD diagnosis, many prospective patients are told they may have to wait as long as six months to see a psychiatrist, but Envision ADHD can get them within 1-2 weeks. Behrens said what he likes best is the flexibility to immediately respond to and connect with patients. Unlike at a large university where his caseload was about 1,200 patients, he plans to cap it at about 200 at Envision ADHD.

Behrens is continuing to test different software and tweak workflows for scheduling and billing and has even offered his model – including the website template and various software – to area non-profits and healthcare organizations for free. “The model doesn’t just work for ADHD, but through team-based care, the various setups can be used to connect psychiatric expertise to all types of patients in need.” To better address the ever growing psychiatrist shortage, we need to think beyond the typical “in person, synchronous visit, fee-for-service model.”   

“It’s so exciting how patients describe the changes they are feeling in very elaborative and imaginative ways,” Behrens said. Three months into treatment, he recalls a once fairly reserved male patient reporting: “I just see things clearer and I’m more calm. I’ve already been promoted at my job and I’ve moved in with my fiancé. I don’t know what’s going on but I’m just happier. My fiancé can’t wait to meet you and thank you.”

That makes Behrens very happy. Because in the end, he said, getting treatment for ADHD is about much more than “can you focus and sit in your seat in a meeting.”

To learn more about Envision ADHD, visit http://www.envisionadhd.com.

To learn more about the superior insurance program and comprehensive services offered by PRMS, click here.

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Happy Three-Year Anniversary to Kraftlove!


Have you heard of an organization called Kraftlove? Kraftlove is a nonprofit that provides creative crafting kits to hospitalized children facing a variety of illnesses and challenges mainly around the Washington DC area. In the three years of box distribution, 2,700 boxes have been assembled and delivered to children.

Anhvinh Wright explains the theme of the 2018 fall project to the PRMS team.

“By providing interactive art projects that inspire creativity and encourage self-expression, we hope to transform the experience in the hospital from one of illness to normalcy, joy and healing,” said Anhvinh Wright, Kraftlove Founder and President.

From left, Vanessa Mejia, Diana Alva and Justin Pruett at one packing station assembling boxes.

PRMS teamed up with Kraftlove for the third time for a box-packing party in September. Over 150 fall art boxes were assembled, packed and distributed to Washington D.C. area hospitals. PRMS appreciates the opportunity to support this organization and to support children in our community.

From left, Renee Lewis, Remy Palmer, Jackie Palumbo, Rich Stagnato, Megan Jones, Ashley Quattlander and Jenna Quinn are hard at work at another station.

Victoria Chevalier adds a finishing -touch to a fall craft box.

PRMS team with the finished Kraftlove boxes.

To learn more about Kraftlove, make a donation, and see additional photos please visit http://kraftlove.com/.

Read more about Kraftlove and PRMS partnering through the years in the following blogs:

-PRMS Helps Share a Little Love in Every Box

-Kraftlove Already Making a Big Difference

-PRMS Teams Up with Kraftlove for the Second Year

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5 Things Psychiatrists Should Avoid When Buying Malpractice Insurance


You have insurance coverage.

You received the lowest rate and have the certificate of insurance.

You are properly insured, right?

Perhaps not.

Here are five of the most common issues you should avoid when choosing a policy.

 1. Not having enough licensing board defense coverage.

PRMS is seeing increased licensing board activity for many reasons such as aggressive boards, greater public attention, easy online access for the public to make complaints and the state’s obligation to investigate all complaints.

Some policies include a basic limit to defend against a board investigation and then charge more if you want higher limits.  PRMS knows the importance of protecting your license and reputation so our policy includes a separate limit up to $150,000 at no additional charge. 

 2. Only one policy type to select from.

Some companies only offer claims-made policies.  However, PRMS offers you a choice.  There are two common policies to consider.

Claims-Made:  This policy protects you in a practice-related legal proceeding if the policy is active when the “claim” is “made” against you during the policy period.  The limits of liability in effect at the time the legal proceeding is made will apply.  If you cancel your policy, you cannot report legal proceedings and should consider additional coverage to extend the reporting period – this is commonly called tail coverage. 

Occurrence:  This policy protects you in a practice-related legal proceeding if the policy was active at the time the treatment or incident occurred, regardless of when the lawsuit is filed.  You don’t need to buy tail coverage with an occurrence policy. 

We will explain your options so you can decide what works best.  Also, PRMS waives tail coverage costs in certain cases such as retirement, longevity with the program, death or permanent disability. Learn more about tail coverage here.

 3. Speaking of tail, some insurance companies have limited options for waiving tail coverage costs.

Tail coverage can be expensive.  The good news is that if you have a claims-made policy with another company, you do not need to buy your insurer’s tail because you may transfer your retroactive date to a policy through PRMS.  

Some companies waive tail costs only if you retire, become permanently disabled or die.  PRMS also waives tail costs for those reasons (retirement means permanent retirement after 5 years’ continuous coverage at age 55+).  However, we also waive tail costs if you maintain a claims-made policy for 10 consecutive years (presuming you are claim free or had no surcharges for claims on your policy).  In most states, we count your previous companies’ claims-made policy years toward the 10-year rule.

 4. Choosing an insurance company with risk management services not specifically designed for mental health.

Other companies usually comingle psychiatry rates and policies with other specialties. In terms of risk management advice, multi-specialty companies can generalize their educational material focused on primary care physicians/surgeons due to their large numbers and higher risk.  As a result, you may not receive enough advice for mental health.

PRMS policies and services are designed for psychiatrists and groups of psychiatrists with allied behavioral healthcare providers.  We are committed to psychiatry-specific risk management services.  We believe risk management – and complimentary access to information and CMEs (PRMS is ACCME accredited) – are essential.  Our advice is based on our superior experience in managing psychiatric claims, lawsuits and significant events for over 30 years as well as addressing about 70,000 psychiatric risk management questions and issues.

 5. Selecting an insurance company that doesn’t have psychiatric claims experience.

At the end of the day, it is about results. Will your company be there for you and act in your best interest when a claim is brought against you?  Do they normally manage psychiatry claims?  Does your company outsource claims defense?

In the over 30 years of our program’s existence, we have managed all claims in-house (no outsourcing).  Also, most of our clients’ claims are dismissed.

Choosing the right malpractice insurance can be a complicated and confusing process, but we are here to help you avoid these and other common pitfalls.

To ask a question or get a personalized rate indication, contact us at (800) 245-3333 or TheProgram@prms.com.

 

The content of this article (“Content”) is for informational purposes only. The Content is not intended to be a substitute for professional legal advice or judgment, or for other professional advice.  Always seek the advice of your attorney with any questions you may have regarding the Content.  Never disregard professional legal advice or delay in seeking it because of the Content.

©2018 Professional Risk Management Services, Inc. (PRMS). All rights reserved.

Actual terms, coverages, conditions and exclusions may vary by state. Insurance coverage provided by Fair American Insurance and Reinsurance Company (NAIC 35157). FAIRCO is an authorized carrier in California, ID number 3175-7.

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