The PRMS Blog

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.

Posted in PRMS Blog | Comments Off on Guest Blog: Finding Novel Ways to Support Adults with ADHD



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

Posted in PRMS "Gives a Hoot!", PRMS Blog | Comments Off on Happy Three-Year Anniversary to Kraftlove!



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.

Posted in PRMS Blog | Tagged , , , | Comments Off on 5 Things Psychiatrists Should Avoid When Buying Malpractice Insurance



AAGP – Supporting the Future of a Specialty


It had been cold and rainy in Washington, DC when my colleague, Remy Palmer, RPLU, and I left for the American Association for Geriatric Psychiatry (AAGP) meeting in Hawaii this past March. Our long plane ride was worth it, not only for the warm weather of Honolulu, but to also catch up with several long-time PRMS clients and make new friends in the field of geriatric psychiatry. The tropical winds were a nice change of pace for us and having the evening reception outside so we could watch the sunset was a stroke of genius by the organizers. We were thrilled to be there, as this year PRMS was the first corporate sponsor to help fund the AAGP Scholars Program for psychiatry residents and medical students. When we were asked for support, we did not hesitate. Not only does this program provide funding for medical students and psychiatry residents to attend the AAGP Annual Meeting, but it also provides a specific educational program geared to trainees during the meeting.

AAGP is faced with meeting the challenge of an expanding population of older Americans and growing the geriatric psychiatric specialty to meet that population’s needs. For over 30 years, PRMS has supported psychiatry on many levels including a focus on residents and initiatives such as the Scholars Program that provides attention to psychiatric specialties. We had the opportunity to meet with the scholars we supported and learned that without our sponsorship they would not have been able to attend the meeting. Other residents commented that the AAGP Scholars Program support and education enhanced their decision to ultimately choose geriatric psychiatry as their specialty.

Next year the theme of the 2019 AAGP meeting will be “Preparing and Partnering for the Future of Geriatric Mental Health.” PRMS will be there once again to support this mission and the future of this specialty. We look forward to seeing you in Atlanta!


Megan Jones is Head of Strategic Product and Sales Analytics and joined PRMS in 1997.

Posted in PRMS Blog | Tagged | Comments Off on AAGP – Supporting the Future of a Specialty



Preparing for Private Practice


Starting or joining a private practice is an exciting time, but it can also be risky.  An essential way to protect your professional reputation and reduce risk is to obtain comprehensive medical professional liability insurance. In this post I will address some important steps you can take to help create and maintain a successful practice.

Build good relationships

If you are entering into, or are already in, a private practice, you should forge and maintain relationships with an experienced risk manager, colleague, attorney, accountant, professional organization and trusted insurance professional.  PRMS licensed insurance professionals utilize extensive experience to provide sound advice to cover your risks and explain complex insurance options.

Cover your psychiatry services

Medical professional liability policies and risk management consultation can be generic for all specialties.  But your practice is not generic – and neither is our program.  This is why our policy, in addition to covering for standard psychiatric treatments, also covers services such as telepsychiatry, evaluations, forensic psychiatry (e.g., expert testimony), Peer or Utilization Review, routine medical care incidental to psychiatry services, publications, teaching, clinical trials and emergency medical treatment without the expectation of compensation.

Know your risk tolerance

Each time you contemplate the range of options between the “floor” of the standard of care and optimal care, it is imperative that you not only identify and evaluate the associated risks, but also recognize your tolerance for those risks. PRMS clients have complimentary access to risk managers who will advise you and help lower your risk.

You can read more about preparing for a private practice here.  Contact us to start building a trusted relationship with an insurance professional by calling 800-245-333 or emailing TheProgram@prms.com.

Posted in PRMS Blog | Comments Off on Preparing for Private Practice



About the Author