DeeAnna Merz Nagel

How important is it for LPCs and LMHCs to be included in the new health bill? I received this important memo today from the Georgia LPCA office and I thought it important enough to post here! Do what you can, even if you only accept private pay clients. Help grow your profession so we are recognized as equal and comparable mental health practioners!

CALL your family, friends, colleagues in the following states. Have them call their senator from their home or office phone. Have them call the Capitol Switchboard at 202-224-3121 TODAY and everyday until we hear from the national lobbyist that LPCs are included.

Currently, only 13 Senators are cosponsors of S. 671, legislation introduced by Senator Blanche Lincoln (AR) to cover LPCs and marriage and family therapists under Medicare:
Senator Mark Begich (AK)
Senator Barbara Boxer (CA)
Senator Daniel Inouye (HI)
Senator Dick Durbin (IL)
Senator Carl Levin (MI)
Senator Byron Dorgan (ND)
Senator Jeff Bingaman (NM)
Senator Sherrod Brown (OH)
Senator Ron Wyden (OR)
Senator Jeff Merkley (OR)
Senator Tim Johnson (SD)
Senator Patty Murray (WA)
Senator John Barrasso (WY)

IF YOUR SENATORS ARE NOT ON THIS LIST, THEY SHOULD BE!
Contact them and ASK THEM TO COSPONSOR S. 671 to show support for establishing Medicare coverage of licensed professional counselors.

LET YOUR SENATORS KNOW that the Senate has already passed legislation establishing Medicare coverage of counselors twice, in both 2003 and 2005. Medicare eligibility for professional counselors is included in Section 1308 of the House health care bill, H.R. 3962.

If enough counselors call, email, and write letters to their Senators it will be hard to ignore Medicare eligibility of LMHCs/LPCs when Senate leaders meet with House leaders to meld together the two bills.

Including LPCs / LMHC will save money and increase access to services.

There are three compelling reasons for Licensed Professional Counselors (LPCs) to become Medicare providers.

1) Counselors are clearly qualified. The training, supervision, and experience requirements for LPC licensure equal, and in some cases exceed, those of many current Medicare providers. Moreover, most private healthcare insurance programs currently recognize LPCs as qualified providers.

2) The availability of LPCs to provide counseling services to Medicare patients will result in more effective and efficient use of taxpayer dollars. Without counseling services, these patients — many of whom are elderly, isolated, and lacking in mobility — must seek support from family and community, where resources are already strained. The result is greater caregiver absences from work, reduced productivity, more workers’ compensation claims, more substance abuse, and poorer health in general across the community. The additional Medicare dollars spent on providing LPC services will be offset by the reduced strain on community resources.

3) The availability of LPCs as Medicare providers will reduce expenditures on hospitalization, by far the most inefficient use of taxpayer dollars in providing mental health services. Hospital systems are not designed to provide preventive care; the restorative care they can provide is limited, expensive, and often difficult to obtain; and the primary clinical focus of these systems is stabilization and release. Once released, mental health patients without counseling services have an even greater likelihood of being hospitalized again.

For these three reasons, we believe that it is imperative for LPCs to become Medicare providers.

As an LPC, even if you choose not to accept third-party payment as with Medicare, this is still an important issue. Senators in Georgia are our employees, just like in all the other states; let them know how they should be representing you!

For additional Information, contact the LPCA office LPCA@mindspring.com or call us 404-370-0200. You can also contact Scott Barstow, ACA’s Director of Public Policy and Legislation, at 800-347-6647 x234, e-mail: sbarstow@counseling.org, or AMHCA’s Director of Legislative Affairs, Julie A. Clements, J.D., at 800-326-2642 X 105, E-mail: jclements@amhca.org

DeeAnna Merz-Nagel is a clinical counselor, teacher, workshop presenter, sat on the ACA Cyber Technology Taskforce, and is co-founder of the Online Therapy Institute

DeeAnna Merz Nagel

I saw a feature on the local news about security and surveillance and I was astonished at how common surveillance cameras are. They are everywhere~ in subway stairways, on street corners, in the grocery store, at major theme parks. And actually, I guess I knew that. We all know that, right? But how many of us walk into a hospital or an office building and don’t even notice the camera at the entrance? What happens if the building you lease has a surveillance camera at the entrance or in the building? It seems far-fetched but it might be a good idea to ask when you sign that new office lease.

Most security companies that install alarm systems will also install surveillance equipment that can be monitored remotely. And while the reasons for installing such equipment varies, our concern as counselors is maintaining client confidentiality. Now that our privacy is not so private anymore, it serves us to take extra precautionary steps. If you have your office in a large building and the camera is at the entrance, scanning everyone who walks in, yet the camera does not follow the person to a destination, is that okay?
Hospital lobbies track everyone coming in the door- patients, hospital staff, vendors, visitors` and yet this appears to be “okay” under HIPAA compliance. But what if you are just one of a couple of tenants in a building or say, a renovated house and the landlord has decided it might be a good idea to monitor the entrance with a camera for extra protection? If you lease an office you might not even know that a camera has been set up.

What would make surveillance acceptable? If the landlord signs a HIPAA Business Associate Agreement does that suffice? And even if that did protect you legally, who has access to the tapes? The landlord? The security company? What if the large building housing many offices has cameras set up in the entrance but the building is located in a small town? I am thinking it becomes easy to connect the dots and confidentiality might be breached.

It used to be that some counsellors were concerned about placing a sign outside indicating counseling services because some people do not want to be seen pulling into a therapist’s office. And then we had to comply with HIPAA if a shared office offered client sign-in. We make sure that client names are not visible to other clients and guests signing in. But now….now we have to worry about cameras? It is a sign of the times!

DeeAnna Merz-Nagel is a clinical counselor, teacher, workshop presenter, sat on the ACA Cyber Technology Taskforce, and is co-founder of the Online Therapy Institute

DeeAnna Merz Nagel

I have been receiving many inquiries asking if online counseling is covered by insurance so I thought I would share what I know with everyone.

Early in 2004, the American Medical Association published a new CPT code 0074T that allowed physicians in the USA reimbursement for online consults. The new code was released January 1st, 2004.

Code 0074T: Online evaluation & management service, per encounter, provided by a physician, using the Internet or similar electronic communications network, in response to a patient’s request, established patient.

In 2008, the CPT code 0074T was replaced. The code relating to online counseling was previously in the CPT manual under category III (emerging technologies). As of 2008, it has been replaced by the new code numbers and is now under category I.

CPT Code 98969 is used to describe online services provided by non physician. CPT code 98966 is used to bill for phone consultation services.

DeeAnna Merz-Nagel is a clinical counselor, teacher, workshop presenter, sat on the ACA Cyber Technology Taskforce, and is co-founder of the Online Therapy Institute

DeeAnna Merz Nagel

I recently received the 2010 American Counseling Association conference line-up and the sessions about technology look great!

As some of you know or have ascertained, my focus topic much of the time involves the impact of technology on the field of mental health so I was just thrilled to see the terrific choices that will be available this year! One of the sessions is about this blog- so if you plan to attend the conference do come meet us and learn more about how blogging enhances the ACA’s mission.

Here is a list of the sessions:
• Best Practices in Cyber Counseling: Meeting New Challenges and Opportunities Worldwide
• Connecting to the Net Generation: Using Social Networking Sites in Therapy
• Counselor Training and Practice in the Virtual World
• Design and Implementation of an Online Counseling Course: Issues and Strategies
• Discover ACA Blogs
• Facebook: Implications for Counselor Education Students, Faculty, and Practitioners
• Shyness: Utilizing Computer Mediated Communication to Transition From the Online to Face-to-Face Social Interaction

Advanced
• Developing and Sustaining Online Counselor Education Programs: Administration, Content Delivery, and Student Support
• The Future of Counseling: Developing and Utilizing Online Counseling Interventions
• Using Second Life With Clients and Classes: Implications for Counselors and Counselor Educators

If you are at the conference and would like to meet, you know where to find me! Provided there are not too many overlaps in scheduling, I will be at the above mentioned sessions!

DeeAnna Merz-Nagel is a clinical counselor, teacher, workshop presenter, sat on the ACA Cyber Technology Taskforce, and is co-founder of the Online Therapy Institute

DeeAnna Merz Nagel

I recently read a blog post by John Grohol of psychcentral.com who often debates whether or not internet addiction is “real.” This is a debate that has existed for a years now and with the next DSM in development, questions arise as to whether internet addiction and cybersex addiction should be included, and if so, what might be the criteria?

What I have found is that it is often a debate of semantics. Is internet addiction real? I think it is real for the people who experience it. I think it is real for the people who describe their lives as out of control due to their compulsive behaviors involving the internet. I think when I client comes to me expressing a desire to change yet is so caught up in the net that they cannot find balance in their lives- well, for that client, I think this internet addiction thing is real. In fact, people actually use those words- “I think I am addicted to the internet.” So as a clinician, how should I respond?

To the client, naturally I validate his or her experience. To the counseling community, I debate what an internet addiction looks like, what the criteria would be for designating someone as abusive or dependent on technology. But really, what is it? Is it an addiction similar to alcohol or drugs? Is it like gambling? If not, what differentiates or sets apart problematic behaviors around the use of technology? For parents, the concerns involve gaming, texting, and sexting on the internet. For partners of loved ones whose behaviors are interfering with the relationship, the concerns are sleepless nights, surfing the web for hours on end, pornography and cyber-affairs.

I am interested in knowing what other counseling professionals think.
How do we help people who are struggling with an “addiction” that does not exist yet manage to validate their experience and support them on their path of healing? How does the client assimilate this ongoing debate that now appears on mainstream television as comedic story lines, documentaries and news?

What are your thoughts?

DeeAnna Merz-Nagel is a clinical counselor, teacher, workshop presenter, sat on the ACA Cyber Technology Taskforce, and is co-founder of the Online Therapy Institute

DeeAnna Merz Nagel

I recently had a conversation with a colleague who said she just couldn’t find her “calling.” She is a counselor and she knows she was led to help people but she feels she is called to deeply fulfill her vocation- she just doesn’t know what or how. She told me about her jobs (plural). One of her jobs is as a counselor at a juvenile detention center. She said she knows she helps her clients. And then with pause she said, “But the work environment is toxic.” And I knew exactly what she meant. Having worked in various settings over the years- many of which were crisis-oriented settings, I could relate. As I dealt with the concerns and needs of my clients I often had to deal with the negative attitudes of burnt out staff people who had seen way too many lives torn apart by abuse, neglect, poverty, disaster, illness and death.

Upon reflection, and knowing how much I have witnessed in my career, I am thinking that each of us can only take in so much before it begins to taint us and deeply hurt us at a soul level. Maybe we should only be allowing ourselves to work in these difficult environments for a much shorter time than we think we can handle. Maybe only a few years at most, and then it is time to move on and let someone else take the challenge. In that way, we can remain whole and be able to continue to have positive impact on the world around us without our own souls being in the balance. I realize there are exceptional people who may be able to do crisis work for years but I am talking to the rest of us.

I didn’t realize the toll all of those years really had on me until I moved away from that level of intense work. Now I know that even as I was helping, I may not have been able to give anything my all, because it was not in me to give. So now I spend time nurturing and feeding my soul so that I give again the way I did way back in those early years of my career…

What do you think?

DeeAnna Merz-Nagel is a clinical counselor, teacher, workshop presenter, sat on the ACA Cyber Technology Taskforce, and is co-founder of the Online Therapy Institute

DeeAnna Merz Nagel

Last week I was interviewed by the Stars and Stripes regarding online counseling and the article entitled Tricare Programs Offer Online Counseling posted today. Some of you may know that Tricare is offering online services now with a pilot program called TRIAP in which military and their family members can obtain assistance online via webcam. The military has also launched services through Tricare using a platform developed by American Well for behavioral telehealth services including the ability to prescribe.

Just a few weeks ago, the EAP Digest published an article about online counseling having finally crossed the chasm, suggesting that after a decade or so, the concept of online counseling is not really such a foreign idea. The article refers to an EAP company in Canada that facilitated over 10,000 email cases in 2008. The same is true for EAPs in other parts of the world.

And most recently, a new study that will appear in the well-respected medical journal, Lancet, is indicating that online therapy is just as effective as face-to-face therapy. In fact, this study has been tweeted and retweeted countless times on twitter. In this same week results of another study from New South Wales, St. Vincent’s Hospital utilizing online therapy as an intervention for social anxiety disorder show similar efficacy. People seem to be very receptive to the idea that online therapy can be helpful to some individuals.

When I first started talking about online counseling as a real and viable option for people the majority of professionals were resistant, even hostile about the idea. Now I am seeing a shift. Perhaps it is because technology has become such a part of our social fabric that resistance is futile, or maybe there is a shift in the profession’s consciousness about thinking through new ways to reach out. I would love to hear feedback about existing concerns regarding the provision of online counseling. I have said all along that online counseling will not replace face-to-face counseling. Online counseling offers another way to deliver interventions. And I was a decade early when I said in 1999 that online therapy would become mainstream. Has the time come?

DeeAnna Merz-Nagel is a clinical counselor, teacher, workshop presenter, sat on the ACA Cyber Technology Taskforce, and is co-founder of the Online Therapy Institute

DeeAnna Merz Nagel

The ACA Weblog has been up for several weeks and we the bloggers seem to offer a nice balance and contrast to each other. But I am wondering, what do you want to read about? What is important to you and what would draw you here on a regular basis?

Do you check in on the ACA Weblog when you think about it or do you subscribe to the RSS feed? Do you follow CounselingViews on Twitter (http://twitter.com/CounselingViews)? As an avid blogger and tweeter myself, I would like to hear what draws you here and frankly, what you do not find interesting as well.

So, this is a short post- because the meat of this post needs to be the readers. Tell me (us) what you think, what you want, what you might like an opinion on. This is a place for ACA and its members to buoy our profession and our organization!

Here’s to another warm, hazy summer day in New Jersey!

DeeAnna Merz-Nagel is a clinical counselor, teacher, workshop presenter, sat on the ACA Cyber Technology Taskforce, and is co-founder of the Online Therapy Institute