site news

June 21, 2009

First, TCORE is going to be a test site for the Same Day Appointment feature of SacDoc. Patients have already been given instructions and appointment codes, and we go live on July 1st. That's ten days from now, and I'm still working full time and trying to be a decent parent (play group, swimming lessons, swim team practice, and meets) so time to work on SacDoc has been scarce. There hasn't been any time in there for updates to this site. It's exciting, though, to see the system coming together. The challenge at TCORE is to handle the 1,500 patients that the county has decided to send my little program, which is staffed and funded for 300. If the Same Day Appointment system, along with the fierce dedication of our staff, can give us the efficiency to do a decent job serving 500% of our design capacity, it will be a miracle.

After my testimony and letters to each of the Supervisors (with a DVD of the entire SacDoc system, including source code, enclosed) I finally got some official attention. Alas, while SacDoc is focused on patient care, the Department of Behavioral Health Services is focused on finance. They stated that they didn't consider SacDoc because it couldn't do Medi-Cal billing (hmmm, they should have asked instead of making that assumption). When I pointed out that they could actually save money by abandoning the Medi-Cal billing altogether and providing care more efficiently, they seemed horrified at the notion. It might provide more care to more patients, but I guess it would decrease their overall budget. I now have a better understanding of why they've made some of the decisions they have. Unfortunately, the monumental budget cuts that the state government has proposed have yet to reach Sacramento County. The millions DBHS spent on Medi-Cal billing won't mean much if the state won't be paying the bills.

I am still working on alternatives to the county clinics that would provide care without directly involving the Sacramento County bureaucracy. In fact, the deeper I get into the workings of the county, the more I become convinced that it is the only viable option if those who need it are actually going to get care. Until July 1st, though, all my efforts have to be concentrated on TCORE.

You might also be interested in this editorial from Sierra Sacramento Valley Medicine or this story about one of my patients.

May 14, 2009

I have a wealth of public speaking experience, but this is the most nervous I have ever been. Unfamiliar venue? Strict time limit? Self disclosure? Important issue? I am not sure why I was so scared. Here, though -- to the best of my recollection -- is what I said in my two minutes:

What an education! Thank you for hosting these workshops.

My name is Ron Risley. I am a family physician and psychiatrist. I have worked in the county’s mental health system since 1997, but that is only part of why I’m here. I am also an adult with serious mental illness. But for the grace of god and some timely psychiatric care, I would not be here addressing you today. I am here to remind you that, because of advances in psychiatric care, brain diseases have become more manageable and less visible. We are your doctors, your automobile mechanics, your school administrators, your boardroom executives, your gardeners, your flight attendants, your lawyers, your neighbors, your friends, your family. Yet my job, once difficult but satisfying, has become a nightmare as I attempt to explain to patient after patient that the lifeline that keeps them functioning and integrated is being cut. The very thing that saved my life is being denied them. How can I explain why a 10% budget shortfall has to result in a plan to eliminate services for 2/3 of them? That the primary care provider to whom DBHS has referred them won’t be able to care for them, because the ”mental health carve out” has already diverted Medi-Cal money to the same county agency that is now refusing to provide them care? Dozens of colleagues and patients know that these cuts will save the county no money: as you have heard here, research has shown time and again that, without outpatient mental health care, those with mental illness end up getting less humane and far more expensive treatment from emergency rooms, from jails and prisons, from psychiatric hospitals and, yes from the County Coroner. One of my patients said, “That’s not politics -- that’s cancer.”

Despite what you may have heard, alternatives are available, but have not been explored.

You are our best hope. You can ignore this tumor, allowing it to grow and disfigure the body politic. You can allow it to metastasize and suck even more money from already beleaguered law enforcement, from primary care medicine, from corrections. Or you can swiftly and decisively cut out the diseased tissue, send DBHS back to evaluate alternatives, and allow healing to begin.

Thank you.