Got Noise? How Noisy Charts are Hurting Your Addiction Treatment Center's Bottom Line

It’s no secret that addiction treatment clinicians are overwhelmed by the demands of clinical documentation. 

They are “bogged down in paperwork,” even if that “paperwork” is mostly virtual. 

Behavioral health professionals face some of the harshest clinical documentation requirements of any healthcare provider and they are often grappling with EHRs and clinical software that is outdated, ill-suited to the work, or simply non-existent. 

Behavioral health is naturally complex. The addiction treatment community’s emphasis on the biopsychosocial model means that every episode of care generates reams of patient data, SOAP notes, test results, clinical measures, patient reporting, care coordination documentation, and more. 

When poorly managed, patient data collected over the course of a single episode of care can become essentially incomprehensible. In these cases, it’s hard to tell the signal from the noise. 

Charts like these are called “noisy charts.”

What is a noisy chart? 

A “noisy chart” is simply a chart with data that feels chaotic. It’s a chart that has too much “noise” competing for attention with the intended signal. It’s hard to read and hard to interpret. Working with noisy charts is aggravating, frustrating and inefficient.

Think of it like a crowded, noisy room. You’re trying to communicate with another clinician, colleague or insurance payer about an important patient matter but there’s so many other irrelevant noises happening in the background that you give up. Or maybe you keep trying to communicate but as you struggle to understand one another, mistakes are made. 

In addiction treatment, a “noisy chart” is usually comprised of some of the following common ingredients:

• Roughly 567 copy-and-paste SOAP notes

• 943 pages of patient reported information, collected in a valiant attempt to deliver “patient-centered care,” never read

• 230 random bits of PHI collected “just in case” but never used in any clinical sense 

• 1,563 “record update notifications” collecting robotically in an inbox

• Clinically important information that resists timely, easy surfacing

• Data that refuses to be tamed by existing filters or sort systems 

• Haphazardly entered data that does not allow for apples-to-apples comparison or analysis

Why Do Some Addiction Treatment EHRs or Patient Records Become Noisy? 

There are several causes of “noisy charts.” 

Occasionally, a wordy clinician is the cause of bloated, unwieldy charts. This, however, is the exception to the rule - most clinicians are too busy to waste time writing epic notes. 

More often, it’s the software design itself that inadvertently cultivates an ideal environment for “noise.” 

While some clinical noise is inevitable, as you learn more about EHR design and optimization, you’ll find that smart design and smart use goes a long way to cutting through the chatter. 

But first, let’s look at the top three consequences of noisy charts: damaged outcome measurements, staff burnout and attrition, and impaired care coordination.

Noisy Charts Damage Outcome Measurements and Make Value-Based Care Impossible

Your addiction treatment organization may be collecting patient data, but if it can’t be used to improve patient care, establish medical necessity, or track patient outcomes and treatment success, it’s not going to be very useful. 

As value-based care continues to loom on the horizon for the behavioral health industry, smart addiction treatment executives are choosing EHRs that can handle outcomes measurements. Documenting the “value” that treatment providers payers and patients can be difficult or impossible in a chaotic, “noisy” EHR environment.

Noisy Charts Pour Gasoline on Your Addiction Treatment Organization’s Staffing Crisis 

If your addiction treatment organization is having difficulty recruiting and retaining talented clinicians on your team, you’re not alone. Demand continues to skyrocket for behavioral health care in the wake of the pandemic as well as the surge in dangerous new drugs like fentanyl and P2P meth. As treatment becomes more complicated and demanding, clinician burnout also continues to rise. This combination of high patient demand and low treatment availability puts extra pressure on the system, leaving very few qualified professionals to accomplish urgently needed work. 

As with most problems, prevention is the smartest strategy. Instead of focusing on how to replace staff members lost to an ever-increasing rate of clinician attrition, why not focus on how to keep your existing staff in their roles as long as possible? 

If pay raises and other bonuses are off the table, what can you do to provide your clinicians with a more satisfying work experience?  

The secret to fostering a healthy and happy work environment is equipping your teams with the tools they need to get the job done well. One of the main tools that addiction treatment clinicians use day in and day out is their EHR - if they have access to one, that is. 

Just implementing any EHR and hoping for the best is unlikely to result in a happier staff. In fact, invest in the wrong system and watch as clinicians run screaming for the door. 

Yes, the frustration level can be that bad.

Noisy Charts Cripple Addiction Treatment Care Coordination 

When your charts are difficult to digest, interoperability - that easy flow of electronic information - suffers. When clinician communication is restricted, care coordination becomes clunky and disjointed, resulting in shoddy, redundant treatment and mistake-prone patient care.

Sometimes, nothing matters as much as your patient’s latest UA results. Other times, that group counseling note that contains vital information about relapse warning signs is the most important, life-saving update your team will receive all day. 

In a chaotic, noisy chart, these pieces of information don’t surface easily and when they do, it’s at the wrong time or the wrong place or both. The result? Balls get dropped. The “golden thread” or clinical narrative is broken. Need-to-know information isn’t passed on or it’s surrounded by so much irrelevant information that it’s overlooked.

An EHR Designed Especially for Addiction Treatment to Quiet the Noise 

Behave Health is committed to making it easier - and more profitable - to operate evidence-based, results-focused addiction treatment centers.

Our all-in-one app puts clinical, administration, staff, admissions, alumni, residents, treatment plans, billing, insurance authorizations and more - all at your fingertips.

Get your free trial started today and see why more addiction treatment centers prefer Behave Health.

PS. Just getting started with behavioral health? Need help with certification, too? Behave Health can also help direct you to the right resources for help with Licensing or Accreditation by either The Joint Commission or CARF. Mention to your product specialist that you’re interested in this service after you start your free trial!

Medicaid Unwinding and State Behavioral Health in Montana, Minnesota, New York, Arizona, Colorado, Tennessee, and Washington

Nearly 40% of Medicaid enrollees meet diagnostic criteria for a mental or behavioral health condition. As federal requirements to retain all Medicaid enrollees during the pandemic begin to fade or “unwind,” it’s the states themselves that have control over the fate of millions of Medicaid enrollments. 

Let’s look at how these changes are playing out in 7 key states: Montana, Minnesota, New York, Arizona, Colorado, Tennessee, and Washington. 

Montana: State Medicaid Updates During the Unwinding of Continuous Enrollment

Medicaid enrollment in Montana flourished during the pandemic and the continuous enrollment period. 

Historically, Montana has a bad track record for Medicaid accessibility. The state denies more applications than most, so it’s expected that the unwinding process in Montana will result in many uninsured residents. States have 12-14 months to complete the “unwinding” process, but Montana has decided on a 10 - 12 month “unwinding” or reprocessing of Medicaid eligibility. 

Montana’s Department of Public Health and Human Services began checking for Medicaid eligibility in April 2023. 

Minnesota State: Unwinding Updates for the Phase-Down of Continuous Enrollment

Minnesota released its “Plan to Unwind Continuous Eligibility Coverage” in February 2023. It outlines the history of pandemic-era changes as well as effects on enrollment and then goes on to name challenges to name “renewal challenges” like budgetary constraints, workforce problems and other barriers to state-provided health coverage. 

The plan provides useful details for those anticipating possible changes to their enrollment eligibility. Eligibility will be reprocessed according to the month in which enrollee’s initially applied. They will begin with those who first enrolled in the month of July. Those enrollees will see a determination made beginning sometime in March 2023. MinnesotaCare renewals are slated for quarter 4 of fiscal year 2023.

New York State: A Three Phase Medicaid Unwinding Plan

New York state has created a toolkit to help New Yorkers understand the unwinding process and navigate health care in the post-COVID world. 

New York’s unwinding plan is a three phase one: first, they’ll spread awareness of important coming changes to Medicaid. Second, they’ll help every enrollee update their contact information with the state so that they can communicate renewal information effectively with individual enrollees. Third, they’ll help New Yorkers through the redetermination process and/or help former enrollees migrate to more appropriate coverage.

Arizona: 600,000 Medicaid Patients At Risk of Losing Coverage During Unwinding

Arizona began the Medicaid unwinding process in April 2023. 

Arizona Health Care Cost Containment System AHCCCS maintains a dashboard containing all the states’ information on this post-COVID change. According to a useful factsheet for Medicaid unwinding in Arizona, more than 600,000 members are at risk of losing their Medicaid and/or KidsCare coverage in the state, due to redetermination criteria and invalid personal contact information.

Colorado: About 80% of Members Should Remain After Medicaid Unwinding

Colorado’s Medicaid program swelled by up to 500,000 new members during the pandemic but it is slated to shed quite a few of those new additions soon. 

The state has gone on record saying that it believes that roughly 80% of current Medicaid enrollees will remain after the great disenrollment program is complete. That said, “hundreds of thousands” of enrollees could lose their Medicaid coverage - whether that’s Health First Colorado, or CHP+, the Child Health Plan Plus - during the unwinding process as it’s slated in Colorado. 

Tennessee: Medicaid Unwinding Likely to be Catastrophic for Many in This Non-Expansion State 

Along with Wyoming, Texas, Kansas, Wisconsin, Mississippi, Alabama, Georgia, Florida, and South Carolina, Tennessee is one of the 10 states in the union that has not adopted the ACA Medicaid expansion. That means that enrollees in this state are vulnerable to a “coverage gap” where poverty-level residents may not be “poor enough” to qualify for the state’s ultra-low Medicaid income requirements but “too poor” to qualify for ACA marketplace coverage subsidies. This is a policy issue where the state is essentially signaling they believe the federal government should cover these individuals, while the federal government is signaling the opposite - that the state should pick up the bill.

This makes Tennessee’s Medicaid unwinding plan to be a highly disruptive one for many vulnerable people in Tennessee.  

Washington State: Medicaid Unwinding Likely to be Less Brutal in This Medicaid Expansion Early Adopter

Washington state, like most other states, saw a huge growth in the number of Medicaid enrollees during the pandemic, in part due to Medicaid expansion. The state was an early adopter of Medicaid expansion in 2014. Currently, Apple Health (Washington’s name for its Medicaid program) ensures well over 2 million people. Those individuals with incomes that have shifted below 138% of the federal poverty level will soon lose their coverage due to the Medicaid unwinding process now underway in the state. 

Working to Understand Medicaid Unwinding in Your State? Behave Health is Here to Help.

Behave Health is committed to making it easier - and more profitable - to operate evidence-based, results-focused addiction treatment centers.

Our all-in-one app puts clinical, administration, staff, admissions, alumni, residents, treatment plans, billing, insurance authorizations and more - all at your fingertips.

Get your free trial started today and see why more addiction treatment centers prefer Behave Health.

PS. Just getting started with behavioral health? Need help with certification, too? Behave Health can also help direct you to the right resources for help with Licensing or Accreditation by either The Joint Commission or CARF. Mention to your product specialist that you’re interested in this service after you start your free trial!