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Provider Capacity Survey - 2019
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1.
Name
(Required.)
2.
Group or practice name (if applicable)
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3.
Service Address
(Required.)
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4.
County and State
(Required.)
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5.
Phone
(Required.)
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6.
Email
(Required.)
7.
Please select your professional behavioral health license and certification:
Doctoral – MD, PhD, PsyD
Licensed Masters – APRN, PMHNP, LPC, LCSW, LMFT, MSW, CMHC
Licensure candidates - LPCC, LSW
Master’s level (but unlicensed) - MA in Counseling, LAC; Certifications - CAC (I-III)
Professional - Coaches, Community Health Workers, Case Managers
Peer support specialist or behavioral health aide
Other (please specify)
8.
Please select the areas of specialization you provide (please select all that apply)
ADHD
Addiction
Adolescent
Adoption
Anger management
Anxiety
Autism
Behavioral
Bipolar
Body Image
Child
Coaching
Co-occuring (mental health & substance abuse)
Culturally Sensitive
Depression
Developmental/Disability
Divorce
Domestic Violence
Eating Disorder
End of Life
Faith Based
Family Conflict
Gambling
Geriatric Counseling
Grief
LGBTQ+
Obsessive Compulsive Disorder
Parenting
Personality Disorder
Psychotic Disorders
Positive Psychology
Post-Partum
PTSD
Relationship/Marital
Self-esteem
Self-harm
Sexual Abuse
School Trouble
Strength-Based
Substance Abuse
Trauma
Women’s Issues
Other (please specify)
9.
What populations do you serve? Please select all that apply.
Children
Adolescent
Young Adults
Adults
Seniors
Family
Couples
Military members or family
Individuals in the criminal justice system
Groups
Other (please specify)
10.
Which of these mental health treatment approaches do you offer? Please select all that apply.
Acceptance and Commitment Therapy (ACT)
Animal Assistance
Art Therapy
Attachment-based
Behavioral Modification
Biofeedback
Brainspotting
Cognitive Behavioral Therapy (CBT)
Critical Incident Stress
Dialectical Behavioral Therapy (DBT)
Dance/Movement Therapy
EMDR
Emotionally-Focused
Existential
Faith-based
Family Systems
Gestalt
Gottman
Integrative/Holistic
Interpersonal
Internal Family Systems
Integrated dual disorder treatment
Maternal mental health
Mindfulness-based
Narrative
Neurofeedback
Person-centered
Play Therapy
Psychoanalytic
Psychodynamic
Psychological Testing and Evaluation
Solution-Focused Brief Therapy (SFBT)
Somatic
Supervision Services
Trauma-focused
Animal-assistance therapy
Wilderness/nature therapy
Other (please specify)
11.
Do you provide mental health services in a language other than English? If yes, please enter the languages
No, only English
Yes, (please specify)
12.
Who provides mental health treatment services in a language other than English? Mark one only:
I speak a language other than English
On-call interpreter (in person or by phone brought in when needed)
Both staff and on-call interpreter
N/A
13.
How many sessions/hours do you currently provide for clients on a weekly basis?
14.
Approximately how often do you refer clients to other providers because you do not have time available to see them?
Weekly or more
One to two times per month
One to two times every six months
One to two times per year
Less than once a year
Never
Comments
15.
Approximately how often to you refer clients to other providers because of patient-provider fit?
Weekly or more
One to two times per month
One to two times every six months
One to two times per year
Less than once a year
Never
Comments
16.
Are you accepting new patients at this time?
Yes
No
Comments
17.
What is the average time between when a new client first reaches out for services (i.e. phone call, online appointment request) and their first date of receiving treament (excluding intake or screening)?
18.
On average, how often (at what frequency) are the majority of your clients seen after an intake?
Once a week
Once every other week
Once every three weeks
Once a month
Less than once a month
Comments
19.
Which of the following types of clients payments, insurance or funding are accepted by this facility or provider for mental health treatment services? Select all that apply
Medicaid
Medicare
EAP
Cash / Self payment
Pro Bono
Private / Commercial Insurance (please specify)
20.
If you accept commercial insurance, what percentage of your current clients utilize their insurance to pay for services with you?
21.
For cash or self-payment, do you offer a sliding scale based on ability to pay?
Yes
No
22.
If you do not accept commercial insurance, could you explain why?
23.
If your credentialing fees and billing management for all insurance claims were paid for by Building Hope, would you be willing to accept more types of patient insurance?
Yes, I would be willing to accept more types of commercial insurance regardless of their reimbursement rate
Yes, I would be willing to accept more types of patient insurance, but only with carriers that reimburse at $85 or more per hour
No, I would not be willing to accept more types of patient insurance regardless of their reimbursement rate
Possibly, but I need more information (please specify)
24.
Do you provide tele-therapy services (i.e. therapy sessions conducted over secure video platform)?
Yes
No
25.
If not, do you refer clients to other providers for tele-therapy?
Yes
No (please write your reason for not referring people to tele-therapy)
26.
On average, how many clients do you either refer to tele-therapy of directly provide tele-therapy to each month?
27.
Which of these crisis services do you provide, if any? Please check all that apply
After-hours services
On-call services
Crisis-services
Reserved or last minute slots
None
Comments
28.
If you do provide crisis services, do you provide them for new clients, current clients or both?
New clients only
Current clients only
Both new and current clients
Other (please specify)
29.
If yes, how many hours do you reserve each week for crisis services?
30.
Would you be willing to reserve crisis hours (or additional crisis hours) in exchange for partial compensation if they were not filled?
Yes
No
Comments
31.
If yes, what percentage of your regular fee would you be willing to set aside hours for?
25%
50%
65%
Other (please specify)
32.
If yes, how many hours would you be willing to set aside per week?
Not willing to set aside appointments
1
2-3
3-5
More than 5
Comments
33.
If not, do you have a local option to which you can confidently refer people in crisis?
Yes
No
If yes, where do you send them?
34.
In an effort to understand provider availability across Summit County, these next questions will ask you about the platform(s) you currently use for scheduling and billing as well as shared platforms you may be open to using.
What kind of patient record keeping system do you currently use?
Paper records
Electronic record keeping system
Comments
35.
If you currently use an electronic record keeping system, which one do you use?
36.
Do you currently use a practice management software or platform (such as Let’s Talk, Simple Practice, Penelope, etc.)?
Yes
No
Comments
37.
If yes, which practice management software or platform do you currently use?
38.
What feature(s) do you currently utilize most on your practice management platform? Please select all that apply.
Scheduling tool (appointment reminders)
Billing management
Credit card processing
Electronic record and note keeping
Client portal
HIPAA compliant tele-therapy portal
None/I don’t use a practice management platform
Comments
39.
Would you be willing to use a shared universal practice management platform, with booked versus open hours visible to Building Hope Navigators, if it was secure, HIPAA compliant, did not disclose the names of clients to any user but you, and was provided free of charge or at a low cost?
Yes
No
I need more information to make this decision
Comments
40.
If you had access to a practice management platform provided free-of-charge/at a low cost to you, which services would you be likely to use? Please check all that apply.
Scheduling tool (appointment reminders)
Billing management
Credit card processing
Electronic record and note keeping
Client portal
HIPAA compliant tele-therapy portal
None, I would not use any of these tools even if they were provided for free or for a low cost
Comments
41.
In an effort to get clients connected to care faster, would you be willing to be part of an online, easy-to-use referral process that allowed you to accept or decline referral clients?
Yes
No
Possibly, but I need more information.
42.
What other methods would you be willing to use to help Building Hope understand provider availability and make referrals in Summit County? Please check all that apply.
Complete a quick weekly survey (via an emailed survey link) to update your weekly open hours for new or crisis clients.
Update a combined, HIPAA compliant provider calendar on a weekly basis.
Use a shared electronic platform for scheduling and availability.
Email Building Hope or note on a centralized calendar or other platform when scheduled or unscheduled openings occur in your day or week.
Other (please specify)
43.
In what areas would you be most interested in receiving free or reduced cost training?
44.
Have you attended any workforce trainings that you would recommend to others?
Yes
No
45.
If yes, please share with us which trainings
46.
For those of you who just credentialed with Peak Health Alliance - Bright and Rocky Mountain Health Plans) would you be interested in an informational session about basic billing and carrier info 101?
Current Progress,
0 of 46 answered