Leader in Developing Standards to Advance, Promote Patient Safety, Quality Care, Value for Ambulatory Healthcare [Interview][Transcript]

joy_himmel_aaahcGuest: Joy Himmel
Presenter: Neal Howard
Guest Bio: Joy Himmel is a behavioral health specialist, who has worked for several years on the revamping and strengthening of the Accreditation Association for Ambulatory Health Care (AAAHC) behavioral healthcare standards.

Segment overview: AAAHC provides rigorous standards for healthcare providers to meet when they embark on a behavioral health integration plan. As more healthcare providers are transitioning to outcomes-driven, value-based delivery models, behavioral health integration is a top priority. Thus, Joy’s work and expertise has proven invaluable to many organizations on the cusp of such changes.

Health Professional Radio – Ambulatory Healthcare

Neal Howard: Hello and welcome to the program. I’m your host Neal Howard for this Health Supplier Segment here on Health Professional Radio. Our guest in studio today is Joy Himmel, she’s Director of Counseling Services at Ross University School of Medicine. Also a Site Surveyor with AAAHC Behavioral Health Standards and she’s been working for a number of years on the revamping and strengthening of the AAAHC Behavioral Health Care Standards. And she’s here to talk about her work with those standards, how it’s affecting the health care community, the future of health care based on these revamped standards. Welcome to the program Joy.

Joy Himmel: Thank you very much, I’m happy to be here and talk a little bit about the Behavioral Health Standards for AAAHC. If you’re not familiar with AAHC it’s the accreditation association for ambulatory health care. We do accredit many different types of organizations of a largest component surgical out-patient surgical center but we also accredit community health, Indian health, college health, coastguard and other entities to like office based surgical out-patient center. So the Behavioral Health Standard of AAAHC which has been chapter 17 for many, many years was recently revamped and revised and pretty much tripled in size in terms of the criteria that we are looking at. Previously that chapter really kind of address the basics of when there is an integrated model of care, meaning that the organization has both health services and behavioral health services that basically the minimal standards applied related to quality of care. What we have done over this last year or so is to really kind of take a look at what we had in place and make it much more specific to what is happening out there in the integrated health and counseling area and also I think to just broaden the scope in terms of the things that we believed based on best practice were indicative of providing good care and good treatment.

N: I want to be clear, are we talking about standards relating to facilities that offer both behavioral health and ambulatory health care services or are we talking about say a hospital that will maybe evaluate you if you have a mental health problem and are brought in but then transfer you to someone else who specializes? Are we talking about revamping standards for as you say both types of care or across the board dealing with both types of care regardless of what services a facility offers?

J: Yeah, I think for AAAHC we tend to accredit those organizations that have ambulatory services and Chapter 17 would apply to any of you of those organizations that offer both medical services and behavioral health services. So examples of those kinds of organizations would be community health for instance would be Indian Health, would be college health because many college health centers offer both medical services and behavioral health. Also applies to coastguard and we were surveying for Airforce, it would apply for them as well. So basically those entities that offer both in terms of their organizational structure.

N: Now how did you become so deeply involved in revamping these standards?

J: Well I’ve been a mental health provider for the last 30 years. I’ve worked in hospital settings, community health settings and the 20+ years in college health settings and so I had a broad base knowledge related to best practice standards and have obviously worked as a mental health professional my whole life. When I became a surveyor in 2009, one of the things I quickly recognized is that our chapter 17 for behavioral health needed to be expanded, just based on my expertise and my experience and so some task forces were put together through AAHC to kind of look at that, information gathering occurred, we did some benchmarking and through a lot of work on a lot of people’s plates, we were able to kind of revamp that chapter 17 into something that I think is really state of the art in terms of providing the standards of care that really allow an organization to indicate that they have a quality service.

N: Talk a bit about the Murphy-Johnson Mental Health Crisis Act.

J: I think that’s an example of an impact that our legal system has related to how we need to pay attention in the clinical world in terms of responding to those things. A part of the new standards for chapter 17 there’s a whole section on crisis management, there’s a whole section on what needs to be provided to providers of behavioral health services in terms of annual training on suicide prevention that needs to be documented and so again the bar is raised fairly high in the standards related to how to respond to crisis, how to have policies and protocols and procedures in place to address it, how to have coordination of care between providers so people don’t get left between the cracks and good referral services as well as timely services. One of the things that we have seen as a challenge in behavioral health for years is really providing services in a timely manner, so really looking at organizations to determine ‘Do they have wait list?’, ‘How long does it take for someone to see a psychiatrist?’ for instance or get medications or get into counseling once they’re referred. So the standards address that and they address the processes that are in place that again help in terms of responding to crisis.

N: What type of response have you observed from health care providers in your experience based on these changes?

J: Well I think the organizations that have been accredited by AAAHC for a number of years, for them it was a transition because many of them were already doing many of the things that we have included in the new standards but they had to kind of fine tune or perhaps they had to put a process in writing or develop a policy even though they were doing it, it needed to be in writing. So I think they had some work to do, we did a workshop for accredited organizations on chapter 17 to get them ready for the change and did that enough beforehand so they had some time to work on it. AAAHC also provides a workshop several times a year in different parts of the country called ‘Achieving Accreditation’ and a lot of organizations that wanted to be accredited of are already accredited but up for reaccreditation attend that. And one of the presentations has been consistently now the last 3 times we’ve done it, chapter 17 and the new Behavioral Health Standards. So we give them these types of forums in order to ask questions, clarify things and the organizations know that they can always call AAAHC for assistance too if they have a question or not sure if they’re complying with the standard the way it’s written.

N: Now these standards touch every aspect of health care. It seems not only the care and the level of care and not only I guess documenting and tracking results based on these changes in these standards. What about the transmission and storage of HIPAA sensitive health care information, do these standards address those types of situations as well?

J: They do. So there’s a whole part that’s devoted to security of records being compliant with not only state but federal regulations, making sure that providers are acting in an ethical manner in line with their clinical discipline but the security of medical records is obviously a big part of chapter 17 as it is a part of the other accrediting standards as well. The way it’s organized, there are core standards that every organization must comply with and those core standards relate to rights of patients which is number one, number two is governance, number three is administration, four is quality of care and five is quality of improvement and six is clinical records so all organizations have to apply to those chapters and make it applicable to them. So part of the rights of patients and also governance and administration, they’re additional standards related to privacy of medical records in addition to chapter 17 so it kind of weaves in and out of many of the different chapters for AAAHC.

N: Where can our listeners go and get more information about AAAHC?

J: Yes, so I would encourage them if they’re interested in looking at accreditation or just learning more to go to the website. If you put in your browser the Accreditation Association for Ambulatory Health Care or AAAHC it should take you really right to the website, there you will find contact information as well as other good information in terms of the types of organizations that we accredit and a little bit more about the standards.

N: Great. You’ve been listening to Health Professional Radio, I’m your host Neal Howard in studio with Joy Himmel, Site Surveyor for AAAHC and Director of Counseling Services at Ross University School of Medicine. It’s been great having you here with us today Joy.

J: Thank you very much.

N: Transcripts and audio of this program are available at healthprofessionalradio.com.au and also at hpr.fm and you can subscribe to this podcast on iTunes.

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