siderea: (Default)
[personal profile] siderea
Constant readers will recall that I wrote a three-part post titled, "Why You Can't Find A Therapist, No, Really". I posted Part 1 on Sept 1st and Part 2 and Part 3 on Sept 30th of last year.

The clinic I work for as a contractor recently paid me, for my last pay period, an amount of money that was four times my typical earnings. Admittedly, how much I actually get paid fluctuates pretty wildly, but I figured I would have noticed having either 4x in arrears or having seen 4x as many patients as usual. But I'm paid via direct deposit, and the corresponding statement saying what I was getting paid for is put in my mail box at the clinic, so I had to wait till I was back in the clinic – today – to pick it up and find up why I was getting all this money.

The statement mystified me when I got it. It was two whole pages of pairs of canceled previous payments and replacement payments and at first I couldn't make heads or tails of it, and then I realized that I was looking at a statement where almost all the patient sessions listed had happened in 2016.

As I mentioned, last month, for the first time in decades, we got a raise. A big raise. Not big enough to be adequate, but big enough to be astounding. It was, we thought, effective starting May 1.

No. Turns out the raise was retroactive. To – apparently – Oct 1, 2016...

...The day after I posted the final sections of "Why You Can't Find A Therapist, No, Really".

Rumor has it that the raise – more properly, the increase in rate paid by at least two of the Medicaid providers – happened because MassHealth (Massachusetts Medicaid) leaned on them to do so, to fix the emergent strike.

Um.

MassHealth? Are... are you there? Are you reading my journal?

If so, thank you! (If not, still thank you!)

I have a few other suggestions for things you could fix!

For instance: I'm currently doing an amazing job (or so my chart reviewer wrote) doing care coordination with a big medical team involving four clinics, three hospitals, and family all involved in the care for a patient with an emergent psychotic illness. I can do that because the patient has MBHP, and MBHP pays for case coordination if it's extramural. I'd like to point out that it's insane that if I have a 15 minute conversation about the diagnostic formulation for a challenging and high-risk case with an in-house psychiatrist, I don't get paid for it (and neither do they), but if I do the same thing with a psychiatrist at a different clinic, I do. How wack is it that I literally wouldn't be able to afford to spend the sort of time on this case that I did (and continue to!) if the patient hadn't coincidentally decided he didn't like my clinic's available psychiatrist and went and found himself another one through his PCP. Surely this can't be the incentive system you want me or the patient (or the psychiatrist) to be functioning under – one where patients are incented to get their psychiatric care from an entirely different facility from their therapist.

And thank goodness that he had MBHP, as pretty much an amazing fluke. No other MassHealth payers pay for care coordination at all. If this guy had been on NHP or Tufts/BMC when he came down with schizophrenia... I shudder to think. Do you realize how much I've been on the phone with MGH's ER and APS and social workers and psychiatrists at local mental hospitals in the last six months?

Don't you think there should be some sort of provision for what happens when someone presents with a psychotic disorder? Like, when a provider slams the big red "R/o Schizophrenia" button, the payer has to start paying for some case coordination? (I'd also recommend that for substance abuse cases, where patients can manipulate providers around meds; and in mandated reporter cases, where you should probably have payers pay therapists for their time filling in DCF/DPPC/DES or whatever.)

I have to think that the time demands of handling such a high-risk case are part of why some – maybe many – therapist are leary of working with psychotic or other high-risk patients. I've been there. I've twice spent four hours – half a work day – keeping a patient in crisis calm and coordinating with the BEST team and then the hospital, and never saw a dime for any of it. Who wants to bring a patient onto their caseload, for whom the total compensation divided across the total hours of work for that one patient come to less than minimum wage?

And I'm just talking about care coordination – I'm not even talking about CPT 90839 and 90840 which last I checked were still universally unfunded. Funding that would be way cool.

I have many other fine suggestions – I swear many of them even aren't just suggestions you pay me more money! I'm happy to talk more about reforms in mental health care.
siderea: (Default)
[personal profile] siderea
Oh god I didn't know it was possible to be this wet without actually wading into a body of water.
elf: Leetah & Nightfall in the woods (Femslash)
[personal profile] elf
Ooh, this is a fun one. My happy-dance memories cross several genres; the hardest part here is not repeating several songs from the "loud" set. There's a whole bunch of pop/rocks songs that get my feet tapping, and a handful of country songs, and a bunch of Irish ceilidh tunes (most of which I don't have names for), because I taught intermediate ceilidh dancing at the Starry Plough for a few years.

Intermediate is the easy level for teachers. Didn't have to teach the basics; didn't have to provide challenges for the experts. Intermediate works on refinement, expanding figure knowledge, and learning new dances.

Hal an Tow | Strip the Willow | Maid Behind the Bar | Sellinger's Round | The Congress of Vienna | Walking on Sunshine | Blue Suede Shoes | Twist & Shout | Baby Got Back | 65 Love Affair | Jose Cuervo | It's a Cowboy Lovin' Night | Relax | Blister in the Sun

But really, there's only one that always pulls me onto the floor )

Meme list
elf: Petalwing, singing (Petalwing Singing)
[personal profile] elf
Ok, we're back to lists. Not that I have a lot of options here; I don't listen to a bunch of loud music, and most of the songs I like aren't loud. But there are a few. I'm including songs that I don't think need to be loud all the way through, but have a section that I prefer to be at top volume so I can scream along with it and not year my own voice.

Wake Me Up Before You Go-Go | Ballroom Blitz | Shut Up and Dance | It's the End of the World as We Know It (And I Feel Fine) | Cum On Feel The Noize | We're Not Gonna Take It | I Wanna Be Sedated | Immigrant Song | Fat Bottomed Girls

...okay, maybe I do have a lot of options. Not as many as some of the others, but I'm not running out.

I have no idea what show or movie this was made from, but it's awesome )

Meme list
elf: Twitchy alligator from Die Anstalt (Twitchy)
[personal profile] elf
Well, here we go, a topic where I don't have a whole playlist to throw around, and if I did, I wouldn't want to. I don't have a lot of people I want to forget in my life; the people I've known who were entirely negative, I want to remember whatever made me despise them so I can avoid it in the future.

So I'm stuck trying to figure out... are there songs I associate with the racist sexist step-uncle in Arkansas? With the kids who harassed me for being terrible at sports? With the teacher who gave me detention for reading in class? (I wasn't reading what everyone else was, because I'd finished it.) With the evil ex?

Wait, yes! There's a song that I like very much, that is so tangled with the evil ex (it was on one of his mix tapes) that I can't listen to it without unpleasant memories. :( Which is as close as I get to "a song that reminds you of someone you'd rather forget," I think.

This song is far too mellow for the associations I have with it. )

Meme list
elf: Silhoette of autumn scene; one glitch sitting on a park bench, another leaping in the air (Glitch - Autumn Day)
[personal profile] elf
This gets interesting, because "reminds me of summertime" often has nothing to do with the contents of the song. I spent a good portion of my preteen and early teen summers in Arkansas, so there are a swarm of country & bluegrass songs that I think of as "summery" because that's when I heard them. But those aren't the only ones I think of as "summertime" songs.

Cotton Jenny | I'm Gonna Hire a Wino | Out of the Frying Pan (And into the Fire) | Delta Dawn | Lady Takes the Cowboy Every Time | Cruel Summer | Stay Young | Good Vibrations | Nobody | Boys of Summer

And one I associate with summer both because of how I first heard it and the contents )

Meme list
elf: Musical notation from the Faerie's Aire and Death Waltz, with quote "Like a dirigible" (Dirigible)
[personal profile] elf
For this one, I also have a swarm to choose from. Probably not as many as color-songs, though; I like lots of songs with numbers in the chorus but not in the titles. I think I'm going to bypass the entire Schoolhouse Rock set (I like all of them, but especially Zero My Hero, Figure Eight, and Little Twelvetoes) and try to stick to "mainstream" songs, or at least, songs intended to be standalones rather than part of something else. (Mainstream's in quotes because I have some filk here; if you don't know what they are, they'd be hard to track down.)

Christmas at Ground Zero | One Tin Soldier | Two of Us | Threes | Wind's Four Quarters | Five Years | Six Days on the Road | Seven Year Ache | 867-5309 | 9 to 5 | At Seventeen | 50 Ways to Leave Your Lover | '65 Love Affair | 88 Lines about 44 Women | 99 Luftballons ...

Wow, there's a lot of mopey in that list. I should pick something that's a bit more perky.
One bouncy cheerful number song, coming up. )
elf: Petalwing, singing (Petalwing Singing)
[personal profile] elf
Really? Just one? I have a whole rainbow of songs I like with colors in the title: Crimson and Clover | Orange Crush | Big Yellow Taxi | Big Bright Green Pleasure Machine | Crystal Blue Persuasion | Purple People Eater | Lavender's Blue ...and then we get to colors not in the official rainbow set... Bad Bad Leroy Brown | Whiter Shade of Pale | Touch of Grey | Black Hole Sun | Pink Shoe Laces | Sister Golden Hair | Maxwell's Silver Hammer...

Gah. Have to pick just one.

I'm going with pirates. )

30 Day Song Meme

Jun. 21st, 2017 11:29 pm
elf: Musical notation from the Faerie's Aire and Death Waltz, with quote "Like a dirigible" (Dirigible)
[personal profile] elf
Stealing this from [personal profile] kshandra. I decided I should blog more, and telling myself to blog more about Important And Interesting Things isn't working, so I should try one of those "blog every day" things. (I've never done well at them.) This time, I picked something easy and fun instead of something that requires Deep Thought that I usually don't have by the end of my workday.

So: 30 days of songs, which are likely to be YouTube embeds (but maybe not, because I have a great love for a lot of filk that's never made it to YouTube); some are likely to get a lot of commentary, and others are likely to be "here it is, end of the day... um, have a music thing."

SUMMER SOLSTICE JAM PARTY BEGINS NOW.

List of Songs to Post Later )

[domesticity, MA] Renting a Bed?

Jun. 16th, 2017 01:06 am
siderea: (Default)
[personal profile] siderea
I keep having bright ideas that seem very plausible, but which then seem to not work in reality. I'm wondering if any of you can advise me about the following.

D, who will be moving into an assisted living facility shortly, is undecided about what size of bed she wants. The room she will have is quite small, so on one hand, she wants to maximize floor space. On the other hand, she's used to sleeping in a full size bed, and not sure she can handle downsizing to a twin.

So I had the brainwave that maybe we could use one of the rent-to-buy furniture places to rent a twin bed for her to try out. While we'd pay a premium for doing this, it would allow her to change her mind and have her full bed moved in if she didn't like the twin, without having to pay the full price for the twin if she didn't like it.

Now, I thought my question would be whether rent-to-own furniture places would even rent mattresses in MA given our laws about reusing mattresses – it turns out they do – or whether rent-to-own furniture places, having the reputation they do of being skeezy, are too disreputable to contract with or would have terms unfavorable to doing what I want – it turns out their model and rules seems ideal to our purpose.

But no. The problem seems to be whether rent-to-own furniture places on the North Shore will rent an entire twin bed.

There only seem to be two furniture rental places that serve the North Shore, Rent-a-Center and Aaron's. Both seem to be convinced that only children use twin beds. Aarons, at least, will allegedly (per website) rent a twin mattress and boxspring set, but none of their bedsets or electric adjustable bed bases are compatable. Rent-a-Center has no twin mattress sets at all; all their twin beds are for children, and either bunk beds, or platform beds (no place for boxspring), all of which are strangely inaccessible with things like elaborate superstructures (e.g. to make the bed look like a car, or a Cindarella coach) or higher than usual bed surfaces for under-bed storage (Captain's beds).

Does anybody have any suggestions about this? I can call the stores and ask if they have things available not on the website, but I figured I should stop and ask if there's things I should know that I don't. Like does anybody know of a local alternative? Has anybody done this?

[tech, soc] if \t then --$salary

Jun. 15th, 2017 05:01 pm
siderea: (Default)
[personal profile] siderea
Via Metafilter: Developers Who Use Spaces Make More Money Than Developers Who Use Tabs

Apparently, a suprisingly robust finding, even after controlling for absolutely everything obvious, and a lot of clever non-obvious things, too.

While correlation does not imply causation, in case you were wondering: 8.6% higher, on average.

[patreon] How do they DO that

Jun. 14th, 2017 08:45 pm
siderea: (Default)
[personal profile] siderea
I swear, not 48 hours after I finally get around to actually putting a Patreon icon on something, Patreon launches a completely redesigned logo.

It's like washing the car to make it rain.