Are Mental Health Clinic Audits Asking the Wrong Questions?

"Mental health clinics of all types, particularly large facilities that receive public support, are subject to quite a bit of oversight and regulation from many different organizations. These can include state health and mental health departments, insurance companies or coordinated care organizations (CCOs), federal agencies like the Centers for Medicare and Medicaid, and other groups. Typically, representatives from these regulatory agencies come onsite and provide periodic audits of the clinic's operations by looking at charts, interviewing staff and clients."

"I've been through many of these myself, on both sides of the evaluation process. These audits require a lot of resources for everyone involved. They are time-consuming and can be quite stressful for programs, as these evaluations can have real-world impacts on things like certification and funding. These reviews can also be useful in identifying and fixing problems while providing some external motivation to keep clinics in compliance with lots of administrative rules and policies."

"We often like to think we would follow all the rules anyway, but some honest introspection usually reveals that having someone looking over our shoulder periodically is more important than we want to admit. At the same time, it is hard not to notice that these quality reviews often focus on relatively minor things, while ignoring much bigger quality issues, in a kind of classic "missing the forest for the trees" manner."

Mental health clinics face oversight from multiple state, federal, insurance, and other agencies. Regulators conduct onsite audits that review charts, interview staff and clients, and produce reports listing required "findings" for correction. Audits demand substantial time and resources and can affect certification and funding. Audits can help identify problems and motivate administrative compliance. Many reviews concentrate on forms, documentation, and deadlines while neglecting larger clinical quality domains. External review often exerts stronger influence than anticipated. Regulation can be refocused to emphasize clinically meaningful quality improvements.

Read at Psychology Today