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[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.

Fig and Ibid on their current home

Jun. 27th, 2017 11:31 pm
james_davis_nicoll: (Default)
[personal profile] james_davis_nicoll
Fig thinks everything is the best thing ever, especially the completely adorable orange cat. Who would like the stranger to stop gazing affectionately at him.

Ibid, on the other hand, won't come out from behind the toilet.

Hummers and Potters

Jun. 27th, 2017 06:55 pm
sartorias: (Default)
[personal profile] sartorias
Why is it (she grumped) that one can be standing at the sink washing dishes and look out to see all kinds of hummers being enchanting around the feeder, and occasionally the yellow and black bird stoking up, but as SOON as one races upstairs for the cell phone cam, they all vanish for hours?

Other than that, it's hot, but that's to be expected. At least the punishing sun is on its slide toward darker earlier, thank goodness.

Hither and yon I've seen "Harry Potter twenty years!" posts but I don't really read more than a paragraph. I read and enjoyed each book, skimming larger and larger sections as each book got more bloated; they never quite inspired a second read, though I could see that had I read them as a kid I would have loved them to bits, and I probably would have struggled with magic wand 'logic' over my own magic delivery system, had I read them early enough.

More interesting to me than the books has been their phenomenal influence on the field--finally YA became an accepted subgenre, and is now a market power house. Before Potter, many of us who said we wrote for kids were asked variations on, "And when will you write a real book?" Many of us had already written about magic schools--had read about them. But of course in those days the received wisdom was that no kid would read a book over 60 k words (though we all did), and the kids had to stay emotionally about twelve.

But this series was the one that caught the imagination of a generation.

It's interesting to see the Potter influence in the writers who grew up on the stories. Literature is always in conversation with itself, and tracing influence is fun when you read back far enough. It's especially interesting seeing the mix of film and story with Potter: in the books, Malfoy, for example, is one dimensional, always rotten except for a line or so in a late book, but the films gave him a beautiful face, and as a consequence there are so many angsty-but-beautiful bad boys with pale blond hair in YA stories written by the Potter generation. As I recall, Malfoy didn't have any angst in the books. He was just a snot. But the best of the fanfic writers gave him tons of angst as he pined for Harry, and at last seduced him--and the fanfic has been a strong influence as it developed many of these writers.

I think there is a terrific PhD thesis in this. (If it isn't already being written.)
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.

Bundle of Holding: Mutant Chronicles

Jun. 27th, 2017 04:55 pm
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[personal profile] james_davis_nicoll



Freelancer! From the distant future the Factions bring you our Mutant Chronicles Bundle featuring the 2015 Third Edition of Mutant Chronicles, the dieselpunk techno-fantasy RPG of future darkness from Modiphius Entertainment. With its fast-playing, cinematic "2d20" system designed by Jay Little (Star Wars: Edge of the Empire), Mutant Chronicles 3E is a thrill ride across a Solar System beset by megacorporate intrigue and the invasion of a terrible alien force.

Book Recs and News

Jun. 27th, 2017 09:49 am
marthawells: (Reading)
[personal profile] marthawells
News: If you missed it yesterday, there are going to be two more Murderbot novellas for a total of four, and 2, 3, and 4 are all coming out next year.


***

(If you've been following my book rec and new book listing posts for a while, you may have noticed this already, but while most book lists emphasize books by popular straight white men, this one emphasizes everybody else. I include books by straight white men, but in about the same percentage that other book lists include everybody else. I also try to highlight books that are less well known.)

(I only link to one retail outlet in the book's listing, but most books are available at multiple outlets, like Kobo, iBooks, international Amazons, Barnes & Noble, etc. The short stories are usually on free online magazines.)


Short story: The White-throated Transmigrant by E. Lily Yu


* Miles Morales - A Spider Man Novel by Jason Reynolds
Miles Morales is just your average teenager. Dinner every Sunday with his parents, chilling out playing old-school video games with his best friend, Ganke, crushing on brainy, beautiful poet Alicia. He's even got a scholarship spot at the prestigious Brooklyn Visions Academy. Oh yeah, and he's Spider Man.


* Bright Thrones by Kate Elliott
An exciting e-novella set in the world of the New York Times bestselling Court of Fives, from World Fantasy Award finalist Kate Elliott!


* Drawing Dead by SM Reine
The vampire slayer is turning into a vampire? Over her dead body. Dana McIntyre has been bitten by a master vampire. She's infected with the venom. And after killing hundreds of vampires to keep Las Vegas safe, she'd rather die than turn.


* Kangaroo Too by Curtis C. Chen
On the way home from his latest mission, secret agent Kangaroo’s spacecraft is wrecked by a rogue mining robot. The agency tracks the bot back to the Moon, where a retired asteroid miner—code named “Clementine” —might have information about who’s behind the sabotage. Clementine will only deal with Jessica Chu, Kangaroo’s personal physician and a former military doctor once deployed in the asteroid belt. Kangaroo accompanies Jessica as a courier, smuggling Clementine’s payment of solid gold in the pocket universe that only he can use.


* The Strange Case of the Alchemist's Daughter by Theodora Goss
Mary Jekyll, alone and penniless following her parents’ death, is curious about the secrets of her father’s mysterious past. One clue in particular hints that Edward Hyde, her father’s former friend and a murderer, may be nearby, and there is a reward for information leading to his capture...a reward that would solve all of her immediate financial woes. But her hunt leads her to Hyde’s daughter, Diana, a feral child left to be raised by nuns. With the assistance of Sherlock Holmes and Dr. Watson, Mary continues her search for the elusive Hyde, and soon befriends more women, all of whom have been created through terrifying experimentation: Beatrice Rappaccini, Catherin Moreau, and Justine Frankenstein.


* Mapping the Interior by Stephen Graham Jones
Blackfeet author Stephen Graham Jones brings readers a spine-tingling Native American horror novella. Walking through his own house at night, a fifteen-year-old thinks he sees another person stepping through a doorway. Instead of the people who could be there, his mother or his brother, the figure reminds him of his long-gone father, who died mysteriously before his family left the reservation. When he follows it he discovers his house is bigger and deeper than he knew.


* Shattered Minds by Laura Lam
Carina used to be one of the best biohackers in Pacifica. But when she worked for Sudice and saw what the company's experiments on brain recording were doing to their subjects, it disturbed her—especially because she found herself enjoying giving pain and contemplating murder. She quit and soon grew addicted to the drug Zeal, spending most of her waking moments in a horror-filled dream world where she could act out her depraved fantasies without actually hurting anyone.


* The Last Good Man by Linda Nagata
carred by war, in pursuit of truth: Army veteran True Brighton left the service when the development of robotic helicopters made her training as a pilot obsolete. Now she works at Requisite Operations, a private military company established by friend and former Special Ops soldier Lincoln Han. ReqOp has embraced the new technologies. Robotics, big data, and artificial intelligence are all tools used to augment the skills of veteran warfighters-for-hire. But the tragedy of war is still measured in human casualties, and when True makes a chance discovery during a rescue mission, old wounds are ripped open. She’s left questioning what she knows of the past, and resolves to pursue the truth, whatever the cost.


* Mars Girls by Mary Turzillo
What Nanoannie and Kapera find at the Smythe’s Pharm is more than the girls bargained for. The hab has been trashed and there are dead bodies buried in the backyard! If that wasn’t bad enough, the girls crash the rover and Kapera gets kidnapped by Facers who claim her parents are murderers! Between Renegade Nuns, Facers, and corp geeks, Nanoannie and Kapera don’t know who to trust or where to go. Kapera only wants to find her parents so they can get to Earth Orbitals and she can be treated for her leukemia. Nanoannie wants to help her friend and experience a little bit of Mars before selling her contract to the first corp that offers to buy it.

Invisible 3 Release Day

Jun. 27th, 2017 10:49 am
jimhines: (Snoopy Writing)
[personal profile] jimhines

Invisible 3 CoverINVISIBLE 3, a collection of 18 essays and poems about representation in SF/F, is out today! The ebook is edited by myself and Mary Anne Mohanraj, and is available at:

Amazon | B&N | Kobo | iBooks | Smashwords | Google Play

As with the first two volumes in this series, all profits go to benefit Con or Bust.

Here’s the full table of contents:

  • Introduction by K. Tempest Bradford
  • Heroes and Monsters, by T. S. Bazelli
  • Notes from the Meat Cage, by Fran Wilde
  • What Color Are My Heroes? by Mari Kurisato
  • The Zeroth Law Of Sex in Science Fiction, by Jennifer Cross
  • Our Hyperdimensional Mesh of Identities, by Alliah
  • Erasing Athena, Effacing Hestia, by Alex Conall
  • Not So Divergent After All, by Alyssa Hillary
  • Skins, by Chelsea Alejandro
  • The Doctor and I, by Benjamin Rosenbaum
  • My Family Isn’t Built By Blood, by Jaime O. Mayer
  • Lost in Space: A Messy Voyage Through Fictional Universes, by Carrie Sessarego
  • Decolonise The Future, by Brandon O’Brien
  • Natives in Space, by Rebecca Roanhorse
  • I Would Fly With Dragons, by Sean Robinson
  • Adventures in Online Dating, by Jeremy Sim
  • Of Asian-Americans and Bellydancing Wookiees, by Dawn Xiana Moon
  • Shard of a Mirage, by MT O’Shaughnessy
  • Unseen, Unheard, by Jo Gerrard

Huge thanks to the contributors for sharing their stories and experiences. I’ve learned so much from earlier volumes in this series, and this one was no different.

And hey, if you haven’t seen the previous volumes…

INVISIBLE: Amazon | B&N | Kobo | iBooks | Smashwords | Google Play

INVISIBLE 2: Amazon | B&N | Kobo | iBooks | Smashwords | Google Play

If you’re a reviewer and would like a copy, please contact me and let me know your preferred format and where your reviews are published.

Mirrored from Jim C. Hines.

truepenny: artist's rendering of Sidneyia inexpectans (Default)
[personal profile] truepenny
Dear Senator Johnson:

Yesterday, you compared me, not favorably, to a car: "We’ve done something with our health care system that you would never think about doing, for example, with auto insurance, where you would require auto insurance companies to sell a policy to somebody after they crash their car."

I cannot tell you how furious I am.

First of all, in comparing health insurance to car insurance, you are implying that:

(1) we can avoid illness, cancer, strokes, etc., the same way a driver, hypothetically, can avoid accidents (although accidents can't always be avoided, either);
(2) human beings are nothing but machines;
3) if we are not useful--as, say, children or elderly people no longer able to work are not useful--we are not worth taking care of;
(4) we decrease in value when we are damaged.

All of these implications are wrong. Frankly, they are all reprehensible. Also, a car accident is in no way, shape, or form like a "pre-existing condition." "Pre-existing conditions" are chronic. You can't deal with them once and then move on, the way you can buy a new car if yours is totaled. You have to deal with a "pre-existing condition" for the rest of your life; it goes on being expensive, eating up energy, and making your daily life harder long after the crisis point (the accident, in your analogy), if there even was one. Many people's "pre-existing conditions" start before they're even born. It is a false and pernicious analogy which you should never have permitted yourself to make.

Moreover, my "pre-existing conditions" are not things that I did, or things caused by my bad choices. The same is true of my friends who are bipolar. The same is true of any child who has cancer. Illness, whether mental or physical, is not a moral judgment, and a person's value, which is inestimable, is neither measured nor affected by the health care they need. And no one can predict the health care they're going to need--in much the same way no one can predict a drunk driver crossing the median and colliding head-on with their car.

Frankly, I have never expected you to oppose TrumpCare, whether it's called the AHCA or the BCRA, and I was angry enough about that. But the contempt this analogy shows for your constituents and for their need to have effective and affordable health care--a need that does not correlate with either their socio-economic status or their moral rectitude and that should never be thought of in terms of free-market capitalism--is appalling, especially from someone who claims to consider it "an honor and a privilege to serve the people of Wisconsin." I sincerely hope that this analogy is not a reflection of your true opinion of your constituents.

Senator Johnson, I AM NOT A CAR. I am a person, created equal with yourself, and I deserve to have my elected representatives respect my humanity and treat me with dignity.

Local news

Jun. 26th, 2017 10:34 pm
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[personal profile] james_davis_nicoll


Mosque approved despite pleas to think of the little turtles and an odd assertion that the mosque would produce more sewage than "normal " spiritual use.

The exgf's cats meet Fig

Jun. 26th, 2017 09:42 pm
james_davis_nicoll: (Default)
[personal profile] james_davis_nicoll
Ibid has a ... troubled history with Nigel so we're holding off on that.

No histrionics but somehow Rufus established himself as a cat Fig needs not to annoy, whereas Nigel is someone Fig will happily follow around.

Also, Fig made himself sick eating daisies, then tried to eat one again.

Escape from Triassic Park

Jun. 26th, 2017 07:03 pm
fadeaccompli: (roles)
[personal profile] fadeaccompli
So, a few weeks back I ran into this one-page RPG on Tumblr. It's called "Escape from Triassic Park", and it's basically "Jurassic Park from the dinosaur perspective," with very fast and silly rules for maximum mayhem. This afternoon, I decided to try it out, and run a very short, very fast game of it for anyone who wanted to play.

(N.B.: The RPG was created by these folks based on the RPGs done by this guy and seems most like this RPG of his about criminal bears. Note has been also made of its similarity to Lasers & Feelings (PDF link), so, credit where it is variously due!)

The obstacles in their path were "all the males are in cryo storage" and "the guards are spliced with dino DNA"; they started "in their own enclosures"; and these are the stories of the Dinosaurs On The Run.

(Most of the OOC comments have been taken out of the log except for clarity, amusement, and where I forgot to do otherwise. One typo has been corrected, and two misordered poses have been put back into order. Otherwise this is exactly as it happened. Based on a true story, etc.)

Session Log )
james_davis_nicoll: (Default)
[personal profile] james_davis_nicoll
I finally found out where I misshelved this.

(no idea what review series I can fit it into)


Dumb Calibre/Kobo question

Jun. 26th, 2017 03:20 pm
james_davis_nicoll: (Default)
[personal profile] james_davis_nicoll
I can see my Kobo has about 300 more titles on it than my laptop Calibre does (because I got the Kobo well before the laptop). How do I move the titles that are on the Kobo to Calibre?
james_davis_nicoll: (Default)
[personal profile] james_davis_nicoll
One issue: I really suck at giving people their free reviews. Would appreciate pointers on how to suck less.

Home Alone

Jun. 26th, 2017 07:18 pm
lurkingcat: (Default)
[personal profile] lurkingcat
Or not because at least Kheldar and I had each other while [personal profile] battlehamster went off to a larp this weekend. Kheldar did a fine job of protecting the house although I could have done without waking up at 2am one morning thinking that I was suffocating only discover that Kheldar was on my chest purring his report at me. He was so very, very pleased about having a human to report to at that time in the morning.

[personal profile] k8bush and [personal profile] teebee were kind enough to invite me round on Saturday night and I sat on their sofa, drank Pimms and lemonade, and talked about all sorts of things but mostly Pokémon. While I'm aware that the new gym changes haven't pleased everyone they're working pretty well for me so far. It seems to have broken the stranglehold that one small group of people had on gyms over a very wide area around here and I'm seeing much lower level players able to take a gym now, whereas previously I think it had become so daunting that most people had given up trying.

[personal profile] teebee called me at around 7pm yesterday evening to point out that there was a raid starting on a nearby gym and it was a small enough target that it didn't need too many players. So I ran around the house shutting windows and locking up while Kheldar stared at me in bewilderment and then bounced off up the road as if I was at least thirty years younger than I actually am and leaned over the fence at the water tower and took part in my first raid. I have a Bayleef now. Only another 105 candies and I'll be able to evolve it ;)

(no subject)

Jun. 26th, 2017 12:30 pm
fadeaccompli: (risky)
[personal profile] fadeaccompli
Finally turned off the crossposting to LJ; it's been failing ever since the new TOS went up over there, anyway.

Alas, alas, for Livejournal of old. Long live the Dreamdwidth!

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Adventures in Mamboland

"Jazz Fish, a saxophone playing wanderer, finds himself in Mamboland at a critical phase in his life." --Howie Green, on his book Jazz Fish Zen

Yeah. That sounds about right.

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