Fit Louisville


Greater Louisville Health Guide is a directory and resource guide to health providers and services in Louisville, Kentucky. Includes listings of area doctors and dentists, hospitals, nursing homes and emergency care.

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1 4 F I T 2 0 1 5 - 2 0 1 6 days and from 10 a.m. to 4 p.m. on Saturdays. Te clinic's busiest times are the evenings and weekends, with people who don't want to take time of for a doctor's appointment. "It's terrible that you kind of have to schedule your mental-health needs around your life, but you do," Rogers-Candee says. "So it's important to have that kind of availability." Tere have been naysayers about this model of care, though. "Here's the things that everybody said to me when I was talking about doing it," Frankel says. "First, they would say, 'Oh, you could never just go fee for service,' meaning we don't take insurance. Nobody thought that people would actually be will- ing to pay to come and be seen. Te second thing they said is, 'Oh, you're just going to get a bunch of drug-seekers.' Everybody envisioned us becoming an emergency room." Visiting Te Couch isn't cheap. To see more patients and spend a lot less time dealing with paperwork and red tape, the clinic doesn't work with insurance companies, meaning all patients pay out- of-pocket. An initial psychiatric assessment is $235 and a half-hour medication check is $110. An hour- long therapy session is $100. (As a comparison, two other local practices list similar fees for hour-long initial visits and half-hour follow-ups for patients paying out-of-pocket.) But Frankel says that patients are willing to pay the $110 when they can't get an appointment with their regular doctor for medication checks or changes. Cost-wise, Rogers-Candee admits, the clinic does compare to an initial emergency-room assessment. "With most any insurance, an emergen- cy-room visit is about $300, so coming here it's $235 and (patients) actually get care," she says. Tere's also the issue of people who come in seek- ing prescriptions for commonly abused anxiety meds Xanax and Klonopin, or drugs used to treat ADHD, like Adderall. Patients get tested for 13 classes of drugs to make sure they're not taking anything that wasn't prescribed. Staf members review records from Kentucky, Indiana, Tennessee and Ohio to make sure patients aren't getting drugs from other providers, which would indicate abuse. Frankel says she disagrees with some other psy- chiatrists in that she sees drug-seeking behavior as an opportunity to help, not to refuse treatment. Rogers- Candee says, "Very few people are addicted to drugs just because they decide, 'Hey, I want to be a drug addict; I think that'll be fun.' Te majority of people become addicted because they're self-medicating, whether it's a physical or mental illness. "We can often say this began with an anxiety disorder, this began with depression, this began with a genetic predisposition to be a person who, when you take a drug, your brain lights up in a way that's like, 'Oh, wow!' We can fnd a way to light up those parts of your brain, maybe not as well, but in a way that's going to be safe, that can improve, as opposed to diminish, your quality of life." And instead of becoming a treatment emergency room like people predicted, Frankel says Te Couch has helped people avoid the ER. "It could be the bipolar patient who's manic and starting to rev up. Tey're not quite psychotic yet, but they haven't slept for three nights, their speech is starting to go faster and faster, they're getting a little paranoid; try to make that person go and sit in an emergency room for four hours. By the time the doc gets to them, they'll need to be hospitalized," she says. Another case: a teenager with suicidal ideation. Parents can make an immediate appointment at Te Couch before the situation escalates. "If somebody's having suicidal thoughts but they don't have a plan or inten- tion of harming themselves, it's going to be more efective to treat them outpatient because they stay within their familiar zone, their family, their friends," Rogers-Candee says. "We can monitor them closely, see them once a week, make sure they're seeing a therapist for support as well." Frankel says she gets asked a lot why there aren't more clinics similar to hers. As far as she knows, it's the only clinic in the country that does psychiatric immediate care and isn't afliated with a hospital emergency room. One of her answers: Stafng a place like this is a difcult endeavor. She says she's had trouble fnd- ing nurses and clinical social workers who can really connect with people and make them feel comfort- able in those frst moments of an intake interview. And there's a shortage of psychiatrists and psychiatric nurse practitioners in general. Still, Frankel is trying to hire more clinicians. She'd like to open more locations, possibly near a college campus because many mental illnesses emerge in young adulthood. And she'd love to see more people open clinics like Te Couch. "I hope people copy it," she says. "Not just this idea, but I think physicians need to start thinking more innovatively. Te way medicine is going now, patients are getting less and less good care, and we've got to come up with better ways." "It's terrible that you kind of have to schedule your mental-health needs around your life, but you do," Rogers- Candee says. "So it's important to have that kind of availability."

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