Healthy Skepticism Library item: 3900

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Publication type: news

Carr C.
Mental Health Therapists Face Financial Stress as Fees Stagnate
New York Times 2006 Mar 26
Documents obtained by The Australian revealed almost 400 adverse reactions had been reported to the Therapeutic Goods Administration, some involving children as young as three.

Notes:

Ralph Faggotter’s Comments:

“…efforts by insurance companies to keep costs down as well as changing treatment patterns, including the increasing use of drugs, rather than psychological therapy, to treat mental ailments. “

This article highlights a widespread problem. The devaluation of psychotherapy in favour of the heavily promoted bandaid measure of psychoactive drug therapy.

Full text:

March 26, 2006
Mental Health Therapists Face Financial Stress as Fees Stagnate
By COELI CARR
For more than three decades, Jessica Hinterman, a licensed clinical social worker who lives in Park Forest, a Chicago suburb, has had a fulfilling private practice, a part-time one so she could spend more time raising her children. But in 2005, she earned at least 10 percent less than the year before, while her practice-related expenses increased.

Contributing to this shortfall in revenue was the fact that in November 2004, she had withdrawn from the provider list of the only health insurance company with which she had a contract.

“When you are on a provider list, the insurance company decides what you should be charging,” Ms. Hinterman said. Though her customary fee at the time was $90 an hour, she could charge only $68 to $72 for patients insured by the company she had contracted with. About two-thirds of her patients were insured by that company.

“I’d get a ceiling on what I was allowed to charge,” she said, “and that ceiling was unrealistically low.”

Like many other health professionals, mental health practitioners like Ms. Hinterman say that they are feeling an economic pinch, partly because of insurance reimbursement schedules that they say have not kept pace with their expenses.

Richard G. Frank, a health economist with a specialty in mental health issues who is a professor at Harvard, said: “Clearly, the earnings of mental health professionals – medical doctors, psychologists, social workers and counselors – have either been flat or been declining for the past five to eight years.”

“It’s not so much the number of visits allowed by managed care to mental health professionals has changed,” he said. “It’s that fees paid to the mental health professionals have not been rising.”

Mr. Frank, who is the co-author of “Better but Not Well” (Johns Hopkins Press, 2006), which examines United States mental health policies, cites efforts by insurance companies to keep costs down as well as changing treatment patterns, including the increasing use of drugs, rather than psychological therapy, to treat mental ailments.

Ms. Hinterman, too, observed that patients found prescription medicines a quicker fix than “prolonged and thorough introspection.”

“We just live in a culture that values speed and efficiency and wants to see complex problems resolved in half an hour,” she said. Given those changes, she no longer wants to rely on the profession she trained for as her sole source of income.

An experienced seamstress, in January 2004 she started Fiber Embellishments, a company that makes scarves, table linens, chefs’ aprons and one-of-a-kind bags made of boiled wool; local retailers are already selling her goods.

Ms. Hinterman’s concerns about earning a livelihood as a mental health professional are not isolated.

“A lot of people have taken a hit, there’s no doubt about it,” said Dava Weinstein, a licensed clinical social worker in private practice in Manhattan, who also teaches in the social work programs at Columbia University and Hunter College.

She also volunteers on a committee that deals with reimbursement issues for clinical social workers at the New York City chapter of the National Association of Social Workers. “Some members have told me, ‘I don’t know how I’m going to pay my mortgage’ and that they’re struggling to pay bills,” she said.

Among the top complaints from social workers about health insurers and the managed care industry are reduced fees, late payments and “inappropriate assessment of the needs of patients.”

Although the colleagues he has spoken with may not be leaving the profession yet, Paul C. Berman, a licensed psychologist in Baltimore who serves as professional affairs officer for Maryland’s psychological association, said there were “lots of gripes.”

Many psychologists in private practice, he said, have said their fees have been reduced year after year, requiring them to work many more hours to maintain the same income.

Mr. Berman said that when he went into private practice in 1990, participating in the provider networks of various health insurance companies, his maximum allowable hourly billing rate was $95, with about half of that paid by the insurance company and the rest by the patient. Today, he said, rates have plummeted to the point that the usual total reimbursement for psychologists is $65 to $75 an hour.

This drop has forced many practitioners to nearly double their client load simply to maintain their income, he said. Not only are lower fees problematic, but there is also the issue of not being paid quickly by managed care companies, and often having to resubmit claims. The time required to complete paperwork is, of course, not billable.

What Mr. Berman, who is no longer part of any insurance company’s provider network, has done – and what he encourages other psychologists and behavioral health care providers to consider – is to diversify the practice.

He now sees only a handful of therapy clients a week, at $95 for a 50-minute session, and earns his living predominantly “outside the insurance reimbursement world,” evaluating people on behalf of social service agencies, lawyers or the courts seeking expert opinions on mental fitness or in matters like custody hearings.

Lynne Spevack, a licensed clinical social worker in full-time private practice in the Wall Street area and in Brooklyn, also advises her colleagues to be active in making changes.

She consults with other social workers on how to expand their practices and leads monthly meetings for the New York City chapter of the social workers’ association on topics like practice-building and marketing. Among her suggestions to colleagues is taking speaking engagements to raise one’s profile.

Ms. Spevack said that even if the practitioner lowered the fee for someone paying out of pocket, the negotiated fee could still be higher than a managed care company would allow, and the practitioner would be “free of the invasion of managed care, paperwork and other administrative burdens,” she said.

“We can learn to ethically sell ourselves. It’s a skill set. There are no reasons people need to be leaving the profession.”

Mr. Berman says he also sees more of his colleagues revamping how they work, often displaying an array of feelings “similar to any life change,” he said.

“First, many practitioners thought managed care would die. “Then there was outrage. Then resignation. Then they felt overwhelmed. Where we are now is taking a proactive stance so we can meet the needs of the changing marketplace and survive financially and professionally.”

http://www.nytimes.com/2006/03/26/jobs/26jmar.html?_r=1&oref=slogin

Copyright 2006The New York Times Company