PLEASE
AND UNDERSTAND WHAT HAS HAPPENED TO YOU (THE PATIENT) AND TO US (THE PROVIDER OF SERVICES)!
"
You can't have 14 year old girls having babies and 15 year old boys doing drugs and alcohol and 16 year olds getting AIDS and 17 year olds not being able to read their own diplomas." Do you know who said that? (realizing this is a paraphrase) Newt Gingrich said it a few months ago.
"Giant MCOs like VBH, Merit, HAI, and Green Spring need hard data to get answers to questions like: how to shorten treatment; how to use lower-degree providers; how to use self-help and education to reduce the need for traditional treatment; and how to determine which contracts or types of business have the greatest profit potential."
THIS IS A HORRIBLE WAY TO CONCEPTUALIZE CARE. We must stand up to this Managed Economic Socialized System (MESS). If not we will surely all be indentured servants at this time next year if we are still behavioral health providers. Chances are though we won't last that long without a major backlash. That means Corporate America cancelling their contracts with Managed Care and contracting directly with the providers again (not a bad idea, but not a chance), providing different services as professionals than are being provided for Managed Care Panels, consumers refusing to accept the health packages being offered, or Congress doing the right thing. That's about all the options.
The Murrah Building is Bombed in Oklahoma City
The Olympic Village is Bombed
Heart Disease
Depression
AIDS
Alcohol and Drug Abuse
Homelessness
Welfare
Illiteracy
Indebtedness
Crime
All of the above have a behavioral component. If we completely take the behavioral health professions apart (and that is what is happening) there will be no trained and skilled professionals to ever help alleviate these problems. In the past we have not applied the expert skills of these professionals in an intensive manner to help solve these terribly difficult issues. And now we are being completely abandoned. Most authorities have cited that there will be about 25% of the psychologists in practice in the next year as there were last year.
Congress has let Managed Care take over.....period. We oppose the structure of Managed Care in the US. Managed Care does not do what it says it will do. Costs have not gone down. Has your insurance payroll deduction decreased in the last year? Probably it has gone up and the monies.
have ended up in the MCO's bank accounts. The number of mergers and acquisitions have become daily financial news.
Managed Care compromises client confidentiality (and their families by asking for history), creates inherent conflicts of interest between clients and therapists, limits provider's ability to act as advocates for our clients, abridges ethics, and makes it difficult to tailor therapeutic strategies to the individuals unique circumstances. Many patients do not know what they have in the way of mental health care until they try to access the benefits
>You may have not really given much thought about the impact of Managed Care on the income of Psychologists and why it is driving many of us out of business. Aside from being excluded from panels and losing business, aside from draconian case management which can actually keep you from getting the care you need, aside from "gag" orders which require state laws to get back our freedom of speech, aside from all of those issues, let's just examine what has happened to our income since Managed Care came on the scene.
Average Patients seen per week ..................................... 30 (if you can get that many referrals from MCO's)
Average Per session billing .............. $90 Average reimbursement from MCO's* and EAP's........................ $70 (often takes up to 6 months)
Income per week for 30 appointments........................................ $2100
x's 50 weeks........................................................$105,000 gross receipts
actual reimbursement in 12 months is about 80% of billings or ................. $84,000
Less the following
Malpractice Insurance ................................................................. $500 minimum
Continuing Education ...............10 hrs x $50/hr min........................$500
Office expenses........................... 50% of gross billings..................$42,500
includes office rent
secretarial help
answering service after hours
accounting services (CPA audit)
limited legal services.....one interesting (and large managed EAP) "recommends that if you are requested to appear in a court hearing for one of their cases that you retain your own legal counsel or receive clinical guidance from your professional association regarding a subpoena to appear. In such situations you are acting on your own behalf and they are unable to advise you."
advertising
electronic billing
bill collection service
office supplies
consummables
testing materials
clinical office software and outcome measures software
computers with e-mail and internet capability
*PruPsych clients covered by Merit are having provider reimbursement rates dropped to $50 according to the August, 1996, Managed Care Strategies©.
Taxes, disability. medical insurance, etc............................................$ 23,000
and that is if all of the above goes smoothly and you have no unexpected expenses. You should also know that since Managed Care came on the scene we have a no show or late cancellation rate of about 33% compared to 2% prior to Managed Care. We are not allowed to charge clients for no-shows or late cancellations. This is a tragedy for those of us who have built respectable livings and offices and have spent up to 12 years getting all the education, training, and education needed to provide services. We can't cut any more expenses. They have made new rules and taken away our patients. Wouldn't you be angry to be told who you could see, how much you were going to be paid if you were going to be paid and have to have responsibility for someone else's life under those conditions?
One can't survive on those kind of wages in a professional environment and continue to meet the standards of practice and ethics that our MS counselor friends do not have to meet. This is far from a level playing field and doctoral level providers are being grossly abused. If any MCO, other third party payor, or anyone else including our Professional Organization spokespersons can tell us how we can survive under prevailing conditions, we will make the space available for your answer. A more to the point question is why should we become extinct and the Managed Care Organizations survive? MCO survival....they are doing much better than just surviving. You might want to see just how well they are doing by clicking MCO Profits and CEO Salaries.
We NEED your help. Please contact your congresspersons and senator and ask them to vigorously support Sen. Pete Domenici, Sen. Ted Kennedy, and Sen. Nancy Kassebaum's fight in the Fall to get sensible mental health coverage for everyone. Send an email to each of the three addresses below letting them know you want doctoral level providers at reasonable reimbursement rates and under professional standards of operating conditions and that you do not condone Managed Cares's outrageous unchecked behavior.
Government
United States Senate
United States House of Representatives
We read our email everyday.
