Psychotherapy Finances

TRICARE, the health plan for members of the military and their families, announced this week that it is extending its Web-based counseling program another year.

The pilot program was launched last summer in a bid to expand services to hard-to-reach beneficiaries, especially returning National Guard members who live in more remote areas of the country.

“We wanted to offer people a variety of options to get mental health care,” TRICARE spokesman Austin Camacho told Psychotherapy Finances in October. “There’s a reluctance to go to a [therapist] because of the stigma attached. But if you do it in the privacy of your own home, there’s an added layer of confidentiality.”

Access to the program was minimal at first, but enough potential was spotted by TRICARE officials to continue it at least through March 20, 2011.

Using a video camera mounted on a PC, members can talk live to a TRICARE counselor who is also using a camera and the free online conferencing service, Skype.

Among those eligible area active duty service members and their families; Reserve members and their family members who are enrolled in TRICARE Reserve Select; and those under the Transition Assistance Management Program (TAMP). Children must be 18 or older.

Members are being treated for stress management, family conflicts, emotional problems due to separation and deployment, parenting issues, and self-esteem issues.

The Skype-TRICARE counseling program is “almost like an EAP type of service,” Camacho said. “Being face-to-face gives the provider another layer of contact. They can pick up on visual cues.”

For more detailed information on the TRICARE service, click here.

Our October, 2009 Psychotherapy Finances article also contains instructions on how to set up a Web-based counseling system, along with costs and required software.

There’s concern in the mental health community that the new DSM-5 will contain language restricting which professions are able to diagnose mental illnesses. It was a hot topic of conversation on a large mental health listserv in February.

The draft DSM-5 is online at http://www.dsm5.org/Pages/Default.aspx. Comments are being accepted on proposed changes.

The idea, though, of restricting who can diagnose from the DSM-5 appears to have grown out of an article last month in Psychiatric Times by H. Steven Moffic. The piece was titled: CAUTION! Who should be the DSM-V Diagnostician?

Arguing that diagnosis of mental illness is becoming increasingly biologically based, Moffic suggests the DSM-5 contain the following language:

“This diagnostic manual is derived mainly from the expertise of psychiatrists. Given the importance of general medical knowledge in making an accurate psychiatric diagnosis, the appropriate use of this manual is for psychiatrists to certify the official diagnosis. The exception would be those who are specially trained and supervised by the American Board of Psychiatry and Neurology.”

This idea has triggered backlash, not only from psychologists, clinical social workers and other providers, but also from some psychiatrists. Reactions have been published online and you can read them by clicking on the article link, above.

Many practitioners are taking the idea seriously. Writing in the March issue of the National Alliance of Professional Psychology Providers (NAPPP) newsletter, The Clinical Practitioner, organization founder John Caccavale sees the new DSM-5 as a “greater threat” to the profession.

“Now, with an updated DSM-V waiting to be introduced, some psychiatrists are calling for an introductory paragraph stating that only a ‘psychiatrist is qualified to make a diagnosis of those conditions found in the DSM,’” Caccavale says.

“This diminishing and evaporating profession, which has thrived by literally pushing a host of drugs that have proven mostly ineffective, now wants to control diagnosing. The rest of us, it appears, should be confined to providing only the services that these ‘Grand Poo Bahs’ decide.

“In essence, psychologists, in their view, should become the ants kept by aphids to keep psychiatrists fed and well nourished while they continue to destroy behavioral health.”

Caccavale suggests psychologists avoid using the DSM-5 and instead use “universal ICD codes,” which he says are accepted by insurance carriers.

“This by itself, will not save behavioral strategies or psychotherapy,” Caccavale concludes, “but it will show that we are serious about moving towards claiming our stake in behavioral health.”

The final DSM-5 is scheduled to be published in May, 2013.

President Obama wants a hard crack down on Medicare and Medicaid fraud. He favors a program to have private companies identify cases of fraud in exchange for earning a bounty – a percentage of the amount saved by the government.

Obama promoted that idea this week, according to the New York Times.

The Times said on Thursday that the president announced at a health care reform rally he was “unleashing auditors around the country as part of a special program to ferret out government overpayments to hospitals and doctors, as well as to other contractors.”

The government plans to sanction use of computer programs by companies that would review Medicare reimbursement records, looking for incongruities.

Psychotherapy Finances brought this issue up in a February 2009 article, CMS launches widely criticized ‘bounty hunter’ program.

At the time, CMS (Centers for Medicare and Medicaid Services) announced implementation of its national Recovery Audit Contractor (RAC) program. Under the plan, CMS contracts with private auditing organizations to uncover fraud. The auditor collects a fee based on what it finds.

The feds were apparently focusing their efforts on medical supplies and home health services. In South Florida alone, 700 providers were charged early last year with defrauding Medicare of $272 million since 2004, according to The Miami Herald.

Physicians, in particular, are incensed by the RAC contingency payments, and have been lobbying for a moratorium on the plan. If the Times story is any indication, that won’t happen.

However, the impact on mental health providers appears to be minimal, at least for now. It looks like efforts to recover funds will be primarily aimed at deeper pockets, according to those familiar with Medicare reimbursement.

Psychologists are hoping Oregon becomes the third state in the nation to grant them prescription privileges. Legislation passed the state’s House and Senate late last month, and is now under consideration by Governor Ted Kulongoski.

He has 30 days from February 26, the day that it passed the House, to veto Senate Bill 1046. If he does nothing, it will become law. Kulongoski hasn’t made up his mind on the issue, according to his spokeswoman, Jillian Schoene.

“Like any other bill, it’ll go to a policy board for their consideration and analysis,” she said. They’ll consider input from psychologists and psychiatrists, as well as the Oregon Medical Association.

You can check the status of SB 1046 on the governor’s Web site, using this link.

Prescription bills pop up every year in state legislatures, with varying degrees of success. So far, only New Mexico and Louisiana have actually approved prescription programs for psychologists.

In 2007, a bill passed both houses of the legislature in Hawaii, only to be vetoed by the governor. This year, according to the American Psychological Association’s Sophie Bethune, there are other serious legislative efforts in Arizona, Illinois and Mississippi.

There are about 1,400 psychologists in Oregon and 400 psychiatrists. Advocates of the prescription bill argue that it’s needed in order to make full-spectrum mental health services available to more residents of the state.

If the bill is signed by Kulongoski, certain psychologists with advanced training could start prescribing July 1, 2011.