Psychotherapy Finances

Therapists are still struggling with online social networking issues, in particular how to handle friend requests” on Facebook. We posted an item on this topic in April, referring to a Washington Post article that assessed the position of professional associations on social networking.

The topic comes up again in the new issue of Access, the newsletter of the Clinical Social Work Association. In his Clinical Focus column, LCSW Keith Myers writes what is essentially a good primer for therapists just thinking about getting into the Facebook/ Linked-in networks. It’s not a “how-to,” though.

In Social Media and Psychotherapy – Beginning in the Middle of the Conversation, Myers weighs the clinical, ethical and legal concerns surrounding Facebook.

If you’re looking to develop a policy for your practice regarding online networking, Myers refers readers to Keely Kolmes, a San Francisco psychologist who has a Website, blog (Mindful Musings) and social media policy.

She addresses “friending” and “fanning” (becoming a “fan” of a person or organization), following on Twitter and her policy on using search engines to Google clients.

Eventually, professional associations will doubtless recommend policies on these issues; for now you’ll have to check out what other therapists are doing and adjust your practice as you deem necessary.

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ValueOptions has introduced online re-credentialing. For details, check the new issue of the company’s newsletter, The Valued Provider.

Public relations has not been the strong suit of health insurers this year. As health care reform was being debated, for example, some companies announced double-digit premium increases.

And WellPoint was the target of scathing criticism in April when a Reuters report accused the company of canceling the policies of women diagnosed with breast cancer. Scrambling to counter the bad publicity, WellPoint announced on May 26 that it was “unilaterally” implementing the federal Breast Cancer Protection Act, which hasn’t even been passed by Congress yet.

Now comes an effort by UnitedHealth Group, one of the nation’s largest insurers and parent company of United Behavioral Health – the largest behavioral managed care organization in the country, surpassing Magellan Health Services. UHG announced last week that it had named a new “vice president of social responsibility.”

Kate Rubin will also become executive director of the United Health Foundation, with a budget of $55 million in 2009.

Speaking of social responsibility, CIGNA Health has this to say on its Website: “CIGNA is one of the fore-runners of displaying corporate social responsibility. CIGNA not only makes monetary donations, but donates water and time to individuals around the globe.

“CIGNA has worked to transform their business to become environmentally friendly. The company conducts most business online to avoid the use of paper and recycles four million pounds of paper every year.”

All of which is bound to make you feel warm and fuzzy about health insurance companies, right?

By the way, look for insurers to become increasingly competitive in the Medicaid market, both in terms of medical services and behavioral health. That’s because a major prong of the health care reform law will be increasing Medicaid rolls throughout the 50 states (using federal money).

Magellan’s First Health Services, which targets the Medicaid market, is changing its name to Magellan Medicaid Administration on July 1. Coincidence? Perhaps not.

The APA’s Monitor on Psychology has a lengthy piece this month on the health care reform law and declares: “The landmark legislation offers new opportunity for psychology.”

The APA likes the overall tone of the law and the idea of expanding health care to 32 million people.

More specifically, leaders are applauding the law’s $10 million set aside for doctoral, internship and postdoctoral training. That would triple the size of existing programs for psychologists.

And health care reform extends a 5% Medicare psychotherapy payment restoration through the end of 2010, retroactive to Jan. 1. The cuts had been scheduled for 2007, 2008 and 2009, but psychologists have convinced Congress to delay them each time. This is yet another reprieve.

APA President Carol Goodheart predicts: “There’s going to be increased demand for mental health services under the new law.”

But the National Conference of State Legislatures has an interesting juxtaposition to The Monitor’s celebratory article, which you can read by clicking here.

The NCSL June 5 report points out how widespread the opposition is at the state level to the reform law. At this point, things appear to be chaotic.

“Members of at least 39 state legislatures have proposed legislation to limit, alter or oppose selected state or federal actions, including single-payer provisions and mandates that would require purchase of insurance,” according to the organization.

Attorneys general in 20 states have also mounted legal challenges to the constitutionality of health care reform, as passed and signed by President Obama.

State legislators are confused about how the law will be implemented. The NCSL says lawmakers are scrambling this summer to come up with a game plan—and not all is going smoothly.

Peggy Welch, an Indiana state rep, says nevertheless states need to push ahead even while legal challenges continue.

“We are overwhelmed, but so are the feds,” she says.

Primary care physicians have steadily drained business away from behavioral health care providers over the years by prescribing – often without evaluation by a mental health professional – pharmaceuticals to their patients suffering from depression, anxiety and other disorders.

This trend has been maintained despite evidence that a combination of talk therapy and medication is often most effective for mental health treatment.

Now, The National Alliance of Professional Psychology Providers (NAPPP) has hired a Washington, DC public relations company to help make a case that physicians should not be able to provide behavioral health services unless “they can specifically demonstrate that they have had and passed the requisite education, training, supervision, and testing.”

That’s according to John Caccavale, one of the NAPPP founders, writing in the organization’s June issue of The Clinical Practitioner newsletter.

“Most primary care physicians, while well meaning, simply do not have the skills or training to evaluate and diagnose serious behavioral disorders,” Caccavale said. “As a result, patients are not receiving the appropriate standard of care that they require and healthcare resources are being misused and squandered.”

There are no limits to a physician’s scope of practice, and that’s wrong, NAPPP argues. “There is a fairly simple remedy: Medical licensure boards should subject physicians to the same limited licensing that every other healthcare professional provides services under,” said Caccavale.

NAPPP hired the firm M+R Strategic Services to orchestrate “a campaign to educate the public” about the issue and “to require physicians to obtain an evaluation and appropriate diagnosis before medications are prescribed.”

But can the ant really move the rubber tree plant? The American Medical Association has one of the most powerful lobbies in the country, and any effort to tinker with physicians’ scope of practice would have to clear some very heavy political machinery.

M+R specializes in “grassroots mobilization,” as well as direct lobbying. “We work with clients to employ creative staging tactics – rolling out a series of events, media tours or other activities around the country (and on the Internet) – in order to build toward bigger events in the country’s major media markets,” according to company’s promotional material.

One of their recent clients was the American Civil Liberties Union (ACLU) in 2007, “a time when the fundamental freedoms that the organization protects were under attack by the Bush Administration.

“M+R helped plan and promote a national ‘Day of Action to Restore Law and Justice’ to raise awareness of the situation within the Democratic Congress and pressure them to act.”

But scope of practice isn’t exactly a hot button issue with the American public, and it will be interesting to see what a Washington lobbyist does with it.