Psychotherapy Finances

As a therapist in private practice, would you consider yourself a creditor if you allow clients to delay a payment or two from time to time?

The answer was unclear, at least from the viewpoint of the Federal Trade Commission (FTC) which implemented a “Red Flags Rule” in 2007 that required any professional who extended credit to develop an identity theft protection program.

Health care providers, including the American Medical Association (AMA) and mental health provider associations, have sought exemption from the policy since then, mainly due to the expense and complexity of setting up an identity theft prevention program.

Obviously, many providers simply turned a blind eye to the FTC regulation while the government itself struggled to define who was covered and who was not.

But the issue has apparently been settled after President Obama signed the “Red Flag Program Clarification Act” on December 18. It exempts most physicians, psychologists, licensed clinical social workers and other health care providers from the requirement.

The new law “limits those covered by the Red Flag Rules to anyone who uses consumer financial reports, provides information to consumer reporting agencies, or advances actual funds toward repayment of a bill,” says a December 29 report from the Clinical Social Work Association.

“While this may apply to a very small group of LCSWs who fall into the above categories, it is a miniscule number compared to the thousands of LCSWs that were originally required to comply with Red Flag Rules, just because they were paid through insurance or billed on a monthly or other delayed basis.”

For a more in-depth look at the issue, see this analysis by the law firm McDermott, Will & Emery forwarded to us by Laura Groshong, director of government relations for the CSWA.

Another viewpoint is available from the AMA, which filed a lawsuit in May requesting physician exemption from the requirement.

It describes in further detail who will qualify as a creditor under the newly clarified law.

Here’s an aspect of the health care reform law that hasn’t received much attention: All Medicaid recipients and those with private insurance must be screened for mental illness.

Assuming the law remain in effect as is - a large assumption considering Republicans will have health reform in their crosshairs when Congress convenes for the 2011 session - depression screenings for children and adults age 12 and up will be mandatory when professional staff are available for diagnosis and treatment.

The benefits were part of a package of requirements for new state health insurance exchanges planned for launch in 2014 by the U.S. Preventive Services Task Force (USPSTF). The Task Force is funded and staffed by the federal Centers for Disease Control and Prevention.

The idea is that early detection and intervention will reduce the need for treatment of more serious mental illness later. Health insurance plans already require, as of September, full coverage of preventive care that includes mental health screenings as long as they are offered by network providers, according to the December 17 issue of Psychiatric News.

Both the American Psychiatric Association and the American Psychological Association are on record supporting the use of funds from the Affordable Care Act for preventive services.

There’s more evidence that fewer people are turning to psychotherapy as treatment for depression.

It’s long been asssumed that primary care physicians have jumped into the role of addressing depression by simply writing a prescription for one of many antidepressant medications available. A new study published this month in the Archives of General Psychiatry puts the trend into perspective with some new numbers.

The study focused on the period from 1998 to 2007. During this time, the rate of outpatient treatment for depression increased from 2.37 per 100 people to 2.88. That’s an additional 2.2 million people.

The percentage of patients using antidepressants edged up from 73.8% to 75.3% over the decade, but the percentage of those accessing psychotherapy plunged more than 10 percentage points from 53.6% to 43.1%.

Since use of medication to control depression increased only modestly, while psychotherapy treatment decreased considerably, the study begs the question: How are these additional 2.2 million Americans being treated?

As recently as 1987, 71% of patients suffering from depression sought treatment from psychotherapists. By 1997, that had dropped to 60% — even though the number of those diagnosed had tripled, according to The Chicago Tribune.

The drop from 71% to 43% represents an astounding 60% decrease in the use of psychotherapy for depression over a 21-year period.

More reasons for therapists to expand their menu of services, perhaps by focusing on wellness issues and including some solid niche marketing ideas.

What are the best career choices for 2011? Health care care and social services jobs will fare the best over the next year, according to a report in the magazine US News.

The magazine listed its top careers in a December 6 report. Based on government statistics, editors picked marriage and family therapist, school psychologist, and public health social worker as part of the best 50 career options.

The magazine said the MFT field in particular “should have strong growth over the next decade.”

“Demand is expected to increase in the future, with employment in this profession expected to rise 14 percent from 2008 to 2018, according to the Labor Department,” the magazine reported. “Fueling part of the growth is a more widespread acceptance of the field, which makes people in need more willing to seek out such counseling.”

Median annual earnings for MFTs was reported at $46,920 in 2009 by the Department of Labor.

The DOL sees 11 percent growth for school psychologists, as well as for clinical psychologists who work with school-related issues, through 2018. The agency says annual earnings vary considerably, from $40,000 up to $109,000.

A related note: Psychotherapy Finances is working on a new report about how clinicians are tapping the niche market for schools and education-related problems. Watch for it in an upcoming issue.

In California, the lines between marriage and family therapists and professional counselors is growing thin. Evidence: The California Association of Marriage and Family Therapists (CAMFT) is changing the URL of its website to www.CounselingCalifornia.com effective January 4.

This is three days after the state Board of Behavioral Sciences starts taking applications for LPCC licensure, and it suggests that the CAMFT website could accommodate both branches of the profession, according to San Diego blogger Benjamin Caldwell of MFT Progress Notes.

In a recent announcement the CAMFT explained: “We researched the way consumers, or potential patients use the web and found that ‘counseling’ holds a much higher web search ranking among people looking for a therapist than the search terms, ‘therapy’ and ‘therapist.’

“California was added to clarify for site visitors that the service is tailored to helping patients find licensed therapists in California, which was not as clear with Therapistfinder.com.”

CounselingCalifornia.com will continue to be open to CAMFT members who want to list their practice. The old URL will remain active but will redirect traffic to the new site to accommodate therapists who have practice materials reflecting Therapistfinder.com.

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The Substance Abuse and Mental Health Services Administration (SAMHSA) identified what it believes are the best TV shows for raising awareness of mental health issues at its fifth annual Voice Awards in Los Angeles.

Judges praised two series in particular, Army Wives, Desperate Housewives, and Grey’s Anatomy. The Army Wives show on Lifetime featured a series on how PTSD impacts military families.

Desperate Housewives, on ABC, featured an episode called, How About a Friendly Shrink? about inpatient psychiatric care. Grey’s Anatomy, on ABS, also highlighted PTSD in the military.