Psychotherapy Finances

We’re currently working on a report concerning a PsyFin reader whose borderline former patient posted a damaging “review” on Yelp.com…What is Yelp.com? It’s a website the public uses to share compliments and complaints about local businesses. Most Yelp entries concern pizza parlors and plumbers — but you can leave a review on any kind of business, including healthcare providers. In this case, the patient is saying that our reader was rude, abusive, showed up late for appointments, and was just a generally terrible therapist.

This is costing our reader money. The bad review pops up whenever anyone searches the web for info about her. We tried it ourselves on Google, and Yahoo, and on Bing. In each case, the review was the first or second item that popped up. We didn’t even have to enter the therapist’s city or state — just her name was enough to bring up the poison. Our reader tells us she knows for a fact that she’s lost at least one referral because of it, and believes it’s probably a lot more.

We’re talking to attorneys and other experts to find out what she can do about it, and we’ll be publishing our findings shortly in Psychotherapy Finances. We’ll let you know when…In the meantime, if something like this has happened to you, please tell us about it. Email: editors@psyfin.com.

Many therapists began branching out into coaching a decade ago. There are several advantages to having a coaching practice alongside your therapy practice so there has been solid growth in this field for some time.

First, you don’t have to deal with insurance – everything is done on a cash basis. In fact, most coaches work with package deals, charging $200 or $300 or more for their services which may include follow-up emails. Second, this is work you can do over the phone, so there’s a convenience factor.

And because so much of it is phone work, you can promote your specialty to a wider geographic audience.

But now insurance companies are getting into the coaching act, too, as we saw with a program promoted this week at WellPoint. The company has built its coaching program around a new survey showing that there is a surprisingly strong demand for health coaching.

Although two-thirds of those surveyed weren’t sure what a health coach is or does, half of those surveyed said they could benefit from someone who prods them to make the best health care choices.

For private practice therapists/ coaches, directing your services at people with chronic health problems may pay off, the study suggests. Three-quarters of Americans who suffer from things like diabetes and asthma say they could use a coach. Women are particularly open this idea – 40% would like health coaching compared with 30% of men.

The WellPoint survey results were based on a poll of 2,500 Americans age 18 and over in March.

AND MORE ON COACHING: The National Association of Social Workers (NASW) has expressed concerns over a new coaching program at OptumHealth Behavioral Solutions (United Behavioral Solutions).

NASW members have complained that OptumHealth’s “care advocates and life coaches [are] conflicting and interfering with their role as mental health providers.”

The organization contacted OptumHealth for clarification of the roles of coaches and licensed clinical social workers, and the company’s responses are detailed in the above link.

The NASW concluded that there was overlap in the roles and encouraged their members to contact OptumHealth themselves so that “corrective action can be taken” when these conflicts pop up.

Clinical social workers were being “instructed” on how to treat certain patients, the NASW said.

Under the health care reform law passed in 2010, 16 million people will be added to the country’s Medicaid rolls by 2014. It would expand the market for mental health services, too, although Medicaid usually offers providers rock-bottom reimbursement.

But lately the push for state control over the program has been growing stronger.

Repubilcan governors would like to see federal block grants for Medicaid, allowing states to fashion their own unique programs for serving the poor. Wisconsin Governor Scott Walker outlined his reasons for the concept in an April 21 New York Times op-ed piece headlined, “Our Obsolete Approach to Medicaid.”

Walker wrote: “What does Medicaid have in common with ‘I Dream of Jeannie,’ ‘Lost in Space’ and ‘Get Smart’? They all made their debut in 1965. Although we enjoy watching reruns of these classics, the television networks have updated their programming. The federal government should do the same.”

He said that “switching from open-ended entitlements to block grants pushes both individuals and states to behave more responsibly,” but added that he believed Medicaid reform will be challenged not only by the Obama Administration, but by health care providers as well.

“It is unlikely that doctors and hospitals will support authentic cost-saving measures as long as they believe there is more money coming from somewhere,” Walker said.

Democrats see block grants as a way of gutting the Medicaid program.

Connecticut Governor Dan Malloy told the online news service Politico in a recent interview: “Look at who is asking for block grants. People who are against the program. Who is saying we don’t want block grants? People who support the program. The reason people who don’t support the program want block grants is they want to kill the program.”

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The number of graduating medical students opting into psychiatry dipped this year for the first time since 2008, Psychiatric News reported.

There were 640 students matching into psychiatric training compared with last year’s total of 670. That’s 4.1% of med school seniors.

This is still above the lows at the beginning of the last decade. In 2001, just 524 medical school seniors chose psychiatry. That number slowly rose through 2005, when 653 went into the field, then dipped again as the U.S. went into recession.

When most people want to find out about a subject, they usually do one of two things. One, they Google the subject on the Internet, or two, they loook it up on Wikipedia.

Wikipedia is an online encyclopedia that covers an incredibly broad range of subjects. But the information it contains is contributed by the readers themselves, or any experts who care to weigh in.

That’s true when the subject is psychology and therapy, too. Wikipedia contains 5,691 articles on psychology and only about a third of them have been reviewed by the organization’s peer assessment panel. So how much of this information going out daily to the general public is good, and how much of it is misleading or outright wrong?

Enter the Association for Psychological Science, which recently launched its APS Wikipedia Initiative. It’s asking psychologists to help fine-tune some of these articles to help the public become better informed.

“Start by looking at the most basic Wikipedia entries in your own area of expertise, and you will see the problem immediately,” says Mahzarin Banaji of the APS. “Although some articles are great (see the articles on autism or confirmation bias), many are stubs, with hardly any content (e.g., see the articles on moral reasoning or Stanley Schacter). The vast majority of entries do not present information in the form in which you teach and think about it.”

Anybody can contribute to Wikipedia and so it’s up to experts in the field to verify the information. As Banaji notes, therapists are sometimes asked to contribute articles to hard-copy encyclopedias that are sold to libraries. That may seem more prestigious, but that’s not where people are getting their information these days. They are learning about mental health on the Web.

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PSYCHIATRISTS STICK WITH TUTU: Organizers of the American Psychiatric Association annual convention next month in Hawaii whipped up some controversy with their selection of Archbishop Desmond Tutu to be the convocation speaker. Tutu has made some controversial comments about Israel and some APA members were incensed about his choice.

Nevertheless, the APA will hear from Tutu at the convention in Honolulu May 14-18.

In an editorial in Psychiatric News, APA President Carol Bernstein said: “I spoke with some of these members … in November at the Assembly meeting, where I explained the process behind my choice and my belief that he had much to offer in his comments about the truth and reconciliation process in South Africa that would be of interest to our members and their guests at the Convocation.

“Unfortunately, some were not satisfied with my explanation and have mounted an intensive campaign in Psychiatric Times and with some Jewish organizations in the United States to demand that I rescind the invitation. A few others have threatened to boycott the meeting, resign from APA, and/or engage in protests.”

She concluded: “Condemning violence is not equivalent to anti-Semitism. Further, APA is not a political organization, and Archbishop Tutu will not be speaking at the APA annual meeting in a political context.”

While Congress debates fundamental changes to Medicare that would save trillions of dollars and shift more cost to consumers, professional associations for mental health care providers are pressing ahead for expansion of provider eligibility.

Currently, only psychiatrists, psychologists and licensed clinical social workers are reimbursed for working with Medicare patients, but efforts have been ongoing to pass legislation that would include licensed professional counselors and marriage and family therapists.

Now comes the Seniors Mental Health Access Improvement Act, introduced in the Senate in March by Sen. Ron Wyden (D-Oregon) and John Barrasso (R-Wyoming). It would allow both LPCs and MFTs to be reimbursed for Medicare services.

What are the chances for this kind of legislation admid the budget cutting frenzy in Washington? The American Mental Health Counselors Association (AMHCA) remains optimistic and is asking members to call their senators.

“We Are at a Critical Crossroads,” the organization said in a news release. “Yes, Congress has actively considered legislation providing Medicare reimbursement to LPCs for several years now. But Congress is now embroiled in an ongoing debate on everything connected to health care reform.

“Furthermore, Congress must pass Medicare legislation this year in order to prevent a scheduled 20% pay cut for physicians under the program from taking effect on December 31, 2011. We need mental health counselor coverage to be part of this Medicare package—and this represents a prime opportunity to achieve our long-sought goals.”

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Suze Orman on social workers’ low pay: Get over it

It’s too bad social workers aren’t making more money, says CNBC financial guru Suze Orman. But they should quit complaining and learn the secrets to living with less.

“You just have to be one of those that seriously live below your means,” Orman told social workers in a phone interview with the website, www.socialworkersspeak.org. “It may mean you rent for the rest of your life. But who cares? So does all of America right now.”

In a written statement to the National Association of Social Workers, Orman added: “If you social workers have what it takes to deal with some of the most serious problems in the United States of America between families, children, elder abuse and so on you have what it takes to take care of your financial children as well - the bills, bucks and pennies that are all in your life.

“And the bottom line is this: you will never be powerful in life until you are powerful over your own money - how you think about it, how you feel about it and how you invest it.

“Do not hide behind the excuse that you don’t make enough money so therefore you’ll never have any money. You can do anything. You just have to know how.”

Most teens struggling with eating disorders aren’t pursuing treatment for their specific conditon, a new study by the National Institute of Mental Health reveals. About 3% of teens in the U.S. are affected by the condition, according to the study published in The Archives of General Psychiatry.

The study analyzed data from 10,000 face-to-face surveys of teens age 13 to 18. About one in five were affected with some type of mental disorder and the NIMH said that “a substantial portion” of these aren’t receiving treatment, either.

The most prevalent eating disorders found in the study were binge eating (1.6%); bulimia (.9%) and anorexia (.3%). Another .8% had threshold anorexia.

The highest rates of bulimia were among Hispanics. The highest rates of anorexia were among Whites.

“The findings clearly underscore the need for better access to treatment specifically for eating disorders,” the NIMH said.

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We’ve featured therapists from around the country who specialize in sports psychology, either as a part of their practice or all of it. Now, the American Psychological Association’s Division 47 (Exercise and Sport Psychology) is launching a new magazine for practitioners in this niche.

It will debut in spring 2012.

The publication will focus not only on athletics but performance enhancement in general, including people who work in the arts. This is a direction that many therapists have taken with this specialty. In that context, many are even selling their services to small businesses and large corporations.

The magazine, Sport, Exercise & Performance will be edited by Jeffrey Martin, of Wayne State University in Detroit. He’s had experience on both sides of the couch — he has run in 40 marathons around the world and won 12 of them, according to the March edition of the APA Monitor on Psychology.