Psychotherapy Finances

Banking is not the most beloved or trusted profession in the U.S. these days. The 2010 Gallup Poll on most trusted professions showed only 22% of Americans have “a great deal” or “quite a lot” of confidence in banks, a record low.

And although when most people think about banks, they think about large financial institutions that were bailed out during the economic crisis, the public tends to lump all banks, small or large, in together.

As a result, bank employees have been taking it on the chin. Like millions of other Americans, they are suffering from stress, depression and job burnout, says Nancy Molitor, president of Division 42 at the American Psychological Association.

We spoke with Molitor, a Chicago-area psychologist, this week for an article we’re preparing on niche marketing opportunities. She had a lot of good and timely ideas, which we’ll explore in an upcoming issue of Psychotherapy Finances.

One interesting tidbit: One of Molitor’s Chicago colleagues has carved out a mini-niche working with bankers and employees of other financial institutions. “He’s been very busy,” she says, because “they feel very under fire — everybody is sort of seeing them as the bad guy.

“People think they’re making too much money. But they’re doing the job of two or three other people, and they’re actually making less money than they used to make. So they’re very stressed.”

Molitor works with the financial services industry as well and adds: “They’re all very stressed. They don’t feel that the public gets what they do.”

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One in five medical claims are processed inaccurately by health insurance companies, the American Medical Association reported this week. The 19.3% error rate cited at the organization’s House of Delegates meeting in Chicago is up 2% over last year, according to The Los Angeles Times.

The company with the highest accuracy rating was UnitedHealth at 90.23%. Anthem Blue Cross Blue Shield came in last among large insurers with a 61.05% rating.

The health insurance industry says one problem is that 20% of claims are still not submitted electronically. Also, one in five are submitted more than 30 days after delivery of care.

- John Nelander, Contributing Editor

The debate continues over what the health insurance landscape will lool like after the bulk of the provisions associated with the 2010 Affordable Care Act go into effect in 2014.

It’s a big issue and not just because of the 2012 election. There are signs that major changes lay ahead for consumers and health care providers alike. Making adjustments to your practice will be the key to flourishing in the new environment.

The feeling in Washington is that despite Republican opposition, and GOP attempts in the House to withhold funding for portions of the reform program, the Affordable Care Act is a train too big to stop at this point. That’s what we heard last week from Laura Groshong, a clinical social worker from Seattle and director of government relations for the Clinical Social Work Association. She had just returned from Washington.

So it’s not surprising that Senate Democrats are challenging a controversial report released earlier this month that contends up to 30% or more of employers will drop employer sponsored insurance (ESI) plans after full implementation in 2014.

The report, by McKinsey & Company, a global management consulting firm, argues: “The shift away from employer-provided health insurance will be vastly greater than expected and will make sense for many companies and lower-income workers alike.”

Their conclusion was based on a survey of 1,300 employers conducted earlier this year. The authors said 30% of employers would either “definitely” or “probably” stop offering ESI plans, and up to 60% will “pursue some alternative to traditional ESI.”

Yesterday, Senate Finance Committee Chairman max Baucus (D-Montana) demanded that McKinsey release its methodology in coming up with that 30% figure. The White House is equally irate.

In the New York Times today, columnist Paul Krugman said McKinsey has refused to disclose how the survey was conducted and suggested that the results were deeply flawed. But it makes sense that if everyone is required to carry health insurance, employers may back away from the benefit.

Even the Congressional Budget Office estimated that 9 million to 11 million would lose ESI but 6 million would be added to ESI rolls. That’s at most a 5 million loss of ESI benefits - and that’s nothing to sniff at, either.

Regardless, many health care providers will be faced with learning the ins and outs of new plans that will be offered to the public, some of them high deductible options. Providers may find that they have to intensify their marketing efforts if more people have to pay out of pocket for care, at least early in the year.

It makes sense that there will have to be some adjustments on both sides of the ledger.

- John Nelander, Contributing Editor

We’ve published several articles over the years about the importance of having a client friendly office. Not only is location important, with accessibility and safety concerns high on the list, but the office itself should make clients feel at ease.

Now, a new study by Ohio State University contends that not only does a tastefully appointed office help clients feel more comfortable, it also shapes their view of the therapist’s qualifications.

“People seem to agree on what the office of a good therapist would look like and, especially, what it wouldn’t look like,” said the study’s co-author, Jack Nasar, professor of city and regional planning at OSU. “Whether it is through cultural learning or something else, people think they can judge therapists just based on their office environment.”

In the study, 242 subjects looked at color pictures of 30 psychotherapy offices in Manhattan. The photos showed the therapist’s chair and surrounding environment from the perspective of where the client would sit. (Sixty percent of the subjects had been to a therapist themselves.)

The subjects were asked about the quality of care they expected based on their viewing of the photos.

“The top-rated offices also pointed to the importance of softness and order,” Nasar said. “For the top five offices, participants most frequently described the office as comfortable, nice, clean, warm and inviting.”

The bottom five offices were described as cluttered, cramped, messy, uncomfortable and unprofessional. Interestingly, there was greater agreement on what makes a bad office than what makes a good office.

Nasar’s conclusion is that the results “suggest that someone visiting a therapist in a low-rated office for the first time may not want to come back.

“It may seem obvious that people will judge someone by the office they keep, but we found that these offices vary a great deal. There are therapists out there who don’t know or who don’t care that they are sending out bad signals to their clients.”

- John Nelander, Contributing Editor

We’ve written a lot about telehealth trends over the years, but we always come to the same conclusion — therapists are reluctant to use such tools as webcams and Skype for a number of reasons.

One is that there is some question about whether Skype sessions meet privacy requirements set by HIPAA and professional ethics codes. But another factor is that insurers haven’t yet to cover telehealth sessions, with some exceptions.

Using Skype or similar webcam may be ideal for distance sessions when long-time clients — who usually see their therapist face-to-face — are out of town, for example. Nevertheless, we’ve only been able to locate a rare half-dozen or so therapists who offer telehealth services in this manner. And when they do, it’s only a client here and there.

But this is now standard practice among military psychologists, the APA Monitor on Psychology reports in its June issue. Referred to as “telemental health,” military practitioners have been using both the phone and the web to bring services to clients globally.

A small but growing number of clinicians in private practice are using the web to “see” clients in remote areas or help others between in-office visits. And now, according to the Monitor: “Medicare, Medicaid and other third-party reimbursement is available for psychologists who deliver such services via videoconferencing and follow specific guidelines.”

The APA says email use in therapy boomed from 2000 to 2008, growing 300 percent over that time. A 2008 survey showed about 10 percent of practitioners were using it at least once a week. Use of videoconferencing jumped from 2-10% over the same period.

Studies have shown Internet-based therapy can be just as effective as face-to-face, to expect more growth in this area now that broadband connections have become the norm. For private practitioners, the idea deserves a second look.

- John Nelander, Contributing Editor