Psychotherapy Finances

There has been a fair amount of criticism to the development of the DSM-5, which is due out in 2013. But few comments have been more pointed than the recent letter sent by the British Psychological Society to the American Psychiatric Association.

The DSM is used to diagnose mental illness not only in the U.S., but in Britain as well. But psychologists in the UK are concerned that the new manual will stigmatize eccentric people, and that it will lead to the “medicalization” of clients’ “natural and normal” responses to life’s experiences.

“We have particular concerns over the draft’s consideration of the inclusion of a range of highly contentious ‘disorders’,” said lead author of the letter, Peter Kinderman of the University of Liverpool.

“These include Attenuated Psychosis Syndrome, which could be seen as an opportunity to stigmatise eccentric people, and to lower the threshold for achieving a diagnosis of psychosis, Gender Dysphoria (especially in children and adolescents) and a range of conduct disorders such as Oppositional Defiant Disorder – diagnosed when a child is ‘headstrong’ or ‘wilful’.”

British psychologists are worried about the expanded use of Attention Deficit/ Hyperactivity Disorder, “and of the increasing use of medication for children, and would be very concerned to see these increase further.”

See the link, above, for the complete response to the latest draft of the DSM-5.

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Bundle, a website devoted to investigating where and how people spend their money, looked at the most expensive health care cities in the country recently. Editors sifted through data from the Kaiser Health Foundation, Medicare, the Datmouth Atlas of Health Care, and non-insurance health care spending.

They found that Miami was the priciest town, largely based on high annual Medicare costs of its retirees ($17,274 per enrollee.)

The others were, in descending order: New York City; Washington, DC; Newark, NJ; Boston; Los Angeles; Corpus Christi, TX; St. Petersburg, FL; Chicago; and Plano, TX.

For details on these cities and other rankings, click here.

- John Nelander, Contributing Editor

Amid all the budget grappling in Washington, there is some business as usual being conducted. This week, a briefing was held for House and Senate staff members to discuss adding psychologists and clinical social workers to the list of health care providers who qualify for federal incentives to establish health information technology programs.

The incentives would come from the Centers for Medicare and Medicaid Services (CMS), where officials are convinced that HIT can lead to efficiencies that can save the feds a potential $1.7 billion over 10 years. The savings would be realized by helping to avoid adverse drug interactions, visits to the ER and hospitalization.

The bill under discussion, The Behavioral Health Information Technology Act of 2011 (S. 539), would allow psychologists and LCSWs to apply for incentive payments of up to $44,000 for establishing and using certified Electronic Health Record (EHR) programs.

These types of programs were encouraged in the medical area for physicians and hospitals through the Health Information Technology Economic and Clinical Health Act of 2009 — but mental health providers were left out in order to reduce the impact on the federal budget.

Not surprisingly, this week’s congressional meeting centered around cost-savings that S. 539 might generate. Even Republican U.S. Rep. Tim Murphy, of Pennsylvania, had some kind words for the plan and noted a study by Avalere Health showing that previously mentioned $1.7 billion savings over the next decade.

Advocates put a human face on the problem with testimony from a Nashville mother whose son waged an eight-year battle to get a diagnosis of schizo-affective disorder. He was in and out of numerous facilities and residential treatment centers, receiving different diagnoses along the way.

Coordinating care was key, said his mother, according to a story published Thursday in Kaiser Health News. “Each provider acted as though it was an island.”

So, advocates have marshalled their arguments. Whether these arguments actually will have legs with the larger House and Senate as members scrap over the budget deficit remains the big question.

- John Nelander, Contributing Editor

The American Medical Association says it will back a legal challenge to a new Florida law that restricts what physicians, therapists and other health care providers can discuss with their patients about gun ownership.

The AMA passed the resolution at its House of Delegates meeting last month with widespread support. Clearly, the delegates are concerned that other states will pass similar laws, or that a federal law may be enacted.

Gun lobbyists worry that data on gun ownership may fall into government hands, squeezing their Second Amendment rights. But mental health therapists in particular sometimes need that kind of information in order to assess safety issues in a household or potential for violence.

David Fassler, treasurer for the American Psychiatric Association, testified at a House of Delegates meeting on the issue. He said the Florida law and similar legislation would have “a chilling effect” on the provider-patient relationship.

“Physicians must be able to ask any clinically relevant question in the evaluation and treatment of patients,” Fassler said, accordingto the July 15 issue of Psychiatrict News.

“As a child and adolescent psychiatrist, I have an obligation to assess potential safety issues in the home, which often includes discussion of gun ownership, access, and storage. It’s troubling that proposals that would limit my ability to ask such questions and document the answers are receiving serious consideration—and, in the case of Florida, favorable legislative action.”

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Do TV portrayals of mental health therapists help or hurt the profession? The subject comes up every time there’s another prime time offering. Here’s a new example: The USA Network’s Necessary Roughness, which features a sports psychologist who manages a major breakthrough with a football player — in the first episode.

Trouble is, the psychotherapist, Dr. Dani Santino, specializes in smoking cessation and weight loss, and has no training in sports psychology.

The Los Angeles Times got in touch with Roland Carlstedt, chairman of the American Board of Sport Psychology who called the show pseudoscience. “Dramatic accounts of sudden therapeutic breakthroughs are indeed a thing of Hollywood and fiction,” he said.

He said the outcome on the show (the player makes a game winning touchdown) is “absurd,” but added that untrained sports psychologists tend to make those kinds of claims. So perhaps in that sense, the show adds a touch of reality.

The real question is, will Necessary Roughness win its Wednesday 10 p.m. EDT time slot?

- John Nelander, Contributing Editor

There seems to be a pharmaceutical remedy for every problem, and they get lots of air time on prime time TV. But many consumers are rightfully wary of such widespread prescriptive solutions and behavioral therapists can sometimes offer them an inexpensive alternative.

Along those lines, the study on migraines released this week should get some media attention. It concluded that behavioral interventions are a cost-effective way to treat the problem because the benefits last indefinitely.

Researchers compared the cost of drug treatment — the assumption was 50 cents per day — to short term behavioral intervention in which the patient sees the therapist a few times and then practices treatment techniques at home.

After six months, the costs were about equal but after one year, the behavioral intervention was $500 cheaper.

“People think behavioral treatment costs a lot,” says Timothy Houle, associate professor of anesthesiology and neurology from Wake Forest University who led the research project. “Now with this study, we know that the costs are actually comparable, if not cheaper, in the long run.”

The interventions included hypnosis, relaxation training, and biofeedback.

“The cost of behavioral treatment is front-loaded,” explained the study’s co-author, Donald Penzien, a professor of psychiatry at the University of Mississippi Medical Center. “You go to a number of treatment sessions but then that’s it. And the benefits last for years.”

The research was published in the June issue of the journal, Headache.

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Magellan Health Services is recruiting therapists to service a large California contract that launches on January 1, 2012. The company is managing behavioral health and EAP benefits for 1.9 million members of Blue Shield of California.

You can apply to the network in one of two ways: Contact Magellan to get a provider application form, which can be requested at (800)430-0535 #4; or by emailing a request to CaliforniaProvider@Magellanhealth.com.

Applicants can also apply through the Council for Affordable Quality Healthcare (CAQH) website by authorizing Magellan to access their Universal Credentialing Data Source information.

For those unsure of how that works, the site contains a tutorial on the application process.

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WellPoint has been socked with a $100,000 fine by the Indiana attorney general for failing to alert 32,000 members promptly of a security breach that could have compromised their healthcare records and other personal information. The company also agreed to offer two years of credit monitoring and pay $50,000 for losses connected to each breach-related incident.

The breach occurred in February and March of 2010 but the company failed to notify consumers of the problem until June. WellPoint also made changes to its security system to prevent similar breaches in the future.

- John Nelander, Contributing Editor

With the recession continuing – at least according to polls of public sentiment – people are looking for ways to get services while keeping a tight grip on their wallets. That’s true in health care generally and especially mental health care, which can be more discretionary.

Phoenix psychologist Tammy Martin Causey is sensitive to that and has been offering clients more low-cost options to get the help they need. “That’s how I’m getting business, because not everybody can afford my fee now,” says Causey, a former president of the American Psychological Association’s Division 42 for independent practitioners.

For example, if a couple seeks help for marriage problems, Causey traditionally would have gone right to a series of one-hour sessions. But, she says: “Now I look at the issues. What do they need?

“Their individual sessions are supplemented by other things, like a workshop on communication, or a group.

“So maybe instead of doing 12 individual sessions they’re doing six individual sessions and also a workshop and other things that don’t cost them as much. But they’re still getting help with their marriage.”

Causey isn’t on managed care panels. So she charges in 15-minute increments, which helps clients work within their budget. She’s done away with the traditional 50-minute session. Some clients might do 60 minutes, others may opt for 45 minutes or even 30.

“For the first two or three sessions they probably need 60 minutes, but after that 45 minutes might be fine,” Causey says. “It’s tailored to what their goals are.”

We’re hearing in general that the demand for mental health services during the recession hasn’t been reduced – if anything it’s increased as people battle stress, anxiety and depression. The goal for therapists is to come up with ways to help this population and keep their practice busy by coming up with some creative solutions.

We’ll have more ideas from Tammy Martin Causey in an upcoming issue of Psychotherapy Finances.

- John Nelander, Contributing Editor