Psychotherapy Finances

In the budget cutting fervor that has gripped the U.S., what exactly is the toll on mental health? About $1.6 billion, according to the National Alliance on Mental Illness (NAMI). The NAMI report covers the fiscal years 2009 to 2012.

States with the heftiest cuts are South Carolina (39.3%); Alabama (36%); Alaska (32.6%); Illinois (31.7%); Nevada (28.1%); the District of Columbia, 23.9%); California, 21.2%); Idaho (17.9%); Kansas (12.4%); and Mississippi (10.4%)

“People with life-threatening mental illness are being abandoned,” said Mike Fitzpatrick, NAMI executive director.

As a result of Medicaid and state cuts for mental health services, more patients are turning to emergency rooms for care, a report earlier this year by National Public Radio said. Perhaps most surprising: Ten percent of Emergency room administrators said they had boarded patients for a week or more.

The real crunch may come in 2014, when the federal government mandates massive expansion of state Medicaid programs in connection with the Affordable Health Care Act. About 32 million Americans are expected to be added to Medicaid roles, according to Katherine Nordal, executive director of the Practice Directorate at the American Psychological Association.

With Medicaid budgets getting slashed, and more people added to the rolls at the same time, the president and new Congress will have tough decisions to make after the 2012 elections.

Still, the APA is encouraging clinical psychologists to make themselves available for Medicaid work, Nordal said in a recent interview. Read the complete interview with Nordal, on Medicaid, Medicare and other topics, in an upcoming issue of Psychotherapy Finances.

- John Nelander, Contributing Editor

It’s not surprising that the need for substance abuse services varies by city and region. But a new report by the Substance Abuse and Mental Health Services Administration (SAMHSA) shows just how widespread these differences are.

SAMHSA’s Drug Abuse Warning Network took a look at hospital emergency room visits for illegal drug use in 11 metropolitan areas around the country. They covered Boston, Chicago, Denver, Detroit, Miami/ Fort Lauderdale, Minneapolis, New York, Phoenix, San Francisco and Seattle.

The rate of emergency room use is an indication of how often signs of drug abuse are missed by health care professionals, as well as friends and family members, the federal agency says.

“When friends, family members and health professionals miss the signs and symptoms of substance abuse the results can be devastating,” said SAMHSA Administrator Pamela S. Hyde. “One consequence is the costly and inefficient use of emergency rooms as a first step to treatment. Substance abuse prevention and early intervention can keep people off drugs in the first place and clear the path to healthier lifestyles.”

Boston is the city with the highest rate of illegal drug-related ER visits, with 571 per 100,000 population. It’s followed by New York City (555); Chicago (507) and Detroit (462).

The national rate is 69 per 100,000. The survey was based on statistics from 2009, during which there were 973,591 visits to emergency rooms throughout the country.

For the complete report, click here.

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Congress approved a last-minute bill to temporarily avert a scheduled Medicare reimbursement cut on Friday, Dec. 23. President Obama was expected to sign the legislation, which gives lawmakers two more months to deliver a long-term solution during a contentious election year.

The 27.5% reduction would go into effect March 1 if no agreement is hammered out. Click here for links to stories in the New York Times, Washington Post and Wall Street Journal.

The bill has no effect on a scheduled 2% reimbursement cut slated for 2013 due to the failure of the Super Committee to come up with an alternative budget slashing plan.

- John Nelander, Contributing Editor

Treatment guidelines are being developed for depression and obesity by the American Psychological Association as the first step in a far-reaching plan to create evidence-based recommendations on how to treat a wide range of mental health disorders.

The project was approved last year by the APA Council of Representatives. A steering committee in charge of the process decided to tackle depressive disorders and obesity first, according to the December issue of the Monitor on Psychology.

The organization was already offering practice guidelines that containing treatment “tips,” the magazine said. But the treatment guidelines will incorporate research and make specific recommendations on how to deal with specific disorders.

“No individual client who comes into a psychologist’s office exactly matches the average patient who has participated in a particular study, so there’s always room for the clinician’s judgment,” Howard Kurtzman, deputy executive director for science in APA’s Science Directorate, told the Monitor. “We just want to inform the clinician about the best and most current research.”

The APA said it made the decision because the Affordable Health Care Act, which goes into effect in 2014, emphasizes the ability to compare methods of treatment. As a result, other professional organizations are preparing treatment guidelines as well.

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First it was a communication sent via your mailbox; then it was email. Now, ValueOptions is blasting news about training, credentialing and other events via its members’ cell phones.

It’s a newly launched program called Provider Pulse. Therapists in the ValueOptions network have begun getting “automated telephonic messages” announcing company news and upcoming events.

For example, a recent message was recently broadcast about the implications of the new parity law, according to the company December newsletter, The Valued Provider.

The company plans to continue the practice at least through 2012.

- John Nelander, Contributing Editor

Republicans are signing on to a 2012 “doc fix” for Medicare providers as part of a plan to extend a payroll tax holiday, but the deal remains shaky, according to the Los Angeles Times.

The tax holiday is a priority for Democrats, but House Republicans have loaded their bill with other provisions the opposition is sure to find objectionable, including a reduction in longterm unemployment benefits and a plan to build an oil pipeline from Canada to the Gulf of Mexico. The proposal has triggered White House environmental concerns.

The House adjourns for the Christmas holiday next Friday, so this is Congess’ last chance to get something done on the doc fix this year. Without it, Medicare providers — including psychologists and clinical social workers — face a 27.4% reimbursement cut scheduled to go into effect Jan. 1.

The doc fix is back on the table every year since cuts automatically take place without congressional action. But so far, Congress has always stepped in to reverse the reductions, even after they’ve gone into effect.

Several retroactive fixes have taken place in recent years, including 2010 when the fix wasn’t approved until June. But as a Kaiser Health News capitol reporter noted, that can create an administrative nightmare for providers.

“The Centers for Medicare and Medicaid Services has provided guidance to physicians saying, ‘Hey, hold your bills before you submit them – Congress is very close to making a fix,’” said Mary Agnes Carey. http://www.kaiserhealthnews.org/Stories/2011/December/06/120611-health-on-the-hill.aspx?p=1

“That kind of solution, as you can imagine, is not too popular with physicians. It creates paperwork headaches. It creates instability for them. They would much prefer to get it done before it expires at the end of the year.”

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The National Association of Social Workers (NASW) is promoting doctorate degrees for masters-level social workers, including LCSWs. Although 30% of DSWs work in academic settings, the organization suggests that a doctorate or PhD will expand a clinician’s referral base.

“On average, social workers with a DSW/PhD earn $17,000 more in annual base pay than those without the degree,” the organization says in its December 2011 newsletter, Leadership Ladder.

The unemployment rate in the U.S. has taken a major toll on men when it comes to health insurance, according to a new paper released by the National Bureau of Economic Research (NBER).

The impact is most significant on white, college-educated men between the ages of 50 and 64, researchers discovered.

They found that for every 1 percentage point increase in unemployment, 1.67% fewer men in this category had health coverage. The correlation did not hold true for women and children.

However, for every 1 point increase in the jobless rate, the number of children in public health programs increases 4.69%.

“We estimate that 9.3 million adult Americans, the vast majority of whom were men, lost health insurance due to a higher unemployment rate along during the 2007-09 recession,” wrote the authors, John Cawley, Asako Moriya, and Kolsai Simon. “This is roughly nine times more than lost health insurance during the previous (2001) recession.”

The NBER is a private, nonprofit nonpartisan organization that studies the impact of economic issues on American society.

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Employment Assistance Programs (EAP) are expecting a flood of calls relating to eldercare problems, a report by the Chicago-based EAP specialist company ComPsych says.

The reason: The holidays are the time of the year when children and other family members are most likely to call or visit elderly relatives and friends. They may be surprised at what they find.

ComPsych is anticipating an 18% increase in these types of calls from worried employees as the holidays approach.

“People can be surprised and upset by how their parent’s or elder relative’s situation has deteriorated since they saw them last,” said Richard Chaifetz, ComPsych CEO. “This can include worsening health, mobility and cognitive problems.”

He suggests employers take the time to remind their workers about work-life resources for eldercare issues before employees make their holiday trips.

- John Nelander, Contributing Editor