Psychotherapy Finances

Licensed professional counselors who undergo a TRICARE credentialing process will soon be able to service beneficiaries of the federal program as independent practitioners.

Counselors are the last licensees among mental health professionals to qualify to treat TRICARE clients independently, says James Finley, director of public policy for the American Mental Health Counselors Association (AMHCA). Psychiatrists, psychologists, clinical social workers and marriage and family therapists already service the program independently.

Counselors have been treating clients from the armed services, and their family members, but only under the supervision of a physician.

That could end as early as this spring, when new administrative rules are generated by TRICARE spelling out specifically how counselors can become “Certified Mental Health Counselors.”

But perhaps the most important component of the new certification is already known. That is, a national certification exam that has been around for some time but is not a requirement for counselor licensure in all states.

“People in many states haven’t seen the exam before,” Finley says. “It’s going to be entirely new to them. And by the way, this is a very difficult test. Many clinicians aren’t going to pass it the first time.”

In addition, counselors will need to apply for credentialing through TRICARE and Finley expects this to involve “a fair amount of paperwork.” The government agency will have its own supervision requirements, for example, that may differ from a state requirement.

Approval for the new licensure was announced Dec. 27. Comments on the administrative rules pertaining to the designation are being accepted until Feb. 27. For its members, comments can be submitted through AMHCA, or they can be submitted directly by going to www.regulations.gov and following the instructions.

They can also be mailed to: Federal Docket Management System Office, 4800 Mark Center Drive, 2nd Floor, East Tower, Ste. 02G09, Alexandria, VA 22350-3100.

To access information about the certification test, go to: http://nbcc.org/OurCertifications.

Finley says he doesn’t know how many professional counselors will begin directly working with TRICARE clients. TRICARE reimbursement rates, he notes, “are not great. They’re about the same as Medicare. But it can be a significant part of a clinician’s business.

“We do know there’s a tremendous amount of PTSD in the TRICARE community, so the demand for services is going to go up a lot over the next decade or more.

“Clinicians should look at this as an area of growth. They’re going to be particularly interested depending on what kind of military presence is in their community. If the bases are there, the people are going to be there.”

CONTACT James Finley in Alexandria, VA at 800-326-2642, X-105 or at JFinley@amhca.org

- John Nelander, Contributing Editor

The U.S. stock market has been moving sideways and seemed stuck in a rut in the 4th quarter of 2011. But that may soon change, for managed care companies at least, as they continue to report end-of-quarter earnings, according to CNBC.

UnitedHealth, the parents company of United Behavioral Health, logged membership gains last year. But an analyst for Wells Fargo says both companies are poised to take maximum advantage of falling unemployment in 2012 and the Affordable Health Care Act.

“Aetna and UnitedHealth are attempting to become leaders in ‘accountable care organizations.’ They were part of Obama’s health-care reform — and the idea is for providers to form narrow networks and create shared systems offering lower-priced products and services,” says Peter Costa, Wells Fargo senior equity analyst.

The private health-care industry is “migrating toward these structures,” he says.

Costa also notes that “enrollment for insurers is a function of the employed market. The more people are employed, the more members are paying premiums for health insurers.”

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Binge eating disorder is back on the slate again for inclusion in the new DSM-5, due out early next year. It was discussed in the DSM-IV but didn’t make it as an official diagnosis.

Now, Psychiatric News reports that due to “an explosion of research” on the problem it’s being proposed for inclusion as a disorder. The definition: Recurrent eating of “an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances.”

Recommended treatments include cognitive behavioral therapy and antidepressants.

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More than half of psychiatrists earned between $175,000 and $300,000 in 2011, according to a survey released by Psychiatric Times.

Here’s the breakdown: 27.5% made between $175,000 and $200,000; 25.9% made between $200,000 and $300,000; 14.2% made between $150,000 and $175,000; 10.9% made less than $100,000; 7.4% made more than $300,000; and 7.1% each made between $100,000 and $125,000 and $125,000 and $150,000.

Psychiatrists’ incomes were basically flat compared to 2010.

The idea of bringing health care services direct to the public through corporate retail outlets has been percolating for the past several years. OptumHealth, for example, launched its NowClinic in fall, connecting nurses and physicians to Rite Aid pharmacy customers via visual Internet connection.

Walmart has been toying with the idea of building its own health care network that would be accessible at its stores throughout the country.

Now, Aetna is experimenting with a wellness program aimed at Best Buy shoppers. The managed care company is selling retail packages that will allow people to access a fitness program online. They sell for $19.99 and are a scaled-down version of Aetna’s “My Resources for Living Well” program.

The Living Well program goes beyond fitness though, and also ventures into smoking cessation, weight loss and stress management. View a demo of the product by clicking here.

The idea of targeting a population in the market primarily for electronics may seem odd. But Louise Murphy, head of Aetna’s behavioral health and EAP division, says: “Best Buy seemed a natural choice for trying out some of our well-being products with the general public.

“These online programs take the things you ‘should do’ and turn them into things you ‘will do.’ If you’re in Best Buy purchasing a pedometer or blood pressure cuff, you might also be interested in a program to help you achieve the health goals associated with that equipment.”

For now, the product is being sold in the Best Buy health technology department in three suburban Chicago stores. The department itself is an experiment for the retailer. It’s a small 1,200 square-foot area in which the company is selling technology-based equipment to support fitness and nutritional goals.

Click here to get an idea of some of the health-related gadgets on the shelves at Best Buy.

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Magellan Health Services is still soliciting applications for its California network in order to accommodate its behavioral health and EAP contract for 1.9 million Blue Shield of California customers. The contract kicked in Jan. 1.

To apply, you can fill out the provider specialty form online by clicking here. If you have questions, call 1-800-430-0535 Option #4; or email Magellan at CaliforniaProvider@MagellanHealth.com.

- John Nelander, Contributing Editor

Seems like there’s an iPhone App or an Android App for practically anything these days. But can you use one of them to find a therapist?

It turns out that yes, United Behavioral Health has designed an app for the Android that will allow users to tap the GPS function on their phone to find a clinician, and even select the type of clinician they’d like to see.

The app displays the therapist’s name and contact information, their areas of expertise, and licensure. The user can then click on the phone to dial the practitioner’s number, and also see a map with directions to the office.

The Android App was released on Dec. 8 and an iPhone App will follow in early 2012. UBH is offering it through an arm of its business called liveandworkwell.com. Liveandworkwell bills itself as offering “confidential resources for mental health and life’s changes.”

The public can download the app at the UBH site or at the Android site.

Android Apps can be downloaded for a few dollars, although some of them are free. The most popular health-related apps are for calorie counting and cardio-fitness. But there are also mental health assessment apps, including this one available for 99 cents. It evaluates the user for signs of clinical depression, phobias, post traumatic stress disorder and panic attacks.

See the full mental health application list here. Click here for a listing of mental health apps consumers are downloading for the iPhone.

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Physicians are going broke, CNN says. Marc Lion, a private practice financial advisor, told the network this week: “A lot of independent practices are starting to see serious financial issues.”

The problem, according to CNN, is declining insurance reimbursements, the constant battle to keep up with changing regulations, and the genearl high cost of doing business.

Cardiologist William Pentz, who has a private practice in Philadelphia, said he and his business partners tapped into their personal assets to make payroll last year. “Many of us are also skimping on our own pay,” he said.

- John Nelander, Contributing Editor