Psychotherapy Finances

It’s been discussed and predicted for several years–Magellan is finally going to a paperless authorization system.

The announcement, in the company’s winter issue of Provider Focus, said the change over is necessary “in an electronic age where accumulating a stack of paper work is unnecessary, costly, and even detrimental to the environment….”

The change will take place in May.

There are a couple of exceptions. Denial notices will still go out via mail and Magellan says there are a few contracts that stipulate authorization through telephone, fax or mail.

Clinicians will be able to access authorizations by logging into their Magellan account and clicking on “view authorizations” on the left-hand side of their “My Practice” page.

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Young, educated black adults are less likely to pursue mental health services than their white counterparts, the American Psychological Association reports in a new study.

Generally, more educated adults are more likely to seek out mental health treatment, but that does not appear to hold true with blacks, the APA says. Not only that, but while whites who had already sought mental health treatment were more likely to seek additional help, the opposite was true for blacks. The main issues are stigma and lack of trust.

The results were based on focus group interviews in 1994, 1995 and 2001. The groups consisted of adolscents ages 13-18; and adults ages 18-26.

Black clients reported “lower quality of care” and “unpleasant experiences” as well as “unfavorable attitudes,” according to an APA news release published this week.

“Practitioners need to address the concerns of black clients in a culturally sensitive and appropriate manner, and during exit interviews, they should ask what is appropriate and what didn’t work,” said study author Clifford Broman, of Michigan State University.

The study was published in the APA journal Psychological Services.

- John Nelander, Contributing Editor

UPDATE: The measure passed the House Friday 293-132, and it cleared the Senate 60-36. It was headed to President Obama for his signature.

ORIGINAL POST: Election year pragmatism has apparently replaced the bitterness of last year’s Congress-White House political battles–and opened the door to another “doc fix” that heads off draconian Medicare reimbursement cuts for the next 10 months.

The deal was reached Thursday by leaders of the House and Senate and extends a temporary two-month fix that was scheduled to end on Feb. 29.

A final vote on the agreement was expected to take place over the weekend.

The doc fix, necessary to avoid a 27.4% cut to physicians, psychologists, clinical social workers and other health care providers, comes up every year. But in light of the acrimony on display last summer over budgets and deficits, some analysists suggested that this could be the year of the Big Cut.

Laura Groshong, a lobbyist and director of government relations with the Clinical Social Work Association, told us in December: “I’m less optimistic now than I’ve ever been. It’s hard to believe that a 34% cut would be allowed, and I’m hoping we can come up with a way to at least minimize it. But at this point I have to be realistic and look at what actually could happen. It’s a very discouraging time.”

The 34% cut was on the table because mental health care providers faced an additional 5% reduction ordered — but again, put on hold — in 2007 as well as another 2% cut that could go into effect in 2013 as a result of the so-called “Super Committee’s” failure to identify meaty budget cuts last November.

This year’s doc fix will cost $20 billion, a quarter of which will be carbed out of the health care reform law’s prevention fund. Another $2.5 billion will come from Medicaid money earmarked for Louisiana. Medicaid payments to hospitals will be cut.

The 10-month reprieve means that the old familiar issue will pop up again before the end of the year. “By taking this to December, it means we get to revisit it again right around Christmas,” congressional analyst Mary Anges Carey told Kaiser Health News on Thursday.

By then, there will be a new political landscape (regardless of which party wins the White House and Congress) and and officials may be able to hammer out a longer-term solution.

- John Nelander, Contributing Editor

Closing up a private practice before retirement is a multi-step process and needs to be carefully planned, as we’ve discussed in past Psychotherapy Finances articles. It’s also the subject of the February edition of the National Association of Social Workers’ Leadership Ladders newsletter.

Steps include notifying current and former patients at least 60 days in advance. “Since there continues to be concerns about confidentially using online resources, a formal letter by postal service may be the best source of communication in this situation,” the organization says.

“You may also notify a former patient by publishing a public notice in the legal section of a newspaper.”

Retain all of your patient records “indefinitely,” the NASW advises, in case a malpractice case comes up later.

The association also recommends a professional will, which dictates how patient records will be handled in the event of your death. Click here to read the full piece.

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A video promoting private practice psychology will be aired on PBS stations in March.

The program features California psychologist John Caccavale, and Nevada psychologist Nicholas Cummings, who helped put together the National Alliance of Professional Psychology Providers (NAPPP), as an alternative to what they see as the more academically-oriented American Psychological Association. NAPPP board member Howard Rubin is also in the video as is psychologist Toby Watson.

“The goal of the video is to promote doctoral level evaluation, diagnosis and treatment as an important part of mental healthcare and to provide consumers with the information that they need to discuss these options with their physicians, who typically see the patient first,” the organization said in its February newsletter, The Clinical Practitioner.

It will include a 3-5-minute segment to be broadcast on PBS in all 50 states. A 30-second piece will be broadcast on cable news networks including Fox News, MSNBC and CNBC. The pieces will eventually be available on the NAPPP website, and on YouTube.

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The movie, A Dangerous Method, about the six-year relationship between Sigmund Freud and Carl Jung, hasn’t exactly taken the American box office by storm. It has grossed $4.6 million domestically since its Nov. 23 release, although it has done better in foreign markets, grossing $15.5 million through Feb. 5 according to Box Office Mojo.

The movie was recently panned by Glen Gabbard, a clinical professor of psychiatry at Baylor University College of Medicine and co-author of Psychiatry and the Cinema.

“The number of accurate protrayals of psychiatry or psychoanalysis in the history of U.S. film can be counter on one hand,” he told Psychiatric News on Feb. 3. The magazine adds: “Safe to say, A Dangerous Method won’t require a second hand.”

The movie is “curiously emotionless and distant from the viewer,” according to Psychiatric News. Says Gabbard: “I suspect that both Jungians and Freudians will be disappointed.”

The dentist as counselor? Perhaps, under a new program announced by Aetna.

With the help of iPad technology, Aetna plans to launch a pilot program in which dentists pursue smoking cessation goals with their patients.

“Through the new program, Aetna will promote tobacco counseling by dentists and will study the impact that a smoking cessation clinical decision support system (CDSS) has on a patient’s tobacco use,” the company said.

The ultimate aim is for dentists to provide “tobacco cessation instruction and intervention” in their offices.

Dentist David Albert, director of the Division of Community Health at the Columbia University College of Dental Medicine in New York City, will help develop the pilot program in the New York area.

Dentists and patients will use the iPad to help distribute medical advice, record patient data and offer advice specific to the individual.

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Physicians have pushed back–almost always successfully–against prescription privileges for psychologists. This year promises a new round of state legislation and more battles between groups of health care providers.

Now, a turf war has erupted in Florida between physicians and pharmacists, who want the right to administer vaccinations for shingles and pneumonia to seniors in their stores.

The arguments are familiar to anyone who has followed scope of practice legislation in the past. Pharmacists argue that having to go to a doctor’s office discourages patients from getting the vaccines.

“It’s a question of access,” says Sally West, director of government affairs for the Florida Retail Federation.

But physicians argue that pharmacists don’t have the medical necessary training.

Rebecca O’Hara, vice president of governmental affairs for the Florida Medical Association, responded: “We want to make sure that people are immunized, and we want to increase the rate of immunizations, but what we don’t want to do is put people unnecessarily in jeopardy.”