Psychotherapy Finances

An estimated 16 million Americans may be added to state Medicaid programs under the Patient Protection and Affordable Care Act. So, organizations representing mental health professionals, notably the American Psychological Association, see the potential for expanded business opportunities when the law fully kicks in starting in 2014.

But there was a glitch in the U.S. Supreme Court ruling upholding the law. While justices backed the insurance mandate, they said the federal government can’t pull Medicaid funding from states that refuse to implement Medicaid expansion.

Already on Friday, Louisiana Gov. Bobby Jindal, a possible vice presidential contender, said he would refuse to implement the ACA, Supreme Court decision or not. While not addressing Medicaid expansion directly, Jindal said Louisiana would not set up a health insurance exchange program as required by the reform law.

Instead, he’s betting that Mitt Romney is elected president and the health care act is repealed. Virginia Gov. Robert McDonnell said his state was evaluating whether or not to follow the law, according to ABC News. Florida Gov. Rick Scott, who has turned down federal money in the past, was unsure whether the state would opt out of Medicaid expansion.

A year ago, Scott turned down federal grants that would have helped move long-term nursing home patients into the own homes.

“There are a lot of programs that the federal government would like to give you that don’t fit your state, don’t fit your needs and ultimately create obligations that our taxpayers can’t afford,” Scott told The New York Times in July.

Two mental health organizations, meanwhile, immediately trumpeted the court’s validation of the ACA. “NASW and its members will work with states to do what is in the best interest of their most vulnerable citizens—and expand Medicaid eligibility to the level set by the ACA,” the National Association of Social Workers said in a release after the decision.

The American Psychological Association said: “In keeping with the Supreme Court’s ruling, states can now decide to expand Medicaid eligibility and, if they choose not to do so, they no longer face a penalty. Thus, it is now essential to encourage states to expand their Medicaid programs for uninsured persons ….”

The American Psychiatric Association recognized the Medicaid ruling in a news release, but did not comment on it directly. “Undoubtedly, volumes will be written in the next few days about what the decision means,” the APA said.

They advised their members to closely monitor the fast-developing story.

- John Nelander, Contributing Editor

What’s the value of mental health treatment in the market place? Duke University conducted a study with Stony Brook University that puts some fresh perspective on the issue.

In a survey of 710 adults, researchers found that people are willing to pay more out-of-pocket to avoid physical illness than to prevent mental illness. The results were featured in the April issue of the journal Psychiatric Services.

“All else equal, the general public doesn’t think it is as valuable to treat mental illness as other types of illness,” said Peter Ubel, senior author of the study and a professor of marketing at Duke. “There is a fundamental disconnect between how bad they think it would be to experience depression and their willingness to spend money to rid themselves of the illness.”

The subjects were presented with five health conditions–three physical problems and two mental illnesses. The physical illnesses were diabetes, amputation of the leg below the knee, and partial blindness. The mental illnesses were depression and schizophrenia. They rated each as to how much of a burden they would be, and how much they’d pay to prevent them.

Interestingly, although schizophrenia scored highest on the burdensome scale, it did not score highest on the willingness-to-pay scale. Depression actually scored lowest on the payment scale.

People were on average willing to pay 40% less for mental illness prevention overall, at least within the categories presented.

The conclusion: “Participants understood that mental illness clearly has a very negative impact on quality of life,” said Dylan Smith, the study’s lead author and associate professor of preventive medicine at Stony Brook University. “Yet [they] were significantly not as willing to pay for effective treatments for these illnesses.”

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Having trouble negotiating the choppy waters of filing Medicare claims? The National Association of Social Workers addressed the issue in its May Leadership Ladders newsletter with Documenting for Medicare: Tips for Clinical Social Workers.

The piece discusses diagnostic assessments, treatment plans, psychotherapy notes and what to do about errors.

- John Nelander, Contributing Editor

The number of babies born suffering from drug withdrawal symptoms is soaring, and so are the costs to treat them.

A study released in the May 9 Journal of the American medical Association found that 14,000 children were born in 2009 with neonatal abstinence syndrome (NAS), triple the number from 2000. Treatment costs soared to $720 million, placing a heavier burden on the Medicaid system.

Researchers at the University of Michigan health system at the University of Pittsburgh’s Department of Obstetrics and Gynecology reviewed discharge data from 2000, 2003, 2006 and 2009. NAS data were obtained through the Health-care Cost and Utilization Project’s Kids’ Inpatient Database.

Newborns with NAS increased from 1.2 per 1,000 births in 2000 to 3.4 per 1,000 in 2009; and the number of opiate-addicted mothers climbed from 1.2 per 1,000 to 5.6 per 1,000 over the same period, according to an article in the June 1 issue of Psychiatric News.

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The Veterans Administration is in the process of hiring 1,600 mental health clinicians to handle a rapidly increasing caseload. Three hundred support staff will also be added to the workforce.

The VA has boosted its mental health care budget by 39% since 2009. And since 2007, officials have seen a 35% increase in the number of veterans seeking mental health services.

The jobs are largely full-time salaried positions at hospitals and clinics. There are openings for psychologists, psychiatrists, licensed professional counselors, clinical social workers and marriage and family therapists. To review current openings, click here.

Source: American Psychological Association News/ Wilkes-Barre Times Leader

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The number of Medicaid patients in Minnesota has skyrocketed 40% since 2010, twice the rate of other states and raising the state’s tab to $4 billion, the Minneapolis Star Tribune reported this week.

However, state officials said costs have been lower than predicted due to negotiation of lower prices through managed care contracts. “Overall, I’d say we need to continue to look at health care programs and costs, but at least for us, it’s not a totally bleak situation,” State Economist Tom Stinson told the paper.

- John Nelander, Contributing Editor

A member of the American Psychological Association has teamed up with Lady Gaga to help launch the singer’s Born This Way Foundation, according to the May issue of the APA’s Monitor on Psychology.

Susan Swearer, professor of school psychology at the University of Nebraska, discussed the issue at a Harvard University event marking the kick-off for the program. The event included Oprah Winfrey and HHS Secretary Kathleen Sebelius.

“Lady Gaga,” Swearer said, “as the licensed psychologist on this panel, it’s really important for me that everybody here realizes the emotional turmoil that victims of bullying face as well as the turmoil of those kids who are doing the bullying. I’d like to know, from a psychological perspective, from a behavioral health perspective, from just a human perspective – do you think you’re going to change the culture where kids are so cruel and mean sometimes that they often just aren’t comfortable with being who they were born to be?”

Lady Gaga replied, “I don’t think I’m going to, certainly. You know, I would say that over time what I would like to do — working with someone like yourself and working with all of the experts that I’ve become so excited to hear from — that I’m hoping that the world undergoes, or the culture undergoes, what I have recently learned to be a ‘psychological autopsy.’

“I would like to do a psychological autopsy on as many bullies and victims as possible. How do we understand what breeds hatred, what breeds anger, and what are the signs that a youth empowered, like Alissa, can pick up on within the school environment, and say ‘Hey, something’s not quite right?’”

To view the entire event on YouTube, click here.

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PacifiCare, a subsidiary of UnitedHealth Group, has been accused of receiving $115 million in overpayments from the Centers for Medicare and Medicaid Services (CMS) in 2007, according to a report in Modern Healthcare and a summary of the report in Kaiser Health News.

Kaiser said PacifiCare had reportedly used patient diagnosis codes “inappropriately” to increase reimbursement in the Medicare Advantage program. PacifiCare has been asked to work with CMS to create “an appropriate payment adjustment,” according to KHN.

Meanwhile, the Washington Post reported on Wednesday that UnitedHealth’s Board of Directors approved a 30% increase in quarterly dividend. The company is based in Minntonka, MN.

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Magellan Health Services President Karen Rohan has resigned and will leave at the end of the month, the company said in a news release Thursday. No further information was provided except to say that Rohan would be taking on “new responsibilities with a major national health plan.”

Rene Lerer, Magellan’s chairman and CEO, will assume “day-to-day management” of Magellan, one of the country’s largest providers of mental health services.

- John Nelander, Contributing Editor

Americans are doing more comparison shopping for health care, according to a new poll released by National Public Radio.

There’s even been a noticeable uptick in the past two years. Among the roughly 80 percent of households in which someone had accessed care, 16% said they had compared prices, up from 11% in 2010. More surprising, perhaps, is that consumers are checking with doctors offices less and looking for information from their insurance company.

Forty-nine percent of those who accessed care said they pulled information from their insurer, almost double from the 26 percent who did in 2010.

Less surprising: “As a shopping tool, the telephone dropped in popularity to 48 percent from 61 percent in 2010,” NPR reported. “Email and the Internet zoomed to 45 percent from 22 percent.”

But are people actually letting cost influence their choices? Apparently so. Almost two-thirds in the latest survey said it did.

“In every age group, regardless of income, more than half of the respondents said that it influenced their choice of provider,” says Ray Fabius, chief medical officer for Thomson Reuters’ health unit, which also participated in the poll. “To me, that’s the biggest revelation.”

The trend is consistent with an increase in more high deductible insurance plans, he added.

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Reparative therapy is back in the news. A bill to ban the controversial treatment for gay minors in California passed the State Senate on Wednesday by a vote 23-13. It now heads to the State Assembly.

Professional organizations representing psychologists and psychiatrists oppose the bill, the Sacramento Bee reported Thursday. However, two changes in the language drew support from two other mental health associations.

One removed a provision that would have allowed lawsuits against therapists who have used reparative therapy in the past. A second would have required written consent even from adults who wanted the treatment.

The senate bill was sponsored by Sen. Ted Lieu, a Democrat from Torrance, who referred to reparative therapy as “junk science.”

- John Nelander, Contributing Editor