“The Pay is the Thing: Re-evaluating Mental Health Reimbursement” Comments, Page 1

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20 Comments (4 Discussion Threads) on “The Pay is the Thing: Re-evaluating Mental Health Reimbursement”

  1. I definitely think that the mental health proposal changes were put forth hurriedly. They need rethinking and reworking. Mental health, especially in today’s stressful, ever moving society, is too important to ignore.

    If we pay the CEOs of corporations for their education and expertise, then we certainly should pay our mental health professionals.

    I hope President Obama does call you. I bet he’d get an earful! But maybe then he’d listen and change what’s broken.

    1. I sympathize with your position as a psychologist myself, but I believe that there is a fundamental flaw in your argument to the degree that you are looking to the government for the solution to this issue.

      The government is broke if you haven’t noticed, and they are extremely inefficient as well. If you think that the White House is going to improve “reimbursement” for psychologists, dream on – it doesn’t matter whether it is Obama or anyone else for that matter.

      I suggest that it is our job as psychologists – not the government’s – to increase our own reimbursement rates by choosing not to participate in these bureaucratic systems and instead engage in effective marketing of our services directly to the public.

      People will open up their wallets and pay for psychological services – IF we can show them that what we know can add value to their lives. In addition, flexible payments arrangements and good business skills can allow psychologists to make therapy accessible to people from all walks of life.

      As such, i would respectfully remind you that if you aren’t getting paid as much as you believe you are worth, it is because you have chosen to participate in a system that doesn’t see the value in what you have to offer.

      Just as we often exhort our clients to take ownership of their lives and stop indulging in victim mentalities, so to do we need to do this in order to save our profession.

  2. Dr. Gosse: You are correct that I could only take patients who can pay my regular fee and if things keep getting worse in our field, then I may have to do just that. But such a course of action would be detrimental because if we all did that, then very few people would be able to afford therapy, especially long-term therapy. Unless you’re just doing brief therapy (which I am not convinced has a high rate of efficacy for many issues), counseling is different from other medical specialties because of its duration. Consequently, it’s less about marketing and good business skills and more about what the average person can and is willing to afford. I know a lot of people who cannot get the relief they need because they don’t have insurance or their plan doesn’t cover mental health to any great degree.

    What I was talking about is fundamental fairness. If 3rd party payers can manage to reimburse physicians at reasonable rates, then they can do the same for us. And if the federal government can afford to spend $100 million on making sure people get the mental health referrals they need, then they have money to spend in an effort to make sure we are paid what we are worth. This doesn’t necessarily mean the government has to pay us directly but that it can spend some money and effort toward making sure that the mental health field is valued appropriately.

    I do not agree with your assessment that the government is broke. We seem to have plenty of money for bailouts, paying members of Congress outrageous salaries and benefits, and funding defense programs that vastly outspend any other country in the world. It’s all about priorities.

    Thank you for reading and commenting.

    1. Misty, thank you for writing this article and generating dialogue about the value placed on our profession by the government and insurance companies for that matter. You raise some valid concerns about how this disparity of value impacts our profession.
      David is right in the sense that the government does not seem to be a willing participant in the solution. I would like him to be more specific on his ideas about effective marketing solutions and reimbursement strategies he establishes with his clientele.
      I own a private practice and employ seven mental health professionals on my staff. Some are veterans in the field and others are just starting their careers. We do a combination of fee for service, negotiated fees, and insurance reimbursement. Currently, we are contract providers on three insurance panels. BCBS establishes the highest reimbursement scale, the other two considerably lower. I would get out of insurance contracted service altogether, but it helps the new hires build their practice.
      I would be interested in hearing what other mental health providers are doing to generate compensation in a system that does not place a high monetary value on our service.

    2. Dr. Hook, if our country’s $16.5 trillion dollars in national debt does not constitute being BROKE, then I don’t know what does.

      That being said, I agree with you that we shouldn’t be bailing out banks, insurance companies, and other entities in corporate America.

      You seem to be suggesting in so many words, however, that the government bail out the psychology profession.

      Perhaps that is part of why are profession is having such a hard time in the first place – between being addicted to insurance payments on the one hand, and being addicted to government funding on the others.

      I respectfully reject the notion that clients will be left out in the cold of more practitioners extricated themselves from these bureaucracies. When we have the power to set our own fees in the marketplace, but practitioners and clients are served.

      When we are making a decent living and enjoying our autonomy, we are also in a better position to offer pro-bono and low fee sessions to clients who are of limited means.

  3. Misty,
    Politicians tend to respond to numbers and money. Perhaps you forgot or maybe you didn’t realize that since World War 11 62% of all mental health services in the US have been and continue to be provided by Clinical Social Workers.
    The VA hires more Clinical Social Workers than any other organization in the nation.
    I refuse to provide services through managed health care and my income has been in the high six figures since the 1980’s.

  4. While I am appreciating this conversation, do we know the actual difference in reimbursement for physicians & psychologists? It seems to me that physicians also have taken a hit with managed care. It may be that they are able to accomplish the 2.5 times our salary simply by being able to see 2 to 3 patients per hour (versus our one client per hour). I just want to be sure in all of our arguments we are comparing apples to apple.

  5. LPC’s, LCSW’s, LMFT’s are also severely underpaid, as are psychologists. It’s becoming harder to attract highly skilled therapists who are willing to work for such low pay rates. Public insurance offered at no cost and insurance HMO plans with affordable insurance rates that attract employers and individuals offer such low reimbursement for participating providers that it’s impossible for for experienced therapists to earn wages commensorate with their experience. While many therapists are exiting into private, cash pay practices or for profit clinics that refuse to accept such rates, the most inexperienced therapists end up providing the services to these groups. The result is that those with the highest risk profiles will be served by the most inexperienced (or burned out, underpaid and undermotivated) providers. This does nothing to solve our mental health crises. Access to health care does not guarantee that the care provided will be helpful or effective. The “system” has not figured out a way to fairly compensate therapists. The more severe, high risk or chronic the problems, the more likely that the reimburement rate for serving such a client will be low. Chronic MH, substance abuse, chronic health problems, unemployment, homelessness and an array of other costly societal problems may be averted by providing the right interventions early, by a highly trained, experienced, capable, competent providers.

  6. Misty, I appreciate you bringing up the issue of mental health professionals being under payed. However, I think that David has it right in focusing the solution on what we can do rather than the government. I don’t think the government is broken. However, waiting on them to fix our compensation is about as likely as educators getting paid commensurate to the value that they actually provide. That’s just not going to happen.

    On the other hand, in my experience, mental health professionals often complain about their compensation because they have been afraid to ask for what they are worth or been afraid to give up their compensation from managed care. Many therapists are under the wrong impression and think that working directly with managed care is the only way to build / sustain a private practice. I started out in the field with that same mindset.

    However, along the way, I learned that there are actually lots of ways to provide services to those in need while getting paid a fairer fee for your professional services. And, in many ways, working directly with managed care handcuffs the therapist while also doing a disservice to your clients. I’ve written about this quite a bit on my blog, Private Practice from the Inside Out at http://www.AllThingsPrivatePractice.com.

    I would invite you and your readers to consider that therapists are trained, in part, in building and sustaining relationships. We’re really good at it! Marketing is simply relationship-building.

    Rather than waiting for our government to “help” us, I want to suggest that mental health professionals put on their business hats, consider taking responsibility for wearing those hats, get out and build some relationships STRATEGICALLY with the intent to gain clients, and risk charging what they are worth.

    I am a fee-for-service Licensed Professional Counselors in private practice. I have been an insurance-free practice for almost 20 years. I provide information to clients about the pros and cons of me choosing to work directly with my clients (rather than managed care) . I have had fewer than 5 potential clients in the last 10 years choose to work with another professional because I did not accept payment from insurance companies. I provide receipts to all of my clients allowing them to file with their insurance companies if they so desire.

    It is an honorable choice to work with clients who have financial needs. And, I do carve out a percentage of my practice to do just that. However, I also maintain that it is an equally honorable choice to work with full-fee paying clients, earning a fair and reasonable fee that allows a therapist to pay his / her mortgage and support his / her family in a comfortable manner.

  7. I’ve been reading the discussion on this topic with great interest. For so many of the reasons discussed, I stopped accepting payments from 3rd party payers of all types a long time ago. I see the value in insurance and insurance reimbursements for those catastrophic situations that almost no one could be expected to pay for out of pocket. But my services are different. And I know and respect the value of those services in the marketplace, especially when compared to “similar” services offered by allied professionals with much less training and experience. And although I am retired now, for years I only accepted clients who share an appreciation for the value of my service and are willing to pay for it. And although at first I saw fewer patients, I eventually made far more money and had far fewer headaches than when I ever accepted a managed-care benefit.

    1. I just joined this conversation and am a bit surprised and put off by the angry tones and finger wagging towards the author. Let’s absolutely discuss differences in opinion, what has worked for others, etc., without haugtily suggesting that your way of doing things is the be all and end all of how to run a practice, make a living and best serve our fellow humans (and perhaps that is where the differences lie…in how much weight we each give the above areas). That said, as a psychologist I too am concerned about making a decent living, especially with all the changes coming with the new CPT codes and ACO’s, BUT also wish to serve clients who can only afford mental health care through their insurance (many who already have high co-pays). It’s great so many of you are doing pro-bono and reduced fee work. However, if we all stick to cash pay practice, then it seems to me that we are not serving the average individual/family who does not have the money to pay for ongoing therapy. We are ignoring a large part of the population (I would argue the majority), who are also stuck with the bureacratic mess of dealing with their insurance company to pay us (and all that comes with that). It’s far from perfect, but to ignore a “broken system,” hurts the average person/family. I got into this field to help my fellow human beings AND make a decent living. I think we can do both! It’s not an easy time for this, but working together as professionals (in a national sense), rather than as islands (or small, local practics), seems to make the most sense from where I stand.

  8. Thanks for a great article. Until the continued stigma about mental illness and seeking treatment for mental illness is addressed and removed, we will continue to be seen as “step-children” and not valued. We as a profession need to advocate for ourselves and continue to demand to be treated with greater respect than we have been by educating our clients and the greater public about the vital services we provide. We may have entered the field due to altruism, but it don’t pay the rent.

  9. In my town of Spokane Counseling organizations are finding it harder and harder to bill insurances for many diagnosed mental illnesses. I work with adolescents dealing with drug and alcohol addictions and have had to stop treatment sessions midway through due to insurance companies refusing to pay. Hopefully someone does something that changes this soon.

    1. I don’t think we can afford to wait for someone else to do something about the problems with insurance companies…we as clinicians have to demand change…every one of us. One’s state association is a good place to start to see how they are addressing these issues and how each of us can effect change. We are far from powerless if we work together!

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