Going Back to School and Job Paths

[PikminOC]

Somewhat true. We used to screen out more acute and complex cases over the phone at my old PP and refer them to other resources. There were a few who snuck through, but not too many. Now, if you don't have many clients coming in...

I'm just not sure they take the time to do that. They are very busy.

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[PikminOC]

I see plenty. There's a slight bit of a wait, but I can easily get my older medicare folks in to see a psychologist or SW for therapy within a month most of the time, particularly with SWs This will get even easier once master's degree folks can bill for it.

So that's an n of 1 that probably sees a lot because many others dont

 

[AcronymAllergy]

So that's an n of 1 that probably sees a lot because many others dont

Yeah, not to derail the thread, but based on my state psych listserv, there aren't many therapists seeing Medicare patients. The ones who do are frequently talking about the rate cuts and potential for losing money.

A bigger chunk of a neuropsychologist's caseload is going to be made up of Medicare-eligible patients, so we're probably more likely overall to see them. Plus, all things considered, Medicare rates for an outpatient neuropsych eval aren't horrible (i.e., they aren't Medicaid). But if CMS keeps shaving off a few % each year (like they have for 2023) instead of upping rates, many/most neuropsychologists will probably start opting out of Medicare as well.

 

[WisNeuro]

Yeah, not to derail the thread, but based on my state psych listserv, there aren't many therapists seeing Medicare patients. The ones who do are frequently talking about the rate cuts and potential for losing money.

A bigger chunk of a neuropsychologist's caseload is going to be made up of Medicare-eligible patients, so we're probably more likely overall to see them. Plus, all things considered, Medicare rates for an outpatient neuropsych eval aren't horrible (i.e., they aren't Medicaid). But if CMS keeps shaving off a few % each year (like they have for 2023) instead of upping rates, many/most neuropsychologists will probably start opting out of Medicare as well.

For psychologists, I have a harder time. But, it's pretty easy to find SW that will take it here and in my former state. Once master's degrees can bill, I think you'll find it much easier still.

 

[R. Matey]

There are plenty of high acuity outpatients. However, I don't think that this is what midlevels are trained to manage or often want to see. Mild to moderate acuity is often preferred by a,lot of therapy practices.

I'd wager social workers get decent training in case management with this population, but probably less psychotherapy training. At least, that's my experience. I've never heard of a case management class in a counseling program, but it could exist.

They may want to see the less acute but they can't control what walks in the door

This is true, and also part of the problem. Many master's level clinicians are generalists despite having the necessary training to be generalists. In psych, generalization is almost a four letter word, but it's the modal level of training and experience for the majority of psychotherapy providers in the US.

 

[Sanman]

So that's an n of 1 that probably sees a lot because many others dont

I can show you an n of at least ~500 psychologists that take Medicare. Just check the major geropsych companies and listerservs. They are out there even if they are not the majority.

 

[Sanman]

I'd wager social workers get decent training in case management with this population, but probably less psychotherapy training. At least, that's my experience. I've never heard of a case management class in a counseling program, but it could exist.

I would agree with your assessment there.

 

[Sanman]

I'm just not sure they take the time to do that. They are very busy.

Some do and some do not. My old group pp did.

 

[PikminOC]

I can show you an n of at least ~500 psychologists that take Medicare. Just check the major geropsych companies and listerservs. They are out there even if they are not the majority.

How many psychologists total in the US? What is the denominator?

 

[PikminOC]

There are plenty of high acuity outpatients. However, I don't think that this is what midlevels are trained to manage or often want to see. Mild to moderate acuity is often preferred by a,lot of therapy practices.

Yes it is obviously preferred, even for me. It's just that the acuity is high and many can't handle it, or they don't even know enough to identify it.

 

[Tulsa]

It might not be a bad idea to pursue an MSW, gain experience clinically, and then you may be able to pick up some clinically-oriented classes in an MSW program mid-career.

 

[AcronymAllergy]

How many psychologists total in the US? What is the denominator?

As of 2015, approximately 106,000 (Where are the highest concentrations of licensed psychologists?). So probably a bit more now, give or take.

I suspect the proportion taking Medicare may also differ by geographic/SES region. It's also possible it may differ based on when it's a solo vs. group practice.

But yeah, unless things change, I don't necessarily see more psychologists taking Medicare in the future.

 

[WisNeuro]

As of 2015, approximately 106,000 (Where are the highest concentrations of licensed psychologists?). So probably a bit more now, give or take.

I suspect the proportion taking Medicare may also differ by geographic/SES region. It's also possible it may differ based on when it's a solo vs. group practice.

But yeah, unless things change, I don't necessarily see more psychologists taking Medicare in the future.

We also have to consider the overall therapist numbers, as psychologists are not the majority of therapy delivery professionals, if we're just considering medicare access numbers.

 

[AcronymAllergy]

We also have to consider the overall therapist numbers, as psychologists are not the majority of therapy delivery professionals, if we're just considering medicare access numbers.

Yep, I'd hazard a guess there must be at least as many other therapists.

 

[WisNeuro]

Yep, I'd hazard a guess there must be at least as many other therapists.

I'd wager it's a multiple. A proportion of licensed psychologists are doing little to no therapy, so it drives that number down. If we hold up the left over number against the numbers of master's therapists/LPCs, SWs doing mostly therapy, and MFTs, I'd imagine they have 3X+ our numbers. Private practice numbers are harder to get, but in my non-VA/non-AMC hospital experience, psychologists doing therapy vs. the other group was about a 1 to 10 ratio, at least. At my last placement, we had 1 psychologist in the OPMH unit, and about 15 other therapists. And there was 1 psychologist who did consults on inpatient units against a larger ratio of other therapists.

But, back to the point of the numbers. If you are solely looking for psychologists who take medicare for OP private practice work, you may be in for a wait, though almost all psychologists who work in a hospital system will take it. But, if you are also considering master's level folks for therapy who take Medicare, you should have an easy time referring out in most places.

 

[Sanman]

I'd wager it's a multiple. A proportion of licensed psychologists are doing little to no therapy, so it drives that number down. If we hold up the left over number against the numbers of master's therapists/LPCs, SWs doing mostly therapy, and MFTs, I'd imagine they have 3X+ our numbers. Private practice numbers are harder to get, but in my non-VA/non-AMC hospital experience, psychologists doing therapy vs. the other group was about a 1 to 10 ratio, at least. At my last placement, we had 1 psychologist in the OPMH unit, and about 15 other therapists. And there was 1 psychologist who did consults on inpatient units against a larger ratio of other therapists.

But, back to the point of the numbers. If you are solely looking for psychologists who take medicare for OP private practice work, you may be in for a wait, though almost all psychologists who work in a hospital system will take it. But, if you are also considering master's level folks for therapy who take Medicare, you should have an easy time referring out in most places.

Agreed, I think the number will skew even lower because it will include small part-time and semi-retired private practice folks that likely only take cash. There seem to be many mid-levels around in full-time PP though. Get closer to the city and nicer suburbs and you get a few more PP psychologists.

 

[WisNeuro]

Agreed, I think the number will skew even lower because it will include small part-time and semi-retired private practice folks that likely only take cash. There seem to be many mid-levels around in full-time PP though. Get closer to the city and nicer suburbs and you get a few more PP psychologists.

Yeah, and with non-SW, master's level people able to bill Medicare soon, you'll see availability increase quite a bit in the PP sector, as well as availability within healthcare systems. I'm not sure it's a good thing for the future of reimbursement, but probably a good thing for patients with mild to moderate MH issues.

 

[Sanman]

Yeah, and with non-SW, master's level people able to bill Medicare soon, you'll see availability increase quite a bit in the PP sector, as well as availability within healthcare systems. I'm not sure it's a good thing for the future of reimbursement, but probably a good thing for patients with mild to moderate MH issues.

I'm not sure it will hurt that badly. It is not like the lack of providers has forced reimbursement upward. Even the folks the with good insurance near me have a hard time finding someone who will accept it. With the increasing popularity of high deductible plans, I feel like a lot of PP folk would rather stay out of network and get their full fee.

 

[WisNeuro]

I'm not sure it will hurt that badly. It is not like the lack of providers has forced reimbursement upward. Even the folks the with good insurance near me have a hard time finding someone who will accept it. With the increasing popularity of high deductible plans, I feel like a lot of PP folk would rather stay out of network and get their full fee.

When it comes to CMS funding, it is much easier for it to be adjusted downward, than upward. As we have seen time and time again.

 

[Sanman]

When it comes to CMS funding, it is much easier for it to be adjusted downward, than upward. As we have seen time and time again.

Of course. This is why I am not for blanket "Medicare For All" as we have discussed in the past. Very easy to adjust rates downward and kill the field. Not that I want to open up that can of worms right now.

 

[PikminOC]

I'd wager it's a multiple. A proportion of licensed psychologists are doing little to no therapy, so it drives that number down. If we hold up the left over number against the numbers of master's therapists/LPCs, SWs doing mostly therapy, and MFTs, I'd imagine they have 3X+ our numbers. Private practice numbers are harder to get, but in my non-VA/non-AMC hospital experience, psychologists doing therapy vs. the other group was about a 1 to 10 ratio, at least. At my last placement, we had 1 psychologist in the OPMH unit, and about 15 other therapists. And there was 1 psychologist who did consults on inpatient units against a larger ratio of other therapists.

But, back to the point of the numbers. If you are solely looking for psychologists who take medicare for OP private practice work, you may be in for a wait, though almost all psychologists who work in a hospital system will take it. But, if you are also considering master's level folks for therapy who take Medicare, you should have an easy time referring out in most places.

Now some of the larger hospitals that have merged aren't even taking Medicare.

 

[PikminOC]

When it comes to CMS funding, it is much easier for it to be adjusted downward, than upward. As we have seen time and time again.

When was it adjusted upward?

 

[PikminOC]

I'm not sure it will hurt that badly. It is not like the lack of providers has forced reimbursement upward. Even the folks the with good insurance near me have a hard time finding someone who will accept it. With the increasing popularity of high deductible plans, I feel like a lot of PP folk would rather stay out of network and get their full fee.

Yes this is exactly correct.

 

[WisNeuro]

Now some of the larger hospitals that have merged aren't even taking Medicare.

I don't doubt that such hospitals exist, but outside of VAs, I have yet to see one of these hospitals. So, I have ti imagine that this is still relatively rare until I see evidence otherwise.

When was it adjusted upward?

Adjusted upward in an overall sense, aside from "inflation increases" that lag actual inflation numbers? I'm not aware of any such increases in my working years. But, they have changed the RVUs for certain codes upwards, which is technically an increase. They did this with some of our MH codes last go round, but also nerfed a few other codes. So, some providers did better, some worse.

 

[PikminOC]

I don't doubt that such hospitals exist, but outside of VAs, I have yet to see one of these hospitals. So, I have ti imagine that this is still relatively rare until I see evidence otherwise.



Adjusted upward in an overall sense, aside from "inflation increases" that lag actual inflation numbers? I'm not aware of any such increases in my working years. But, they have changed the RVUs for certain codes upwards, which is technically an increase. They did this with some of our MH codes last go round, but also nerfed a few other codes. So, some providers did better, some worse.

Aurora health care near my relatives house doesn't take it. And now they have merged with advocate and ascension. My relative have Medicare.

There's these mega corporations now with hospitals that are are creating monopolies.

 

[WisNeuro]

Aurora health care near my relatives house doesn't take it. And now they have merged with advocate and ascension. My relative have Medicare.

There's these mega corporations now with hospitals that are are creating monopolies.

If it's the Advocate/Aurora Health systems in WI, they take it last I checked. Do you have a press release or something that shows this?

"More than half of the hospitals in the United States are nonprofits or government-run. The federal government requires them to operate emergency rooms open to all patients regardless of their ability to pay, accept patients insured by Medicare, and use surplus funds to improve facilities and patient care to demonstrate they are giving back to the community."

 

[WisNeuro]

Aurora health care near my relatives house doesn't take it. And now they have merged with advocate and ascension. My relative have Medicare.

There's these mega corporations now with hospitals that are are creating monopolies.

I'll further clarify this, unless they change their tax status, as they are a 501c3, they have to take Medicare/Medicaid.

 

[PikminOC]

I'll further clarify this, unless they change their tax status, as they are a 501c3, they have to take Medicare/Medicaid.

I know that's why I didn't understand. They said they weren't taking any more Medicare patients. Are they allowed to do that with that ?

 

[WisNeuro]

I know that's why I didn't understand. They said they weren't taking any more Medicare patients. Are they allowed to do that with that ?

As far as I know, 501c3s cannot do that under federal statutes and maintain that status.

 

[Sanman]

I know that's why I didn't understand. They said they weren't taking any more Medicare patients. Are they allowed to do that with that ?

Are we talking original Medicare or Medicare (dis)Advantage?

 

[PikminOC]

Are we talking original Medicare or Medicare (dis)Advantage?

Regular medicare