BCBS Massachusetts Child Psych incentive

[NeuroKlitch]

Don't know if this has been discussed , but saw that BCBS Massachusetts is reimbursing child psychiatrist 50% more as an incentive to switch to insurance based practices . Are there any other incetives that exist like this nationally ? Do you expect these incentives to continue in the near future ?

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[Old&InTheWay]

I wouldn't expect this kind of thing to continue past the point the insurance company has lured enough psychiatrists back into accepting their insurance.

 

[Sushirolls]

I wouldn't expect this kind of thing to continue past the point the insurance company has lured enough psychiatrists back into accepting their insurance.

^^^This. And then on top of that, I bet they will be scrutinizing extra close after the conveniently reduce the rates, or decide to not reimburse the prolonged services codes, etc or whatever other special codes get used and then decide to drop the insurance, they will make it a pain to cut lose.
'oh, we didn't get your certified letter, you are still in network'
'oh, in your contract, you ahve to keep delivery services until they find another in network specialist, see, right here this paragraph says so!'
A whole slough of shady things will be set up to stick it to and capture these C&A.

Insert the star wars meme here "Its a trap!"

 

[NewYorkChildPsych]

This isn't much of an incentive. I would still rather spend time with patients and families than on paperwork/chasing BCBS for reimbursement.

 

[Monocles]

I live in Mass... this initiative hasn't come close to making a dent.

Every year we still get endless big-wig speakers talking about healthcare disparity and trying to shame the audience (100% of which are academic clinicians who by DEFAULT have a significant population of masshealth patients...) about their part-time private practice. Meanwhile said speaker has a publicly google-able website listing their rates of, surprise, $1k+ an hour.

This is an economic problem and there's probably an economic solution but I don't know if BCBS has the will or money to meet it. The primary reason why 60%+ of psychiatrists in mass do not take insurance is "too much hassle". If the administrative burden can somehow be shifted 95% onto insurance payers and not clinician then there might be less barriers. But also right now the market demand for MH clinicians is *astronomically* beyond the available demand. Even if the market magically gets flooded with hundreds of new NPs and psychologists and SWs, the cash practices will still survive and thrive b/c of the demand from families with means.

 

[nexus73]

I saw a dermatologist last week. New patient only took 15 minutes.

Psychiatry is a different job that takes time but insurance is biased away from that. Derm could see 4 99203s in an hour plus procedures for simple biopsy or skin tag removal. Child psych initial is likely 90 minutes or more if doing good work and if you aren’t getting paid for extended service you could be stuck with only 99205. It’s just the nature of different specialties where psych requires eliciting and synthesizing complex social and medical issues, current symptoms, substance use, childhood trauma, developmental issues etc into a thorough diagnostic formulation.

Derm can say, that looks like cancer let’s biopsy it.

Orthopedics can say the X-ray shows your leg is fractured, you need surgery.

When compared to these specialties it’s no wonder child psychiatrists don’t take insurance because it doesn’t compensate them for the demanding work they do.

 

[Merovinge]

I saw a dermatologist last week. New patient only took 15 minutes.

Psychiatry is a different job that takes time but insurance is biased away from that. Derm could see 4 99203s in an hour plus procedures for simple biopsy or skin tag removal. Child psych initial is likely 90 minutes or more if doing good work and if you aren’t getting paid for extended service you could be stuck with only 99205. It’s just the nature of different specialties where psych requires eliciting and synthesizing complex social and medical issues, current symptoms, substance use, childhood trauma, developmental issues etc into a thorough diagnostic formulation.

Derm can say, that looks like cancer let’s biopsy it.

Orthopedics can say the X-ray shows your leg is fractured, you need surgery.

When compared to these specialties it’s no wonder child psychiatrists don’t take insurance because it doesn’t compensate them for the demanding work they do.

I see some people balk at $400-600/hour cash pay rates, even among psychiatrists, and then you look at what the dermatologist is billing for 4 99203s + procedures or what the surgeon is billing for 6 99214's in an hour with insurance rates. The reality of how modern medicine has pushed hard for short encounters and reimbursed them heavily while good psychiatric practice requires the exact opposite is exactly why the cash pay population exists as it does.

 

[Monocles]

I see some people balk at $400-600/hour cash pay rates, even among psychiatrists, and then you look at what the dermatologist is billing for 4 99203s + procedures or what the surgeon is billing for 6 99214's in an hour with insurance rates. The reality of how modern medicine has pushed hard for short encounters and reimbursed them heavily while good psychiatric practice requires the exact opposite is exactly why the cash pay population exists as it does.

For the unfamiliar, what do those numbers look like?

 

[Merovinge]

For the unfamiliar, what do those numbers look like?

I can't say for derm but 99214's bill in the range of $100 (very low end) to $150+. If you even average $125 and 5/hour that will approximate a $600/hour rate. You might note some surgery offices have more overhead than psych but they can also make money via procedures, referrals for imaging/lab testing done in the organization, as well some other sources of revenue that are not possible in psych (like administering chemo, rad/onc procedures).

 

[Sushirolls]

My derm for 99214 got ~$110 more than what I get paid by the same exact insurance company for a 99214.
And mine was a routine annual skin check. No acute issues.

This is why Psychiatrists opt out of insurance. I'm motivated more with each passing day to change from being an insurance practice to cash only.

So if they see 4 people in an hour, and I only see 2, they are grossing $800 dollars more per hour based upon just that one insurance. Wow, after punching in those numbers... I feel nauseous.