CNN Article - Psychologists to Strike

[PikminOC]

Well then, perhaps they should cease providing mental health care since it seems to impact profitability so severely. Actually - I would like to see some real numbers that support your contentions because most of what you said feels like speculation right now.

Many places don't have mental health services specifically for this reason. Us people who run businesses know the costs involved.

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[AbnormalPsych]

Well then, perhaps they should cease providing mental health care since it seems to impact profitability so severely. Actually - I would like to see some real numbers that support your contentions because most of what you said feels like speculation right now.

They probably would love to. They get their insurance premiums from their members, then as an HMO, every service they have to provide is money out the door from that.

 

[msc545]

They probably would love to. They get their insurance premiums from their members, then as an HMO, every service they have to provide is money out the door from that.

I feel almost certain that their beancounters have made sure that the premiums they collect are enough to pay for their version of mental health care and a lot more.

 

[msc545]

Many places don't have mental health services specifically for this reason. Us people who run businesses know the costs involved.

Please seriously help me understand this - why is mental health care so much more expensive than medical care?

 

[WisNeuro]

The issue of MH care being a revenue loss is pretty ubiquitous, not just CA. You can read about this plenty with some simple searches. And, for those of us who have actually seen the numbers in large settings when going through budget projections and planned restructures, it is no surprise. Providing inpatient care is a force multiplier for these losses. The only places making money are private places that curate their patient population, or are only cash pay with wealthy patients, for the most part. And it all comes down to reimbursement. The hospital gets a small fraction of what is billed for those patients, especially the ones on medicare/aid/state equivalent. In some states, medicaid doesn't even covers testing materials costs for neuropsych testing, we treated then as pro bono cases.

 

[Pragma]

The issue of MH care being a revenue loss is pretty ubiquitous, not just CA. You can read about this plenty with some simple searches. And, for those of us who have actually seen the numbers in large settings when going through budget projections and planned restructures, it is no surprise. Providing inpatient care is a force multiplier for these losses. The only places making money are private places that curate their patient population, or are only cash pay with wealthy patients, for the most part. And it all comes down to reimbursement. The hospital gets a small fraction of what is billed for those patients, especially the ones on medicare/aid/state equivalent. In some states, medicaid doesn't even covers testing materials costs for neuropsych testing, we treated then as pro bono cases.

Yes, at the end of the day, reimbursement!

 

[Sanman]

Please seriously help me understand this - why is mental health care so much more expensive than medical care?

Reimbursements are low overall, there are no moneymaking procedures, it is resource/personnel intensive, and those with more serious MH conditions skew low income, which means medicaid reimbursement. The well-off worried go to private pay therapy in nice offices. A pcp might spend 7-15 min with a patient and bill for it while therapists are spending 45-60 min. Our rates have been flat for the past 20 years. Meanwhile, the costs for the building space and electricity we use are going up. What gave you the impression it was profitable for them?

Insurance is kind of like a gym membership. They make the most money on folks that sign up for membership and never use the facilities. If providers are bursting at the seems, they are losing money.

 

[smalltownpsych]

From what I recall from my years living in SoCal is that Kaiser is a cheaper insurance company that uses a strict HMO model and is geared toward working class people. Medicaid and Medicare reimbursements don’t factor in to their system unless they have started offering HMO plans geared for those individuals. Either way, HMOs make money when they limit access for customers and limit pay to providers. That’s how they operate. They did this so well that now most companies have followed their model to an extent and is why I am not contracted with any insurance companies.

 

[cara susanna]

It's almost like for-profit health insurance companies are a terrible idea because, by definition, they have to maximize profits by denying care or services...

 

[WisNeuro]

It's almost like for-profit health insurance companies are a terrible idea because, by definition, they have to maximize profits by denying care or services...

Well, Medicare isn't better on the reimbursement side of things, it's just subsidized by taxpayers. If I was full clinical, although Medicare is easy to deal with, I'd consider opting out and going cash due to low reimbursements per time spent. I consider my IME/forensic work to subsidize me still doing a certain percentage of clinical work at this point. MH reimbursement just sucks, plain and simple. The fact that reimbursements have been essentially flat for decades means that they have technically been cut by the amount of inflation during that time, year over year.

 

[msc545]

Sacramento Mayor Darrell Steinberg will mediate negotiations between Kaiser Permanente and the National Union of Health Care Workers, which represents roughly 2,000 mental health clinicians who have been on strike for nearly 10 weeks. During a rally Friday in Oakland, NUHW President Sal Rosselli announced that the union agreed to work with Steinberg to try and settle a key issue that has bogged down negotiations. Rosselli said he had just left a two-hour meeting with Steinberg where he introduced himself as, not the mayor of Sacramento nor as former president pro tem of the California Senate, but as the individual who spearheaded state legislative efforts that put billions of dollars into mental health care for California communities. “I hope within days we come to a resolution,” Rosselli said. “Our hope is a tentative agreement, and that tentative agreement must include a fundamental change in the relationship, where Kaiser executives agreed to collaborate with you, with our clinicians, to finally fix the behavioral health system.” The company and union have been at odds over how much time therapists should have to take care of patients’ needs outside therapy sessions. Mental health providers have said that, in addition to putting their notes in Kaiser’s system, they often must connect patients with other resources and use the tools of their profession to assess a patient’s conditions. In a statement released Friday afternoon, Kaiser officials said they were committed to reaching an agreement that met patients’ needs. “After much back and forth, we are at a point where to move this forward and find a solution, we need an independent, third-party mediator,” company officials said in the statement. “We are pleased that NUHW has agreed to join with us in this. We proposed, and NUHW agreed, to ask Mayor Steinberg to mediate our contract negotiations.” The mayor’s representatives did not immediately comment. Steinberg has been meeting with both sides today. Rosselli also noted that it was Steinberg who helped to negotiate a tentative deal in 2015 as NUHW prepared to go into an open-ended strike. Therapists, represented by the National Union of Health Care Workers, said Kaiser members routinely wait months to see their clients in Sacramento and elsewhere around Northern California after an initial intake session to assess their needs. Kaiser members also have contacted The Bee to share how long waits for treatment affected them or their family members, saying they felt trapped in a “circle of horror” because contracted therapists on the company-provided lists were either not seeing new patients or didn’t have the credentials to treat them.

Read more at: https://www.sacbee.com/news/local/health-and-medicine/article267324062.html#storylink=cpy

Reimbursements are low overall, there are no moneymaking procedures, it is resource/personnel intensive, and those with more serious MH conditions skew low income, which means medicaid reimbursement. The well-off worried go to private pay therapy in nice offices. A pcp might spend 7-15 min with a patient and bill for it while therapists are spending 45-60 min. Our rates have been flat for the past 20 years. Meanwhile, the costs for the building space and electricity we use are going up. What gave you the impression it was profitable for them?

Insurance is kind of like a gym membership. They make the most money on folks that sign up for membership and never use the facilities. If providers are bursting at the seems, they are losing money.

I see. thanks!

 

[PikminOC]

It's almost like for-profit health insurance companies are a terrible idea because, by definition, they have to maximize profits by denying care or services...

Not for profits are the same.

 

[Sanman]

From what I recall from my years living in SoCal is that Kaiser is a cheaper insurance company that uses a strict HMO model and is geared toward working class people. Medicaid and Medicare reimbursements don’t factor in to their system unless they have started offering HMO plans geared for those individuals. Either way, HMOs make money when they limit access for customers and limit pay to providers. That’s how they operate. They did this so well that now most companies have followed their model to an extent and is why I am not contracted with any insurance companies.

True, I was speaking about the system more generally. That said, it is not like the insurance reimburses the hospital out of line with these figures. Kaiser tends to be on the lower end of the commercial spectrum.

 

[PikminOC]

The Bee to share how long waits for treatment affected them or their family members, saying they felt trapped in a “circle of horror” because contracted therapists on the company-provided lists were either not seeing new patients or didn’t have the credentials to treat them...
...
This is common with many insurance companies. Ghost networks. Not just Kaiser.

 

[Fpg1245]

Kaiser has quite a reputation for not providing therapy in a timely or regular manner, and for using psychologists as workhorses. VIa word of mouth, I've heard of someone who works there writing notes after hours and on weekends because they see clients back to back all day. No admin time. Waitlists are ridiculously long to get into see therapists for individual therapy, and appointments are spaced out 3-4 weeks, sometimes more.

Also, a non-profit reporting over $8 billion net income in a year? Where does that excess go when you're a non-profit?

My best wishes to all the psychologists at Kaiser striking--I hope they get everything that their union is advocating for. The irony of Kaiser's rep saying the union is using "unethical" means by striking and not providing needed mental health services when the psychologists are striking unethical conditions by Kaiser--such manipulative language.

So it’s ethical for your employer to exploit labor if you can somehow prove that your “customers” will suffer.

Also since when has ethics ever been in the vocabulary of hospital admin? Oh I know when they need to guilt workers into providing free work!

 

[erg923]

It's almost like for-profit health insurance companies are a terrible idea because, by definition, they have to maximize profits by denying care or services...

I cannot speak to Kaiser's business model. But such a blanket statement of MCOs is completely false and is a common misconception amongst providers of all medical and behavioral health specialty.

Care that is medically necessary (i.e., clinically appropriate and not excessive to do the stated job) is covered and paid per the provider and member contract with the health plan. Which, they have both agreed to in advance. Services that are excessive to treat current symptoms/needs and/or NOT empirically validated are not approved for payment. It is really that simple.

ONLY paying for care services that are clinically appropriate and necessary at the time of request for treatment or maintenance of a condition, and in-line with current best-practices based on evidence allows such companies to be profitable. If they were not allowed this oversight, the system would fiscally collapse within just a couple years. I would like to emphasize this point again.

Fee-for-service CPT codes are a real problem. Payment based on this can be a real corrupter. No doubt. But individual MCOs actually have no power to change the current system of CPT codes/method or reimbursement.

Rampant misuse/abuse of RTC and other expensive, high levels of care in several states was recently written about in a New York Times article, by the way.

 

[WisNeuro]

So it’s ethical for your employer to exploit labor if you can somehow prove that your “customers” will suffer.

Also since when has ethics ever been in the vocabulary of hospital admin? Oh I know when they need to guilt workers into providing free work!

I suspect that it's more setting the stage for a legal defense in light of the CA statutes. As for free work, yes and no. If they are like most MH departments, once you factor in salary and benefits, some of those workers are net revenue losses for the systems.

 

[msc545]

The Bee to share how long waits for treatment affected them or their family members, saying they felt trapped in a “circle of horror” because contracted therapists on the company-provided lists were either not seeing new patients or didn’t have the credentials to treat them...
...
This is common with many insurance companies. Ghost networks. Not just Kaiser.

"They all do it" is not a valid defense of anything.

 

[WisNeuro]

The point is that Kaiser is not the disease, but rather a symptom of a more systemic disease that is the current MH reimbursement infrastructure.

 

[PikminOC]

The point is that Kaiser is not the disease, but rather a symptom of a more systemic disease that is the current MH reimbursement infrastructure.

Yes thank you.

 

[msc545]

Yes thank you.

Actually, it is predatory Capitalism, a particularly odious form of a fundamentally flawed economic system that encourages exploitation, and one that Kaiser practices. Increasing reimbursements would only increase Kaiser's profits.

 

[WisNeuro]

So, the only fix is to force systems lose even larger amounts of money on MH care, or have other patients subsidize MH care? Or, are we going hope that the underpants gnomes have a fix?

 

[cara susanna]

I mean, how do other first world countries do it? I'm guessing taxpayer subsidized?

 

[PikminOC]

I mean, how do other first world countries do it? I'm guessing taxpayer subsidized?

They don't do it. Even harder to get in other countries

 

[PikminOC]

Is it over? They met yesterday right?

 

[Sanman]

I mean, how do other first world countries do it? I'm guessing taxpayer subsidized?

Yes, but the problems are similar to our system with limited access and long wait lists. Psychotherapy is limited unless you pay for it yourself and I believe only time limited CBT is used in government sponsored programs.

The NHS mental health 'service'? There isn't one

 

[Fan_of_Meehl]

Yes, but the problems are similar to our system with limited access and long wait lists. Psychotherapy is limited unless you pay for it yourself and I believe only time limited CBT is used in government sponsored programs.

The NHS mental health 'service'? There isn't one

It's anecdotal, but I've heard of UK citizens complaining of having to wait for 6 months (or longer) just to get in to a first appointment with a therapist trained in CBT.

 

[Pragma]

Yes, but the problems are similar to our system with limited access and long wait lists. Psychotherapy is limited unless you pay for it yourself and I believe only time limited CBT is used in government sponsored programs.

The NHS mental health 'service'? There isn't one

I am curious what reimbursement is like.

 

[WisNeuro]

I am curious what reimbursement is like.

Clinical Psychologist Salary in United Kingdom - Average Salary

Clinical Psychologist make an average of £49,020 / year in United Kingdom, or £25.14 / hr. Try Talent.com's salary tool and search thousands of salaries in your industry.

uk.talent.com

How Much Money Do Psychologists Make? | Private Therapy Clinic

Psychology is not a money-making venture but if you can build up enough credibility there is a potential to earn. Click here to learn more.

theprivatetherapyclinic.co.uk

womp womp

 

[Sanman]

I am curious what reimbursement is like.

Clinical Psychologist Salary in United Kingdom - Average Salary

Clinical Psychologist make an average of £49,020 / year in United Kingdom, or £25.14 / hr. Try Talent.com's salary tool and search thousands of salaries in your industry.

uk.talent.com

How Much Money Do Psychologists Make? | Private Therapy Clinic

Psychology is not a money-making venture but if you can build up enough credibility there is a potential to earn. Click here to learn more.

theprivatetherapyclinic.co.uk

womp womp

I was googling a bit and saw references up to 100k, but most NHS jobs seem to be 50-60K. It is part of the reason that Medicare For All concerns me. That could be us.

 

[WisNeuro]

I was googling a bit and saw references up to 100k, but most NHS jobs seem to be 50-60K. It is part of the reason that Medicare For All concerns me. That could be us.

Mayhaps, but I also believe that clinical psychology is a masters level profession in the UK. So it's commensurate with mid level practitioners here.

 

[msc545]

Is it over? They met yesterday right?

It is not over, and it is unlikely to be over anytime soon.

 

[Sanman]

Mayhaps, but I also believe that clinical psychology is a masters level profession in the UK. So it's commensurate with mid level practitioners here.

Psychotherapist/ counsellor is licensed at the masters level (or even below for some jobs). Clinical Psychologist is still a protected term for those with Doctorates there. So, the jobs I saw listed as psychologist were for doctoral level providers.

 

[Pragma]

Clinical Psychologist Salary in United Kingdom - Average Salary

Clinical Psychologist make an average of £49,020 / year in United Kingdom, or £25.14 / hr. Try Talent.com's salary tool and search thousands of salaries in your industry.

uk.talent.com

How Much Money Do Psychologists Make? | Private Therapy Clinic

Psychology is not a money-making venture but if you can build up enough credibility there is a potential to earn. Click here to learn more.

theprivatetherapyclinic.co.uk

womp womp

Ewe!

 

[WisNeuro]

Psychotherapist/ counsellor is licensed at the masters level (or even below for some jobs). Clinical Psychologist is still a protected term for those with Doctorates there. So, the jobs I saw listed as psychologist were for doctoral level providers.

3 year undergrad degree, 3 year postgrad degree. They are, in all practicality, masters level clinicians.

 

[Pragma]

3 year undergrad degree, 3 year postgrad degree. They are, in all practicality, masters level clinicians.

Physician salaries also appear lower overall relative to the US

The Complete Guide To NHS Pay For Doctors

An NHS doctor’s salary is more complicated than it might at first appear and varies according to grade, years in role, and where in the UK the job is based. NHS pay is reviewed annually by the Review Body on Doctors’ and Dentists’ Remuneration (DDRB), who make recommendations to the government...

www.bmj.com

 

[WisNeuro]

Physician salaries also appear lower overall relative to the US

The Complete Guide To NHS Pay For Doctors

An NHS doctor’s salary is more complicated than it might at first appear and varies according to grade, years in role, and where in the UK the job is based. NHS pay is reviewed annually by the Review Body on Doctors’ and Dentists’ Remuneration (DDRB), who make recommendations to the government...

www.bmj.com

Yeah, my household would take a sizable paycut moving to the UK.

 

[Sanman]

3 year undergrad degree, 3 year postgrad degree. They are, in all practicality, masters level clinicians.

We can argue years vs degree conferred, but I don't think that is the reason for the lower salary level there.

Physician salaries also appear lower overall relative to the US

The Complete Guide To NHS Pay For Doctors

An NHS doctor’s salary is more complicated than it might at first appear and varies according to grade, years in role, and where in the UK the job is based. NHS pay is reviewed annually by the Review Body on Doctors’ and Dentists’ Remuneration (DDRB), who make recommendations to the government...

www.bmj.com

Physicians there also have fewer years of education and salaries are significantly lower there than here. I do believe that this is more a function of marketplace alternatives than education. Healthcare providers here can refuse/limit Medicaid/Medicare and not starve as people have other insurance options. In England, where salaries are lower on average than in the U.S. and the culture is not that, I imagine that private pay is rarer.

 

[AbnormalPsych]

Is it over? They met yesterday right?

It is not over, and it is unlikely to be over anytime soon.

Kaiser mental health workers return after tentative agreement reached, ending strike in NorCal

STRIKE IS OVER: Kaiser mental health care workers in Northern California are back at work on Wednesday after a tentative agreement was reached Tuesday, ending a historic 10-week strike.

abc7news.com

 

[msc545]

Kaiser mental health workers return after tentative agreement reached, ending strike in NorCal

STRIKE IS OVER: Kaiser mental health care workers in Northern California are back at work on Wednesday after a tentative agreement was reached Tuesday, ending a historic 10-week strike.

abc7news.com

Tentative means possible, but I hope that it is over. I had not seen this until you posted it.

 

[AbnormalPsych]

Thank you for operationalizing the word tentative.

 

[PikminOC]

Kaiser mental health workers return after tentative agreement reached, ending strike in NorCal

STRIKE IS OVER: Kaiser mental health care workers in Northern California are back at work on Wednesday after a tentative agreement was reached Tuesday, ending a historic 10-week strike.

www.google.com

 

[msc545]

Repeating what was already posted won't make it stick better.

 

[WisNeuro]

I mean, repetition does help with free recall in most people. So yes, it technically would.

 

[AbnormalPsych]

https://www.cnn.com/2022/10/21/business/mental-health-workers-strike/index.html

Among the changes was an increase from 60 to 90 minutes in the time therapists have to conduct an initial assessment of children. Kaiser Permanente also committed to increase staffing, according to the union.

Kaiser therapists vote to end 10-week strike

The vote marks the end of the longest mental health worker strike in American history.

www.sfgate.com

Therapists at Kaiser Permanente in Northern California voted Thursday to ratify a new contract with the health care giant, marking the end of the longest strike by mental health workers in American history.

Workers voted 1,561 to 36 to end the 10-week strike and accept the contract. The vote came two days after a tentative agreement was announced in a joint statement between Kaiser and the National Union of Healthcare Workers, which represents the 2,000 non-psychiatrist therapists of the HMO's Northern California branch. The four-year contract will be retroactive to September 2021, expiring in September 2025.

Key terms of the deal include an increase in pay for bilingual therapists; additional hours per week for all clinicians to “perform critical patient care duties,” such as responding to calls and emails and planning treatment; and commitments from Kaiser to hire more therapists and expand crisis services for patients.


Natalie Rogers, a Kaiser emergency mental health therapist in Santa Rosa, told SFGATE that ratifying the agreement means getting to help patients again, but acknowledges that the strike took a toll on patients and workers.

"It was important for us to go on strike, because we know that our patients deserve better care. ... But it came at a very high cost for a lot of therapists and their families and our patients not being able to receive care," she said. "That was the hardest part is that we were out for our patients, but they were also being hurt by us being out. So ratification really means that we are able to get back to work; we're able to work with Kaiser to continue to improve the mental health resources for our patients."

A key provision of the agreements is the introduction of five committees, which will meet over the span of six months and make recommendations for improvements to Kaiser's care model, which the insurer will be required to fund and implement. In its statement, the union said these committees are key to ensuring Kaiser will finally adhere to a state law that requires patients be scheduled for follow-up sessions within 10 business days of seeing a therapist, unless otherwise approved by a clinician.

“I’m proud of Kaiser therapists for standing up for their patients and their profession,” Sal Rosselli, president of the National Union of Healthcare Workers, said in a statement provided by the union.

But the fight in Northern California — and elsewhere — continues. In Hawaii, mental health care professionals have entered their eighth week of striking for similar demands.

"I just feel like there's still so much work to be done," Rogers said. "Us returning to work, we did so with a lot of compromise. And ultimately, we're not where we want to be as far as the care that we want to give to our patients, but it is a step in the right direction."

A representative for Kaiser did not immediately respond to a request for comment from SFGATE.

 

[msc545]

https://www.cnn.com/2022/10/21/business/mental-health-workers-strike/index.html

Among the changes was an increase from 60 to 90 minutes in the time therapists have to conduct an initial assessment of children. Kaiser Permanente also committed to increase staffing, according to the union.

Kaiser therapists vote to end 10-week strike

The vote marks the end of the longest mental health worker strike in American history.

www.sfgate.com

Therapists at Kaiser Permanente in Northern California voted Thursday to ratify a new contract with the health care giant, marking the end of the longest strike by mental health workers in American history.

Workers voted 1,561 to 36 to end the 10-week strike and accept the contract. The vote came two days after a tentative agreement was announced in a joint statement between Kaiser and the National Union of Healthcare Workers, which represents the 2,000 non-psychiatrist therapists of the HMO's Northern California branch. The four-year contract will be retroactive to September 2021, expiring in September 2025.

Key terms of the deal include an increase in pay for bilingual therapists; additional hours per week for all clinicians to “perform critical patient care duties,” such as responding to calls and emails and planning treatment; and commitments from Kaiser to hire more therapists and expand crisis services for patients.


Natalie Rogers, a Kaiser emergency mental health therapist in Santa Rosa, told SFGATE that ratifying the agreement means getting to help patients again, but acknowledges that the strike took a toll on patients and workers.

"It was important for us to go on strike, because we know that our patients deserve better care. ... But it came at a very high cost for a lot of therapists and their families and our patients not being able to receive care," she said. "That was the hardest part is that we were out for our patients, but they were also being hurt by us being out. So ratification really means that we are able to get back to work; we're able to work with Kaiser to continue to improve the mental health resources for our patients."

A key provision of the agreements is the introduction of five committees, which will meet over the span of six months and make recommendations for improvements to Kaiser's care model, which the insurer will be required to fund and implement. In its statement, the union said these committees are key to ensuring Kaiser will finally adhere to a state law that requires patients be scheduled for follow-up sessions within 10 business days of seeing a therapist, unless otherwise approved by a clinician.

“I’m proud of Kaiser therapists for standing up for their patients and their profession,” Sal Rosselli, president of the National Union of Healthcare Workers, said in a statement provided by the union.

But the fight in Northern California — and elsewhere — continues. In Hawaii, mental health care professionals have entered their eighth week of striking for similar demands.

"I just feel like there's still so much work to be done," Rogers said. "Us returning to work, we did so with a lot of compromise. And ultimately, we're not where we want to be as far as the care that we want to give to our patients, but it is a step in the right direction."

A representative for Kaiser did not immediately respond to a request for comment from SFGATE.

"Commitments" made by Kaiser are, based on history, worthless. We will be revisiting these issues again in several years.

 

[Sanman]

"Commitments" made by Kaiser are, based on history, worthless. We will be revisiting these issues again in several years.

I imagine in just under 3 years. That is how contracts work.

 

[WisNeuro]

Again, just a symptom of a larger disorder. This is just kicking the can down the road.

 

[AbnormalPsych]

Next up, County hospital employed physicians to strike:

'Time's up': Santa Clara County doctors to strike - San José Spotlight

After two years of stalled contract negotiations, Santa Clara County doctors say they've had enough. Physicians are preparing to strike in early November.

sanjosespotlight.com

What ever happened with the nurses strike in Minnesota a few weeks back?

 

[PikminOC]

Next up, County hospital employed physicians to strike:

'Time's up': Santa Clara County doctors to strike - San José Spotlight

After two years of stalled contract negotiations, Santa Clara County doctors say they've had enough. Physicians are preparing to strike in early November.

sanjosespotlight.com

What ever happened with the nurses strike in Minnesota a few weeks back?

The nurses got what they wanted quickly. Over in three days.