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PhD/PsyD Ethical guidelines on private practice after-hours coverage

Locrytham

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10+ Year Member
Jan 22, 2008
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Boston, MA
  1. Psychologist
Hi all,

I am in the process of starting up a solo private practice and was wondering psychologists are required to provide after-hours coverage and/or be on-call 24/7 in the private practice setting. I am trying to figure out whether I need to pay for an after-hours answering service, or if I can just say in my voicemail message what my hours are (they will be normal business hours, maybe a couple of evenings) and if patients receive this message after hours and are having a clinical emergency, to call 911 or go their nearest emergency room.

I have been reading around and haven't been able to find anything definitive of the topic. There was some advice online about checking with the insurance plans one is contracted with to make sure that 24/7 availability and after-hours coverage is not a clause in the contract - I do plan to take insurance. Does anyone have guidance on whether ensuring 24/7 coverage typically is required for plans you work with?

Of course, I understand I have to arrange for coverage for things like planned vacations or extended illnesses (still working on securing this), but this seems like a separate matter.

Ty!
 

PsyDr

Psychologist
15+ Year Member
Dec 18, 2005
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Resnick says 24/7 is standard of care. Which he pulled out of his butt.

Best course of action:

1) Call around to psychologists in your area, after hours. Document that they say, “yeah I’m not available or something; call 911”. Do that about a dozen times. Document preferably in handwriting on a piece of paper, dated, scanned and emailed to yourself. Congratulations: you’ve established what the community standard of care, or at least the reasonable minority standard. Ain’t nobody able to sue you now for a few years. Until you redo this process.

2) call your malpractice insurance company and ask. They’ll have free consultation. Do what they say. Congratulations now you’ve beat out any negligence stuff.

3) set up your voicemail according to #1

4) use informed consent stuff from your malpractice insurer and/or professional orgs. Add in something about how you are unavailable after X time. With the procedure if after that time ( it’s always call 911).

5) google malpractice lawsuits+psychologist+your state. Now you know what’s possible. Hint: we get sued for custody stuff, insurance fraud, and sleeping with patients. Adjust #4 accordingly.

6) read the actual laws of your states practice code or stuff or whatever. Change your informed consent using that language. Psydr informed consent has an exceptional correlation to that language. Takes 30 minutes.
 
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romanticscience

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Jun 19, 2009
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  1. Attending Physician
Hi all,

I am in the process of starting up a solo private practice and was wondering psychologists are required to provide after-hours coverage and/or be on-call 24/7 in the private practice setting. I am trying to figure out whether I need to pay for an after-hours answering service, or if I can just say in my voicemail message what my hours are (they will be normal business hours, maybe a couple of evenings) and if patients receive this message after hours and are having a clinical emergency, to call 911 or go their nearest emergency room.

I have been reading around and haven't been able to find anything definitive of the topic. There was some advice online about checking with the insurance plans one is contracted with to make sure that 24/7 availability and after-hours coverage is not a clause in the contract - I do plan to take insurance. Does anyone have guidance on whether ensuring 24/7 coverage typically is required for plans you work with?

Of course, I understand I have to arrange for coverage for things like planned vacations or extended illnesses (still working on securing this), but this seems like a separate matter.

Ty!

If it helps, one particular insurance company requires 24/7 coverage which they define as being be satisfied by any of the following:

1. Answering Service
2 On-Call Arrangement with Another Network Credentialed Practitioner of the same or similar specialty.
3 Answering Machines that have a call back number whereby the practitioner on-call can be directly assessed.
4 An Emergency Department that acts as an answering service and can page the practitioner directly after hours for the patient and the hospital provides written confirmation of these arrangements.
5 For Behavioral Health Providers Only: Crisis Center - Only if the center can contact the practitioner directly via arrangements.
 
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Locrytham

Full Member
10+ Year Member
Jan 22, 2008
17
1
201
Boston, MA
  1. Psychologist
Psydr informed consent has an exceptional correlation to that language.

Thanks for the tips! Yes, so far my credentialing has been approved for one insurance company - it was a transfer of credentials from the previous practice I belonged to though, so there wasn't a credentialing application I had to fill out which specified whether 24/7 coverage was required and if so what were the parameters. I will call them to double-check.

PsydDr - what do you mean "PsyDr informed consent has an exceptional correlation to that language?"

Also, I appreciate your frankness about your opinions on Resnick's ethical guidelines :p
 

PsyDr

Psychologist
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Dec 18, 2005
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Thanks for the tips! Yes, so far my credentialing has been approved for one insurance company - it was a transfer of credentials from the previous practice I belonged to though, so there wasn't a credentialing application I had to fill out which specified whether 24/7 coverage was required and if so what were the parameters. I will call them to double-check.

PsydDr - what do you mean "PsyDr informed consent has an exceptional correlation to that language?"

Also, I appreciate your frankness about your opinions on Resnick's ethical guidelines :p

1) Don’t get so caught up in ethics. The law is really what matters. I’m guessing you’re more ecp. Ethics violations can mean other psychologists call you naughty. Legal violations can mean you lose your license, your assets, and even wind up in jail.

2) it seems that what you are really asking about is what a specific contract requires. The best course of action is to find what other psychologists do, in your area that are contracted with that insurance panel. Again: call, handwritten dates and times, etc. If the insurnace does not enforce that clause with everyone else, then it might be reasonable to believe that this is a legally unenforceable clause.

3) It’s an almost certainty that your malpractice insurance offers a free legal consultation. They’ll only answer questions about the legal requirements for care, NOT the contract. It’s not a bad idea to use that service.

4) Hire an attorney to look the contract over. A very focused consult should be relatively cheap (eg., $300). Like a referral question, you want to be as focused as possible. “Can you look at this clause in this contract and advise me exactly what is required. I also have called 51% of the psychologists in my area that take that insurance, and here’s that information ”.

5)Your specific question: the states in which I am licensed have laws outlining what is required for informed consent. I copy those specific laws, paste them into my informed consent document, change up some of the pronouns and stuff, add in some stuff abijt how there are likely additional things I don’t know about, and have the patient initial next to each part of that law. Sometimes patients will ask about the unknown stuff. I explain to them I don’t want to lie, but I send their bill to the insurance company, and I have no real knowledge about how they work, how they maintain confidentiality, etc. So I can’t really explain some of those things. People seem to like the honesty. If I ever get a board complaint about informed consent stuff, the board will have evidence that each legal standard was met using almost the exact same verbiage. That’s a very difficult legal hurdle for them to overcome.
 

Locrytham

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Jan 22, 2008
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Boston, MA
  1. Psychologist
I don't know if I'm still considered ECP (I graduated in 2015), but I'm definitely new to the independent practice world.

Later today I found in the insurance provider manual it *did* state that 24/7 coverage was necessary; however, when I called their Provider Relations department, the representative said it would be fine to have an after-hours message that directs patients to call 911 or go to their nearest ED if they are having an emergency, and that measures like hiring an answering service or checking and responding to messages after-hours 24/7, even in an emergency, were *not* necessary. I've written in my informed consent that I do not check my messages as frequently in the evenings or weekends/holidays, and that if they have a clinical emergency, they should first call 911 or go to their ED as I cannot guarantee I will be available immediately.

I documented this in a memo since it seems to contradict what reads in their own manual.

Yes, I think my informed consent is pretty air-tight. I base much of the clauses about patient payment responsibility, etc. on Joe Scroppo's example from his private practice that he makes available on my liability insurance's website.
 
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