group:individual at CMHCs

[BlackSkirtTetra]

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My jurisdiction is switching over from a fee-for-service payment system to a managed care system.

And as part of that process, we are being forced to lower our ratio of group:individual therapy from around 70:30 to 90:10.

The reasoning behind this is all due to money, because in a group of 18, if 15 people cancel, you can still bill for 3 people, whereas in individual therapy if the client cancels, you're SOL.

This concerns me because so many of our clients NEED individual therapy and are going to be transitioned away from it.

It is my understanding that other Community Mental Health Centers around the country have had to do this, so I'm looking to hear from other people about your experiences in terms of how this has affected clients, group attendance rates, and your work environment...

 

[paramour]

Wait, so to make sure that I understand this correctly, you're required to offer more groups than individual services? 😕

I currently work at a CMHC, and we offer both services, but we certainly offer more individual than group. However, many of those individuals receive both individual and group services (in addition to psychiatric or other case management services). Clients here still get billed if they don't cancel ahead of time, so although it may be a "waste of your time," it's not like the facility is losing money. Obviously clients with insurance will have to pay out-of-pocket as insurance will not pay for those visits, so it leaves clients with some incentive to call ahead of time--and we never have a shortage of folks attempting to get in for a session, so there's usually someone to fill the slot (even with same day cancellations often).

EDIT: We also have some fairly strict rules for cancellations/no shows in addition to billing clients. If clients have two of these, then they're referred (and required to complete) a "motivational engagement" group prior to returning to their usual services (whether it be individual/group). If they do not complete the group, then a hold is placed on their account for 90 days and they are unable to receive services (except for emergency/crisis/walk-in services to be reviewed on an individual basis) until that point.