obamacare

[Yoyomama88]

Psych reimbursements will now be covered at a level similar to primary care visits?

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[Shikima]

HHS just released a statement citing that all insurance companies will reimburse at the same rate as our medicine counterparts.

 

[SuperSoccer19]

This is going to sound very ignorant, but I am not currently working in a position where I have to deal with insurance. What does this really mean?

 

[Shikima]

My understanding.

Historical context was that MH reimbursements were in the 63-68% range in comparison to our medicine colleagues who would receive about 72-74% reimbursement mark. My numbers could be wrong, but you can google it. Well documented.

 

[FrasierMD]

Part of the battle in combatting stigma of mental illness includes battling the stigma associated with our field as a medical specialty. I cant help but think the disparity in reimbursement was related to this (at least historically). The HHS ruling is a hugely positive moment for the field.

 

[Shikima]

Very positive! But.... who knows what changes will occur and how reimbursements in the future will be affected overall by ACA and insurer's interpretations.

 

[SuperSoccer19]

cool--thanks! makes sense

 

[whopper]

Agree with Shikima. Anyone with some experience with government reimbursement knows they aren't exactly the easiest people to deal with and for all I know, getting reimbursed by them under the ACA could end up being a big pain in butt. It looks good on paper, what happens in reality could be very different. I'd advise people to hold their breath for now as to how the ACA will work out. It could be good, it could be bad.

 

[Shikima]

I too am worried about future reimbursements under ACA... I'm not very hopeful.

 

[Shikima]

.

 

[trophyhusband]

Agree with Shikima. Anyone with some experience with government reimbursement knows they aren't exactly the easiest people to deal with and for all I know, getting reimbursed by them under the ACA could end up being a big pain in butt. It looks good on paper, what happens in reality could be very different. I'd advise people to hold their breath for now as to how the ACA will work out. It could be good, it could be bad.

So I feel like I need to speak up here since people don't seem to understand this or the ACA very well. You will not be getting reimbursed by the government under the ACA (ignoring Medicaid expansion). The ACA plans are run by private insurers and provider payments will be coming from them and not the government.

In regard to the OP, insurers are supposed to now start covering psych at the same level as all other medical services. My understanding is that the Feds won't really be enforcing anything in this regard and it's more up to the individual state insurance commissioners to enforce this new rule. So if your particular state's insurance commissioner is not proactive in regulating insurers who knows if they'll comply. I'm sure there will be some lawsuits that help move enforcement along but it could take awhile.

And as these HHS rules tend to go the Feds have excluded themselves from the requirements (so Medicare and Medicaid aren't subject to the rule).

That's my understanding anyway.

 

[Shikima]

Because rates are going up and services expected to be covered, I'm not too terribly positive that current rate will improve.

 

[vistaril]

Because rates are going up and services expected to be covered, I'm not too terribly positive that current rate will improve.

ACA will be bad for us because it will be more complex. There will be a greater number of plans present in any area, and a greater number of options within those plans present. Right now if a market has 50% bcbs, 25% humana, 20% aetna(just to make up examples) and 5% everything else, it's pretty easy for outpt practices to decide what they will and will not do in terms of the contracts. It's possible to manage and keep track of in other words. But if that insurance pie is broken up into many different tiny slices.......well, that's going to be a hassle.

 

[whopper]

Not trying to get political, but it's possible the ACA may even be struck down. I find it unlikely and several weeks ago I'd say it was on the order of not worth consideration (1 in a million); now I'm seeing it as an unlikely possibility (around 5%) but not able to be ruled out.

The government has done a poor job (being diplomatic) on an enacting the ACA and it already had several in this country already defiantly against it. If that darned website doesn't get working, one could create an argument that'd have merit that it's unfair/unconstitutional to fine someone for not having health insurance when the method to get it doesn't even work. That could fuel even more resentment and garner enough independent and Democrat votes to repeal the law.

The point is not to be political, but that like a predator waiting to jump on the prey, if one is considering private practice, you're better off having an understanding of the landscape you're dealing with. You could wait to see how the ACA pans out, but it might be repealed. If repealed, the landscape will change again.

 

[hamstergang]

ACA won't be repealed. It wouldn't be found unconstitutional because all they'd have to do is push back the deadline or wave fines for a while and then it would all work as expected.

 

[whopper]

A law can be repealed through methods other than being found unconstitutional. The executive branch could write a new law nullifying it. Again, I find it highly doubtful that it'd happen but if the momentum continues against it, I wouldn't consider it unthinkable.

 

[Shikima]

The problem right now is the lack of quality care in order to sacrifice for numbers, and in return, the reimbursement. 15 min med checks with 45 min intakes is borderline distasteful. You can't even click the boxes fast enough on the screen, get the scripts either printed or e-faxed, out the door and then the next into the office.

Nevermind if you have a complicated case.....

 

[OldPsychDoc]

Article with a few key facts.

I find it especially interesting that the Kaiser Foundation estimates that there are already only enough psychiatrists to meet the needs of 53% of those needing mental health services.

 

[Shikima]

And it's only going to get worse with the numbers.

 

[whopper]

TrophyHusband-You were right in mentioned that the ACA doesn't deal with direct reimbursement, but the more general point was that the government isn't reliable in a lot of regards, specifcally in making sure they pay their end with medical providers.

And it's only going to get worse with the numbers.

If the ACA does what it's supposed to do, that is get more people healthcare, there will still not be enough psychiatrists to meet the demand. The demand has always been there.

 

[Shikima]

I am not hopeful.