where's the disconnect?

[bajaba]

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http://online.wsj.com/news/articles/SB10001424052702304281004579218204163263142

I don't get it. They need more psychologists/psychiatrists... so why is it so difficult to get an internship and a good-paying job afterwards?

 

[woodstock219]

I agree with United's analysis of the situation. It's been my experience that we have plenty of licensed or license-eligible (being supervised) clinicians working in the field, but that the convoluted reimbursement systems for insurance are hindering access to services. A great many insurance companies are still viewing mental health treatment as an optional support, one which does not have a quantifiable outcome in the same way that physical health treatment typically does and as such is not worth supporting. While I will not say I'd go so far as to point to Medicare/Medicaid as optimal models of mental health support/reimbursement, I would say that they are about the only organizations that have taken the approach that treatment of mental illnesses, developmental disorders, and the like is a necessity for the well-being of an individual and responded accordingly.

In a broader context, I feel that this is simply a symptom of a more complex societal issue rooted in the belief that having a "mental illness" or "developmental disability" is seen as either a mark of shame or a means of providing an excuse for adverse/irresponsible behavior. I've never seen a person in my life be told that because an individual is unable to work due to his cancer that he/she's a failure as a person or that when a child breaks his/her leg they are simply finding a lazy way of avoiding PE, but such rationalizations are frequently used in the context of mental disorders/illnesses. As a result, we have many people not seeking out services because they are afraid of being outcasts, as well as an insurance and social climate which says "we shouldn't be paying to support the treatment of weak and immoral people."

(my apologies on going somewhat off course with the social context piece, but I believe it's an important component in why these issues are occurring)

 

[WisNeuro]

Yeah, this is not a supply problem. More than enough mental health professionals to go around (at least with psychologists, there actually may be a shortage of prescribing providers). Get insurance companies to actually cover mental health instead of denying any and all claims under the sun and maybe it'll get better.

 

[bcliff]

In my state, psychological testing is reimbursed by medicaid at roughly 30% of our out-of-pocket rate. To my knowledge, our office is one of the only (if not the only) psychological clinics that still accepts medicaid within a 100 mile radius. We have pages upon pages of patients and families (medicaid/private insurance - but all require preauthorization for testing) waiting to come in for an initial consult for a psychological evaluation.

IMO reimbursement needs to improve (which seems unlikely), and a more streamlined process for verifying benefits/eligibility and securing preauthorization and filing claims should be developed (also seems unlikely). It's hard to expect a provider to see a patient for a third of what they would typically charge and also expect them to complete hours of unbillable insurance work, when they have an alternative (i.e. predominantly cash only services like educational testing, forensic testing, & presurgical evaluations, etc.) that pays significantly more. RxP seems like a viable alternative for some psychologists, but with only two states and the DoD allowing it, it doesn't apply to the majority of providers.

Roughly for every psychological assessment one of our clinicians administers, I would estimate that there is roughly 60 - 90 minutes of work that needs to be done with the pt's insurance (verification, preauthorization, claims, etc.). Some cases that are more complicated (i.e. 2+ insurance policies, divorced parents, etc.) can take much longer than that to coordinate.

 

[DynamicDidactic]

Can't read the article, pay wall.

But there is a definite dearth of prescribers for psychotropic medication, almost everywhere in the states (big cities to rural communities). This dearth is in response to the managed health care system refusal to appropriately reimburse other forms of mental health care (also, pill popping is much simpler and faster than therapy). Why? Because its expensive, requires more manpower, and is highly varied in treatment course among practitioners. This will not change anytime soon unless something in the field changes. Unfortunately, expense and manpower (there is only so many people a single practitioner could see) are probably not going to change. However, consistent and reliable treatment (even if not more effective, cause medication is not) is something that could change. So, until a patient stops getting 10 different kinds of treatment from 10 different types of practitioners not much will change. I think we need consistent and reliable interventions across mental health settings, but that is just my opinion.

 

[Therapist4Chnge]

Agreed with most of what has been said. There are probably enough providers for most things (e.g. generalist practice), but a growing % of those people are unwilling to accept the shrinking reimbursements being offered by insurance companies. Some of the rates are downright pathetic. The system rewards administrators (e.g. paper pushers) and punishes the providers. The consumer/patient is stuck with whatever they are given. If/When I leave the public sector I'm foregoing all insurance, as it just isn't worth the hassle. I have a billing company and an admin to handle the paperwork and it *still* wastes hours a week for me.

 

[WisNeuro]

Can't read the article, pay wall.

But there is a definite dearth of prescribers for psychotropic medication, almost everywhere in the states (big cities to rural communities). This dearth is in response to the managed health care system refusal to appropriately reimburse other forms of mental health care (also, pill popping is much simpler and faster than therapy). Why? Because its expensive, requires more manpower, and is highly varied in treatment course among practitioners. This will not change anytime soon unless something in the field changes. Unfortunately, expense and manpower (there is only so many people a single practitioner could see) are probably not going to change. However, consistent and reliable treatment (even if not more effective, cause medication is not) is something that could change. So, until a patient stops getting 10 different kinds of treatment from 10 different types of practitioners not much will change. I think we need consistent and reliable interventions across mental health settings, but that is just my opinion.

Actually, when you look at time-limited EBT's, they are cheaper than years of medication management.

 

[DynamicDidactic]

Actually, when you look at time-limited EBT's, they are cheaper than years of medication management.

that's great. I wish we were able to move the field into that direction faster.