Psychotherapy Finances

The dentist as counselor? Perhaps, under a new program announced by Aetna.

With the help of iPad technology, Aetna plans to launch a pilot program in which dentists pursue smoking cessation goals with their patients.

“Through the new program, Aetna will promote tobacco counseling by dentists and will study the impact that a smoking cessation clinical decision support system (CDSS) has on a patient’s tobacco use,” the company said.

The ultimate aim is for dentists to provide “tobacco cessation instruction and intervention” in their offices.

Dentist David Albert, director of the Division of Community Health at the Columbia University College of Dental Medicine in New York City, will help develop the pilot program in the New York area.

Dentists and patients will use the iPad to help distribute medical advice, record patient data and offer advice specific to the individual.

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Physicians have pushed back–almost always successfully–against prescription privileges for psychologists. This year promises a new round of state legislation and more battles between groups of health care providers.

Now, a turf war has erupted in Florida between physicians and pharmacists, who want the right to administer vaccinations for shingles and pneumonia to seniors in their stores.

The arguments are familiar to anyone who has followed scope of practice legislation in the past. Pharmacists argue that having to go to a doctor’s office discourages patients from getting the vaccines.

“It’s a question of access,” says Sally West, director of government affairs for the Florida Retail Federation.

But physicians argue that pharmacists don’t have the medical necessary training.

Rebecca O’Hara, vice president of governmental affairs for the Florida Medical Association, responded: “We want to make sure that people are immunized, and we want to increase the rate of immunizations, but what we don’t want to do is put people unnecessarily in jeopardy.”

Licensed professional counselors who undergo a TRICARE credentialing process will soon be able to service beneficiaries of the federal program as independent practitioners.

Counselors are the last licensees among mental health professionals to qualify to treat TRICARE clients independently, says James Finley, director of public policy for the American Mental Health Counselors Association (AMHCA). Psychiatrists, psychologists, clinical social workers and marriage and family therapists already service the program independently.

Counselors have been treating clients from the armed services, and their family members, but only under the supervision of a physician.

That could end as early as this spring, when new administrative rules are generated by TRICARE spelling out specifically how counselors can become “Certified Mental Health Counselors.”

But perhaps the most important component of the new certification is already known. That is, a national certification exam that has been around for some time but is not a requirement for counselor licensure in all states.

“People in many states haven’t seen the exam before,” Finley says. “It’s going to be entirely new to them. And by the way, this is a very difficult test. Many clinicians aren’t going to pass it the first time.”

In addition, counselors will need to apply for credentialing through TRICARE and Finley expects this to involve “a fair amount of paperwork.” The government agency will have its own supervision requirements, for example, that may differ from a state requirement.

Approval for the new licensure was announced Dec. 27. Comments on the administrative rules pertaining to the designation are being accepted until Feb. 27. For its members, comments can be submitted through AMHCA, or they can be submitted directly by going to www.regulations.gov and following the instructions.

They can also be mailed to: Federal Docket Management System Office, 4800 Mark Center Drive, 2nd Floor, East Tower, Ste. 02G09, Alexandria, VA 22350-3100.

To access information about the certification test, go to: http://nbcc.org/OurCertifications.

Finley says he doesn’t know how many professional counselors will begin directly working with TRICARE clients. TRICARE reimbursement rates, he notes, “are not great. They’re about the same as Medicare. But it can be a significant part of a clinician’s business.

“We do know there’s a tremendous amount of PTSD in the TRICARE community, so the demand for services is going to go up a lot over the next decade or more.

“Clinicians should look at this as an area of growth. They’re going to be particularly interested depending on what kind of military presence is in their community. If the bases are there, the people are going to be there.”

CONTACT James Finley in Alexandria, VA at 800-326-2642, X-105 or at JFinley@amhca.org

- John Nelander, Contributing Editor

The U.S. stock market has been moving sideways and seemed stuck in a rut in the 4th quarter of 2011. But that may soon change, for managed care companies at least, as they continue to report end-of-quarter earnings, according to CNBC.

UnitedHealth, the parents company of United Behavioral Health, logged membership gains last year. But an analyst for Wells Fargo says both companies are poised to take maximum advantage of falling unemployment in 2012 and the Affordable Health Care Act.

“Aetna and UnitedHealth are attempting to become leaders in ‘accountable care organizations.’ They were part of Obama’s health-care reform — and the idea is for providers to form narrow networks and create shared systems offering lower-priced products and services,” says Peter Costa, Wells Fargo senior equity analyst.

The private health-care industry is “migrating toward these structures,” he says.

Costa also notes that “enrollment for insurers is a function of the employed market. The more people are employed, the more members are paying premiums for health insurers.”

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Binge eating disorder is back on the slate again for inclusion in the new DSM-5, due out early next year. It was discussed in the DSM-IV but didn’t make it as an official diagnosis.

Now, Psychiatric News reports that due to “an explosion of research” on the problem it’s being proposed for inclusion as a disorder. The definition: Recurrent eating of “an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances.”

Recommended treatments include cognitive behavioral therapy and antidepressants.

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More than half of psychiatrists earned between $175,000 and $300,000 in 2011, according to a survey released by Psychiatric Times.

Here’s the breakdown: 27.5% made between $175,000 and $200,000; 25.9% made between $200,000 and $300,000; 14.2% made between $150,000 and $175,000; 10.9% made less than $100,000; 7.4% made more than $300,000; and 7.1% each made between $100,000 and $125,000 and $125,000 and $150,000.

Psychiatrists’ incomes were basically flat compared to 2010.

The idea of bringing health care services direct to the public through corporate retail outlets has been percolating for the past several years. OptumHealth, for example, launched its NowClinic in fall, connecting nurses and physicians to Rite Aid pharmacy customers via visual Internet connection.

Walmart has been toying with the idea of building its own health care network that would be accessible at its stores throughout the country.

Now, Aetna is experimenting with a wellness program aimed at Best Buy shoppers. The managed care company is selling retail packages that will allow people to access a fitness program online. They sell for $19.99 and are a scaled-down version of Aetna’s “My Resources for Living Well” program.

The Living Well program goes beyond fitness though, and also ventures into smoking cessation, weight loss and stress management. View a demo of the product by clicking here.

The idea of targeting a population in the market primarily for electronics may seem odd. But Louise Murphy, head of Aetna’s behavioral health and EAP division, says: “Best Buy seemed a natural choice for trying out some of our well-being products with the general public.

“These online programs take the things you ‘should do’ and turn them into things you ‘will do.’ If you’re in Best Buy purchasing a pedometer or blood pressure cuff, you might also be interested in a program to help you achieve the health goals associated with that equipment.”

For now, the product is being sold in the Best Buy health technology department in three suburban Chicago stores. The department itself is an experiment for the retailer. It’s a small 1,200 square-foot area in which the company is selling technology-based equipment to support fitness and nutritional goals.

Click here to get an idea of some of the health-related gadgets on the shelves at Best Buy.

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Magellan Health Services is still soliciting applications for its California network in order to accommodate its behavioral health and EAP contract for 1.9 million Blue Shield of California customers. The contract kicked in Jan. 1.

To apply, you can fill out the provider specialty form online by clicking here. If you have questions, call 1-800-430-0535 Option #4; or email Magellan at CaliforniaProvider@MagellanHealth.com.

- John Nelander, Contributing Editor

Seems like there’s an iPhone App or an Android App for practically anything these days. But can you use one of them to find a therapist?

It turns out that yes, United Behavioral Health has designed an app for the Android that will allow users to tap the GPS function on their phone to find a clinician, and even select the type of clinician they’d like to see.

The app displays the therapist’s name and contact information, their areas of expertise, and licensure. The user can then click on the phone to dial the practitioner’s number, and also see a map with directions to the office.

The Android App was released on Dec. 8 and an iPhone App will follow in early 2012. UBH is offering it through an arm of its business called liveandworkwell.com. Liveandworkwell bills itself as offering “confidential resources for mental health and life’s changes.”

The public can download the app at the UBH site or at the Android site.

Android Apps can be downloaded for a few dollars, although some of them are free. The most popular health-related apps are for calorie counting and cardio-fitness. But there are also mental health assessment apps, including this one available for 99 cents. It evaluates the user for signs of clinical depression, phobias, post traumatic stress disorder and panic attacks.

See the full mental health application list here. Click here for a listing of mental health apps consumers are downloading for the iPhone.

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Physicians are going broke, CNN says. Marc Lion, a private practice financial advisor, told the network this week: “A lot of independent practices are starting to see serious financial issues.”

The problem, according to CNN, is declining insurance reimbursements, the constant battle to keep up with changing regulations, and the genearl high cost of doing business.

Cardiologist William Pentz, who has a private practice in Philadelphia, said he and his business partners tapped into their personal assets to make payroll last year. “Many of us are also skimping on our own pay,” he said.

- John Nelander, Contributing Editor

In the budget cutting fervor that has gripped the U.S., what exactly is the toll on mental health? About $1.6 billion, according to the National Alliance on Mental Illness (NAMI). The NAMI report covers the fiscal years 2009 to 2012.

States with the heftiest cuts are South Carolina (39.3%); Alabama (36%); Alaska (32.6%); Illinois (31.7%); Nevada (28.1%); the District of Columbia, 23.9%); California, 21.2%); Idaho (17.9%); Kansas (12.4%); and Mississippi (10.4%)

“People with life-threatening mental illness are being abandoned,” said Mike Fitzpatrick, NAMI executive director.

As a result of Medicaid and state cuts for mental health services, more patients are turning to emergency rooms for care, a report earlier this year by National Public Radio said. Perhaps most surprising: Ten percent of Emergency room administrators said they had boarded patients for a week or more.

The real crunch may come in 2014, when the federal government mandates massive expansion of state Medicaid programs in connection with the Affordable Health Care Act. About 32 million Americans are expected to be added to Medicaid roles, according to Katherine Nordal, executive director of the Practice Directorate at the American Psychological Association.

With Medicaid budgets getting slashed, and more people added to the rolls at the same time, the president and new Congress will have tough decisions to make after the 2012 elections.

Still, the APA is encouraging clinical psychologists to make themselves available for Medicaid work, Nordal said in a recent interview. Read the complete interview with Nordal, on Medicaid, Medicare and other topics, in an upcoming issue of Psychotherapy Finances.

- John Nelander, Contributing Editor

It’s not surprising that the need for substance abuse services varies by city and region. But a new report by the Substance Abuse and Mental Health Services Administration (SAMHSA) shows just how widespread these differences are.

SAMHSA’s Drug Abuse Warning Network took a look at hospital emergency room visits for illegal drug use in 11 metropolitan areas around the country. They covered Boston, Chicago, Denver, Detroit, Miami/ Fort Lauderdale, Minneapolis, New York, Phoenix, San Francisco and Seattle.

The rate of emergency room use is an indication of how often signs of drug abuse are missed by health care professionals, as well as friends and family members, the federal agency says.

“When friends, family members and health professionals miss the signs and symptoms of substance abuse the results can be devastating,” said SAMHSA Administrator Pamela S. Hyde. “One consequence is the costly and inefficient use of emergency rooms as a first step to treatment. Substance abuse prevention and early intervention can keep people off drugs in the first place and clear the path to healthier lifestyles.”

Boston is the city with the highest rate of illegal drug-related ER visits, with 571 per 100,000 population. It’s followed by New York City (555); Chicago (507) and Detroit (462).

The national rate is 69 per 100,000. The survey was based on statistics from 2009, during which there were 973,591 visits to emergency rooms throughout the country.

For the complete report, click here.

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Congress approved a last-minute bill to temporarily avert a scheduled Medicare reimbursement cut on Friday, Dec. 23. President Obama was expected to sign the legislation, which gives lawmakers two more months to deliver a long-term solution during a contentious election year.

The 27.5% reduction would go into effect March 1 if no agreement is hammered out. Click here for links to stories in the New York Times, Washington Post and Wall Street Journal.

The bill has no effect on a scheduled 2% reimbursement cut slated for 2013 due to the failure of the Super Committee to come up with an alternative budget slashing plan.

- John Nelander, Contributing Editor

Treatment guidelines are being developed for depression and obesity by the American Psychological Association as the first step in a far-reaching plan to create evidence-based recommendations on how to treat a wide range of mental health disorders.

The project was approved last year by the APA Council of Representatives. A steering committee in charge of the process decided to tackle depressive disorders and obesity first, according to the December issue of the Monitor on Psychology.

The organization was already offering practice guidelines that containing treatment “tips,” the magazine said. But the treatment guidelines will incorporate research and make specific recommendations on how to deal with specific disorders.

“No individual client who comes into a psychologist’s office exactly matches the average patient who has participated in a particular study, so there’s always room for the clinician’s judgment,” Howard Kurtzman, deputy executive director for science in APA’s Science Directorate, told the Monitor. “We just want to inform the clinician about the best and most current research.”

The APA said it made the decision because the Affordable Health Care Act, which goes into effect in 2014, emphasizes the ability to compare methods of treatment. As a result, other professional organizations are preparing treatment guidelines as well.

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First it was a communication sent via your mailbox; then it was email. Now, ValueOptions is blasting news about training, credentialing and other events via its members’ cell phones.

It’s a newly launched program called Provider Pulse. Therapists in the ValueOptions network have begun getting “automated telephonic messages” announcing company news and upcoming events.

For example, a recent message was recently broadcast about the implications of the new parity law, according to the company December newsletter, The Valued Provider.

The company plans to continue the practice at least through 2012.

- John Nelander, Contributing Editor

Republicans are signing on to a 2012 “doc fix” for Medicare providers as part of a plan to extend a payroll tax holiday, but the deal remains shaky, according to the Los Angeles Times.

The tax holiday is a priority for Democrats, but House Republicans have loaded their bill with other provisions the opposition is sure to find objectionable, including a reduction in longterm unemployment benefits and a plan to build an oil pipeline from Canada to the Gulf of Mexico. The proposal has triggered White House environmental concerns.

The House adjourns for the Christmas holiday next Friday, so this is Congess’ last chance to get something done on the doc fix this year. Without it, Medicare providers — including psychologists and clinical social workers — face a 27.4% reimbursement cut scheduled to go into effect Jan. 1.

The doc fix is back on the table every year since cuts automatically take place without congressional action. But so far, Congress has always stepped in to reverse the reductions, even after they’ve gone into effect.

Several retroactive fixes have taken place in recent years, including 2010 when the fix wasn’t approved until June. But as a Kaiser Health News capitol reporter noted, that can create an administrative nightmare for providers.

“The Centers for Medicare and Medicaid Services has provided guidance to physicians saying, ‘Hey, hold your bills before you submit them – Congress is very close to making a fix,’” said Mary Agnes Carey. http://www.kaiserhealthnews.org/Stories/2011/December/06/120611-health-on-the-hill.aspx?p=1

“That kind of solution, as you can imagine, is not too popular with physicians. It creates paperwork headaches. It creates instability for them. They would much prefer to get it done before it expires at the end of the year.”

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The National Association of Social Workers (NASW) is promoting doctorate degrees for masters-level social workers, including LCSWs. Although 30% of DSWs work in academic settings, the organization suggests that a doctorate or PhD will expand a clinician’s referral base.

“On average, social workers with a DSW/PhD earn $17,000 more in annual base pay than those without the degree,” the organization says in its December 2011 newsletter, Leadership Ladder.

The unemployment rate in the U.S. has taken a major toll on men when it comes to health insurance, according to a new paper released by the National Bureau of Economic Research (NBER).

The impact is most significant on white, college-educated men between the ages of 50 and 64, researchers discovered.

They found that for every 1 percentage point increase in unemployment, 1.67% fewer men in this category had health coverage. The correlation did not hold true for women and children.

However, for every 1 point increase in the jobless rate, the number of children in public health programs increases 4.69%.

“We estimate that 9.3 million adult Americans, the vast majority of whom were men, lost health insurance due to a higher unemployment rate along during the 2007-09 recession,” wrote the authors, John Cawley, Asako Moriya, and Kolsai Simon. “This is roughly nine times more than lost health insurance during the previous (2001) recession.”

The NBER is a private, nonprofit nonpartisan organization that studies the impact of economic issues on American society.

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Employment Assistance Programs (EAP) are expecting a flood of calls relating to eldercare problems, a report by the Chicago-based EAP specialist company ComPsych says.

The reason: The holidays are the time of the year when children and other family members are most likely to call or visit elderly relatives and friends. They may be surprised at what they find.

ComPsych is anticipating an 18% increase in these types of calls from worried employees as the holidays approach.

“People can be surprised and upset by how their parent’s or elder relative’s situation has deteriorated since they saw them last,” said Richard Chaifetz, ComPsych CEO. “This can include worsening health, mobility and cognitive problems.”

He suggests employers take the time to remind their workers about work-life resources for eldercare issues before employees make their holiday trips.

- John Nelander, Contributing Editor