Docsplainin' -- it's what I do

Docsplainin'--it's what I do.
After all, I'm a doc, aren't I?

Friday, August 15, 2008

Managed Care is Killing Me

The economy is going into free-fall. The cost of consumer goods is up 5.6% this year, the worst it's been in 17 years. Tax collections in our state are down by more than 6%. Population growth has slowed in the 10-county Metro area. Home values are plummeting in the midst of rising foreclosures. Our state's jobless rate is at a 15-year high and expected to get worse. Everywhere you look there's more bad news.

In the meantime, what insurance will pay for our services has remained stagnant--or declined. Psychologists are probably the only professional group that has lost ground in the last few decades. Managed care is killing us.

One way in which it is doing so is by adding significantly to the paperwork/case management burden that we face. Just one small example is this fax memo I received from one company:
  • Wellness Assessments are to be completed in your office at the time of the initial evaluation and faxed to [insurance company]
  • A second Wellness Assessment is to be completed in your office during the 3rd, 4th, or 5th session and faxed to [insurance company]
  • A set of algorithms are applied to all Wellness Assessments designed to identify potential clinical risk
    • Some potential risks yield a letter that requires you to determine whether the identified concern has been fully assessed and, if applicable, addressed in the treatment plan. It is strongly recommended that you file the letter and document that the risk is being addressed in treatment or has been ruled out in the course of assessment/treatment
    • Potential risks that yield a Care Advocate outreach call require you to complete a brief clinical review
For members who have seen you in the past and return to treatment, representing a new episode of care, the Wellness Assessment should be completed even if the member completed Wellness Assessments during a previous treatment episode.

During the first two quarters of this new initiative, you have seen between one and five new referrals. In all or most cases, a Wellness Assessment was not sent. Please review these requirements to support your implementation of this process.

This is a level of supervision which I have not received since I was in grad school. Let me just say that I don't need an insurance company computer to tell me when a client is at risk or a Care Advocate to tell me--after the fact--what to do about it!

A Wellness Assessment, by the way, asks some very intrusive questions of the client:
  • In the past month have you felt you ought to cut down on your drinking/drug use?
  • In the past month have you felt annoyed by people criticizing your drinking/drug use?
  • In the past month have you felt bad or guilty about your drinking/drug use?
  • In the past week, approximately how many drinks of alcohol did you have?
This is protected information that is now going to be faxed to... who? A clerk? I certainly don't know. And besides running algorithms on it, what will they do with this information? It's not anonymous: It asks for complete identifying information at the top.

These are actually useful questions, as are the others on this sheet, but they are also questions that competent therapists routinely ask. Why we should have to ask them twice and fax them in for someone to second-guess us (we are, after all, fully licensed to practice psychology independently) is beyond me. Besides which, all this c**p takes time I could be spending with the patient! Actually helping them with these problems!!

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