Therapists Explore Dropping Solo Practices to Join Groups

Excerpted from “Therapists Explore Dropping Solo Practices to Join Groups,” Shots: Health News from NPR. October 24, 2013 -- In the corporate world of American healthcare, psychologists and other mental health therapists are still mostly mom-and-pop shops. But the business model for therapists is shifting away from solo practices and toward large medical groups, say mental health experts. That change is propelled by the Affordable Care Act, which mandates mental health benefits in insurance coverage, and by the Mental Health Parity Law, which requires private and public insurers to cover mental health needs at the same level as medical conditions — by charging similar copays, for example.

Organizations that advocate for mental and behavioral health — groups that long complained that they were treated as second-class providers — have applauded the federal laws. But inclusion has come with some unhappy caveats, including less pay and more paperwork. Patients used to paying $150 in cash for a therapy session will, with some limitations, have sessions covered by their health plan. That means many therapists will have to figure out innumerable insurance plans and byzantine billing codes for the first time.

In many ways, therapists are encountering what medical doctors have complained about for years: the confusing, confounding and, some might say, hostile insurance bureaucracy that providers must tangle with in order to get paid. The increasing complexity of running a practice has meant more therapists are taking down their shingles or forming groups with other therapists to share the burden, executives at national mental health groups say. Others have joined large medical groups that offer mental health services as part of comprehensive care.

Commentary

CMDA Member and Psychiatrist Robert Rogan, DO, JD: “This article touches on several current issues in mental health affecting our society. One, the loss of autonomy, may be far more serious than we realize. The freedom to serve as we in conscience believe best is something we need as believing practitioners. Conscience issues are already prominent in current medical practice in general. If we can’t ‘choose our clients,’ we may find ourselves being asked to provide therapy in an area we find morally uncomfortable.

“People do seek mental health services and pay ‘out of pocket’ not just for insurance reasons but also for privacy. The HIPAA regulations with compliance that began on September 23, 2013 seem to reflect this possibility.

“Paperwork issues are not just documentation chores but very concerning potential legal traps. Billing is serious business for more than just reimbursement reasons. We need to be truthful but careful in what we write. Also, we need to be ultra-careful what we sign. We need to know every pitfall in contracts we sign. If there is legal terminology you don’t know, look it up or get legal counsel. A subtle term like ‘hold harmless,’ now in very common use, can be the entrance to a professional minefield.

“On the other side, solo practice can have physical dangers with our changing patient demographics. Group practice can provide more collegiality as ‘iron sharpens iron.’ We can be of great use in practices where mental health service is needed by other non-mental health practitioners.”

Resources
Healthcare Right of Conscience Ethic Statement
Augustine College at CMDA CD Set