Health Care Reform Propels Shift in Mental Health Business Model

[comicartfans.com]

By now, many patients may have noticed a change in their doctors' offices. Perhaps you've been asked to sign new confidentiality agreements, or maybe your doctor moved into a larger office with more providers. The phenomenon of large provider groups gobbling up small health care provider practices has arrived, and it's having an especially significant effect on mental health providers. 

Psychiatrists and psychologists are feeling a loss of autonomy, as their patients and schedules are now being chosen and managed by larger institutions.  In some cases, these providers are also taking significant cuts to their paychecks.  Blue Shield of California, for instance, recently asked psychologists on their plans to accept anywhere from a 10- to 30- perfect discount for patients who will buy health plans through Covered California. (Kaiser Health News, 10/24/13.)

As more and more patients expect their mental health care to be covered by insurance, there may soon be a trend away from smaller practices who may not accept as many insurance plans. As patients

But the shift from solo/small practices toward large medical groups isn't all bad, especially not for patients. 

For patients, it may mean lower prices, especially when for mental health services. Where as patients might have paid $150 out of pocket for a therapy session, those same sessions may now be covered by insurance via the 2008 mental health parity law.  Mental health parity requires private and public insurers to cover mental health needs, if at all, just as they do physical health conditions, such as similar co-pays for for physical and mental health services.

In addition, quality of care has great potential to increase as a result of this shift. For example, mental health providers are becoming increasingly integrated into multidisciplinary practice and health clinics.  When a psychologist or psychiatric nurse practitioner sits alongside internists and pediatricians, a more holistic approach to patient care develops that can cut back on unnecessary tests and treatments, potentially saving money for institutions, as well as patients.

Integrated Healthcare Means Better Healthcare

"Half the state's adults and two-thirds of adolescents with mental illness aren't getting treatment. But new research finds that the disabled and poor could get comprehensive care," according to a new California HealthCare Foundation study.  

The reason is that private insurance has historically lacked mental health coverage.  This has forced patients to seek mental health care via the public system.  In California alone, over $7.8 billion in public funds was spent on mental health care in fiscal year 2012-2013. $3.3 billion of that paid for Medi-Cal beneficiaries.

The ACA is expected to close some of the gaps in mental health services by improving access to many more people.  In California specifically, the law will expand who is eligible for Medi-Cal (coverage for poor and disabled residents), enabling them to receive comprehensive mental health services.  Additionally, individuals purchasing health insurance on Covered California will now have access to mental health care.

Healthcare Reform also encourages integration between mental health and physical health care, says Neal Adams, deputy director of the California Institute for Mental Health.  This is the practice where physicians and mental health doctors coordinate the care of their patients by keeping one another informed about all aspects of the patient's health in order to provide the most comprehensive care.  The goal is for doctors who see a patient for a physical check-up will also be aware of and screen for mental health status in order to coordinate care with a mental health specialist if necessary.

For interactive maps of mental health coverage in California compared to poverty levels, see Mapping the Gaps: Mental Health in California.

Privacy vs. Gun Control, the Debate Continues

Just when we thought the HIPAA Final Rule was, well, "final," HHS may be making additional changes less than seven months since the behemoth Final Rule was published in January 2013.

Since December, President Obama has called for the creation of the National Instant Background Check System, or NICS - a database to be used by gun dealers to determine whether a potential gun buyer is prohibited from purchasing a gun.

The database only works, however, if states volunteer lists of residents who are not allowed by guns because of, among other reasons, they have been involuntarily committed to a mental hospital, or a court has found them to have a serious mental illness. Currently many states do not participate, so the Obama administration is seeking to change part of HIPAA to require state reporting.

Although HHS has not yet released a proposed outline for this rule change, they have received over 2,000 comment letters from gun advocates and mental health professionals, alike. While gun advocates fight for the constitutional rights of gun owners, mental health professionals worry that this new HIPAA modification would compound the stigma of mental illness and could discourage those patients from seeking treatment.

However, even with an expanded database, the gunshow loophole remains.  As many as 40% of firearms ar purchased at such venues where the NICS system is not required.  Mark Heyrman, mental health professor at the University of Chicago noted that adding more records to the ineffective database will only hurt people's privacy without improving safety.

The move toward an expansion of the database falls on the heels of the government's collection of of citizens' phone and internet data in the national headlines, creating worry that this database may one day go public.