Sunday, October 2, 2011
Monday, August 1, 2011
Be Outraged . . Very Outraged
I just read this. I thought my poor, noninsured clients had it bad!
Access to Urgent Psychiatric Care Severely Limited
Even Patients With 'Excellent' Private Insurance Left Out in the Cold
By Fran Lowry
July 25, 2011 — A preliminary study has confirmed the authors' worst suspicions — that access to outpatient psychiatric care, even for privately insured patients who have been referred by emergency departments, is severely limited.
The study, available online, is also to be published as a letter to the editor in the August print edition of Annals of Emergency Medicine.
"As Massachusetts clinicians caring for patients with mental illness, we experience frequent difficulties obtaining psychiatric care for our patients," write J. Wesley Boyd, MD, PhD, from Cambridge Health Alliance and Children's Hospital Boston, Massachusetts, and colleagues. "But how bad are things really?"
To find out, Dr. Boyd and his team posed as patients insured by Blue Cross Blue Shield of Massachusetts PPO, the largest insurer in Massachusetts. They called every in-network mental health facility within a 10-mile radius of downtown Boston, claiming that they had been evaluated in an emergency department for depression and then discharged with instructions to get a psychiatric appointment within 2 weeks.
Only 8 of the 64 facilities listed by Blue Cross as preferred providers offered appointments, and of these, just 4 offered an appointment within the recommended 2-week time frame.
Twenty-three percent of the facilities never even bothered to call back, despite 2 telephone calls from the supposedly depressed patients.
Another common reason appointments were unavailable was that 23% of psychiatric providers required that the patient already be enrolled with a primary care physician affiliated with their psychiatric facility.
Money Loser
"We didn't think it would go too well, but we were really surprised at just how bad it was," Dr. Boyd told Medscape Medical News. "Given that we used what we thought was a very good private insurance, one that didn't require prior authorization, to be able to get only 8 appointments out of 64 and only 4 appointments within 2 weeks, it was pretty sad."
Dr. Boyd said that psychiatry is a money loser for institutions, and as a result, facilities do all they can to limit the amount of psychiatry services they offer.
"That's why they put in all these stipulations, like you can only be seen here if you have a primary care doctor within our system. If you're getting a titanium hip replacement, have you ever heard of there being a requirement that you must have your primary care doctor at the same facility where that surgeon is operating? No, because it's a huge money maker. They'll fly you in from out of state to get a titanium hip replacement," he said.
One step toward improving this situation would be to improve reimbursement for people who provide psychiatric services.
"I think one measure of the humanity of a society is how well it takes care of its most needy, and psychiatric patients often cannot advocate for themselves. They have gotten a short shrift. Managed care has hit psychiatry harder than any other discipline in medicine," he said.
Dr. Boyd also noted that separating psychiatric coverage from most insurance plans is another factor making it difficult for people to access care.
"We want to highlight the problem and alert people in hopes that psychiatry as a discipline will become better respected and therefore reimbursed better, which will open up access. The other message we want to stress is merely having insurance is no guarantee that you are going to have access to services," he said.
Shortage Specialty
Commenting on the study for Medscape Medical News, Carolyn B. Robinowitz, MD, a psychiatrist in private practice in Washington, DC, and a former president of the American Psychiatric Association, said the study highlights the lack of availability of psychiatric services in general.
"The article shows that we are a shortage specialty. There aren't enough of us, and we have to do some things to improve our accessibility and availability," she said.
"These numbers are disconcerting," Dr. Robinowitz agreed. "As these ACOs [accountable care organizations] and other systems are developed, the challenge is going to be try to use mental health providers, psychiatrists, social workers, and psychologists to work together so that the solo practitioner seeing patients is not quite so isolated," she added.
Dr. Robinowitz also said that currently there is no system in place in the United States for urgent care.
"This lack of a system probably feeds into the lack of availability. So it is probably a combination of economics, or poor reimbursement for psychiatric care, as well as a system problem.”
Dr. Boyd and Dr. Robinowitz have disclosed no relevant financial relationships.
Ann Emerg Med. Published online July 21, 2011. Text
Medscape Medical News © 2011 WebMD, LLC
Send comments and news tips to news@medscape.net.
(Oh, for those keeping track, Torchwood still sucks, as of Friday's episode. But if you are so inclined, the BBC published three new radio plays all stories pre-Children of Earth. You can find them in the "song" section of iTunes.)
Access to Urgent Psychiatric Care Severely Limited
Even Patients With 'Excellent' Private Insurance Left Out in the Cold
By Fran Lowry
July 25, 2011 — A preliminary study has confirmed the authors' worst suspicions — that access to outpatient psychiatric care, even for privately insured patients who have been referred by emergency departments, is severely limited.
The study, available online, is also to be published as a letter to the editor in the August print edition of Annals of Emergency Medicine.
"As Massachusetts clinicians caring for patients with mental illness, we experience frequent difficulties obtaining psychiatric care for our patients," write J. Wesley Boyd, MD, PhD, from Cambridge Health Alliance and Children's Hospital Boston, Massachusetts, and colleagues. "But how bad are things really?"
To find out, Dr. Boyd and his team posed as patients insured by Blue Cross Blue Shield of Massachusetts PPO, the largest insurer in Massachusetts. They called every in-network mental health facility within a 10-mile radius of downtown Boston, claiming that they had been evaluated in an emergency department for depression and then discharged with instructions to get a psychiatric appointment within 2 weeks.
Only 8 of the 64 facilities listed by Blue Cross as preferred providers offered appointments, and of these, just 4 offered an appointment within the recommended 2-week time frame.
Twenty-three percent of the facilities never even bothered to call back, despite 2 telephone calls from the supposedly depressed patients.
Another common reason appointments were unavailable was that 23% of psychiatric providers required that the patient already be enrolled with a primary care physician affiliated with their psychiatric facility.
Money Loser
"We didn't think it would go too well, but we were really surprised at just how bad it was," Dr. Boyd told Medscape Medical News. "Given that we used what we thought was a very good private insurance, one that didn't require prior authorization, to be able to get only 8 appointments out of 64 and only 4 appointments within 2 weeks, it was pretty sad."
Dr. Boyd said that psychiatry is a money loser for institutions, and as a result, facilities do all they can to limit the amount of psychiatry services they offer.
"That's why they put in all these stipulations, like you can only be seen here if you have a primary care doctor within our system. If you're getting a titanium hip replacement, have you ever heard of there being a requirement that you must have your primary care doctor at the same facility where that surgeon is operating? No, because it's a huge money maker. They'll fly you in from out of state to get a titanium hip replacement," he said.
One step toward improving this situation would be to improve reimbursement for people who provide psychiatric services.
"I think one measure of the humanity of a society is how well it takes care of its most needy, and psychiatric patients often cannot advocate for themselves. They have gotten a short shrift. Managed care has hit psychiatry harder than any other discipline in medicine," he said.
Dr. Boyd also noted that separating psychiatric coverage from most insurance plans is another factor making it difficult for people to access care.
"We want to highlight the problem and alert people in hopes that psychiatry as a discipline will become better respected and therefore reimbursed better, which will open up access. The other message we want to stress is merely having insurance is no guarantee that you are going to have access to services," he said.
Shortage Specialty
Commenting on the study for Medscape Medical News, Carolyn B. Robinowitz, MD, a psychiatrist in private practice in Washington, DC, and a former president of the American Psychiatric Association, said the study highlights the lack of availability of psychiatric services in general.
"The article shows that we are a shortage specialty. There aren't enough of us, and we have to do some things to improve our accessibility and availability," she said.
"These numbers are disconcerting," Dr. Robinowitz agreed. "As these ACOs [accountable care organizations] and other systems are developed, the challenge is going to be try to use mental health providers, psychiatrists, social workers, and psychologists to work together so that the solo practitioner seeing patients is not quite so isolated," she added.
Dr. Robinowitz also said that currently there is no system in place in the United States for urgent care.
"This lack of a system probably feeds into the lack of availability. So it is probably a combination of economics, or poor reimbursement for psychiatric care, as well as a system problem.”
Dr. Boyd and Dr. Robinowitz have disclosed no relevant financial relationships.
Ann Emerg Med. Published online July 21, 2011. Text
Medscape Medical News © 2011 WebMD, LLC
Send comments and news tips to news@medscape.net.
(Oh, for those keeping track, Torchwood still sucks, as of Friday's episode. But if you are so inclined, the BBC published three new radio plays all stories pre-Children of Earth. You can find them in the "song" section of iTunes.)
Wednesday, July 27, 2011
Walter Reed and Tea Party Wackos
According to Wikipedia:
Major Walter Reed, M.D., (September 13, 1851 – November 22, 1902) was a U.S. Army physician who in 1900 led the team that postulated and confirmed the theory that yellow fever is transmitted by a particular mosquito species, rather than by direct contact. This insight gave impetus to the new fields of epidemiology and biomedicine, and most immediately allowed the resumption and completion of work on the Panama Canal (1904–1914) by the United States. Reed followed work started by Carlos Finlay and directed by George Miller Sternberg ("first U.S. bacteriologist").
We closed the hospital that carries this man's name because the same hospital was allowed to deteriorate to the point where it could not be salvaged. I just heard on my local Fox News channel that its services will be incorporated into another hospital and the Dr. Reed's name added but still, is this what it comes down to in America? Are we so alien from our past that we fail to honor our real heroes in favor of remembering the name of all the "Real Housewives of New York"?
Walter Reed championed not only public health but the health of the warriors who kept this country and the world safe. His innovations and fights forced the government to provide proper care for our vets as well as the general public through things we take for granted, like street cleaning and water sanitization. Yet when his hospital namesake was allowed to grow mold and now to be sidelined, we say nothing. Another example of how our failure to appreciate history harms us all.
*****************
I am bracing myself to stay in a job I hate to be the only family member with a check. Because the Congress cannot agree with the President, my dad and my husband may not get the social security pay they are due. Many of you don't believe it is going to be this bad, that the threat is REALLY that serious. HELLO TEA PARTY FOLK - You know what? The crystal ball I have to predict the outcome of my therapy clients doesn't work and I would bet yours doesn't either. Even so, I don't want to take a chance on your psychic powers or your legend growing in your own mind. My people need their checks. If they don't come, will you cover our bills and the increased cost on my credit cards?
Major Walter Reed, M.D., (September 13, 1851 – November 22, 1902) was a U.S. Army physician who in 1900 led the team that postulated and confirmed the theory that yellow fever is transmitted by a particular mosquito species, rather than by direct contact. This insight gave impetus to the new fields of epidemiology and biomedicine, and most immediately allowed the resumption and completion of work on the Panama Canal (1904–1914) by the United States. Reed followed work started by Carlos Finlay and directed by George Miller Sternberg ("first U.S. bacteriologist").
We closed the hospital that carries this man's name because the same hospital was allowed to deteriorate to the point where it could not be salvaged. I just heard on my local Fox News channel that its services will be incorporated into another hospital and the Dr. Reed's name added but still, is this what it comes down to in America? Are we so alien from our past that we fail to honor our real heroes in favor of remembering the name of all the "Real Housewives of New York"?
Walter Reed championed not only public health but the health of the warriors who kept this country and the world safe. His innovations and fights forced the government to provide proper care for our vets as well as the general public through things we take for granted, like street cleaning and water sanitization. Yet when his hospital namesake was allowed to grow mold and now to be sidelined, we say nothing. Another example of how our failure to appreciate history harms us all.
*****************
I am bracing myself to stay in a job I hate to be the only family member with a check. Because the Congress cannot agree with the President, my dad and my husband may not get the social security pay they are due. Many of you don't believe it is going to be this bad, that the threat is REALLY that serious. HELLO TEA PARTY FOLK - You know what? The crystal ball I have to predict the outcome of my therapy clients doesn't work and I would bet yours doesn't either. Even so, I don't want to take a chance on your psychic powers or your legend growing in your own mind. My people need their checks. If they don't come, will you cover our bills and the increased cost on my credit cards?
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