Convince business leaders of parity's dividends. (Challenge Carve-Outs and Discrimination).
Since more than half of all health care financing is controlled by business, it pays to help business leaders understand the cost effectiveness of good mental health coverage, said Dr. Norman A. Clemens of the University Suburban Health Center in Cleveland.
"The fact is the businesspeople we've gone out to see are much more sophisticated than they were in the '80s when we [in the mental health community] went out to talk with them," Dr. Clemens said.
In a session on strategies for reversing the discriminatory tactics of mental health carve-outs, other speakers said that psychiatry needs to work more closely with the American Medical Association, which has been more aggressive than the American Psychiatric Association in addressing the carve-out issue.
Dr. Jerome H. Rogoff cut right to what he considered to be the heart of the issue.
"Carve-outs discriminate," said Dr. Rogoff, a Newton, Mass., psychiatrist and a past president of the Massachusetts Psychiatric Association. "With managed care, the major device that's used is the rubric of medical necessity"
Specifically, he said, the for-profit carve-outs used by many managed care companies often deny covered care by claiming it is not medically necessary and hoping the psychiatrist won't challenge the denial.
Psychiatry, Dr. Rogoff said, is discriminated against more than any other specialty. He cited the example of Medicare paying 50% for psychiatric services and 80% for other specialties. And with that discrimination comes "more hassles, more barriers, more phone calls you have to make, more waiting on the phone, more ways in which it becomes harder and harder to get the services for your patient," he said.
"Simply put, it is putting up barriers to access to treatment, Dr. Rogoff said.
Dr. Clemens, who chairs a committee on APA business relationships that was formed 2 years ago, said the group has been pleasantly surprised with the response of business executives and the U.S. Chamber of Commerce.
"The reaction has generally been, 'Where have you been?' " Dr. Clemens said. "They recognize that particularly depression, anxiety disorders, and substance abuse take a tremendous toll on their workforce in terms of productivity, absenteeism, and disability."
The key, he said, is to work with middle-level human resource managers who can make a financial case to top executives about the fiscal sense of good mental health coverage. Businesses want to get what they're paying for, Dr. Clemens explained. Carve-outs were sold to them, not just on the basis of cost containment, but also on the basis of quality-and businesses have been grievously disappointed, he added.
Dr. Kenneth R. Silk said that other physicians, and particularly the AMA and its members, have been ahead of the APA in opposing mental health carve-outs. The APA and its members should work closely with their colleagues to pursue the issue, said Dr. Silk, associate chair for clinical and administrative affairs at the University of Michigan, Ann Arbor.
"If people had tried to treat surgeons this way, [the surgeons] would have gone forward, scalpels unsheathed," he said.
He called for a joint AMA-APA commission to oppose mental health carve-outs. This would go a long way toward helping the community at large understand the connection of mental health to overall health, Dr. Silk said.
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|Publication:||Clinical Psychiatry News|
|Date:||Aug 1, 2002|
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