Monday, March 23, 2009

in other news...

So I've been aware of how many of my latest postings have been about the Pope or things I struggle with in the Catholic tradition. So for this post, I've decided to point my ire elsewhere, and what more commonly despised object could I find than a managed health care company?! (really, it's kinda like shooting fish in a barrel with these guys....)

You see, MBH is the company that manages mental health care services for clients covered by medicaid in Nebraska. As such, they manage services for many of the most severely mentally ill people in our state. So they made this decision recently that may sound technical, but that actually has a big impact on how services are provided.

You see, they've apparently decided that when psychiatric care is billed as "psychotherapy with medication management" (which is the most common billing code for psychiatric care), it is "overlapping" with standard psychotherapy codes by psychologists and counselors and the like. In other words, they won't pay for both.

Do they let providers know of this change ahead of time? No.

Do they give providers another way to get paid? Well...kind of. See, to still get paid, they're now asking the psychologist/counselor to contact the psychiatrist and inform them of this change. Then the psychiatrist has to weigh if they're willing to take a reduced fee for billing under another code (for "medication management" alone). If so, they can submit a request to MBH to change their authorizations to this "medication management" code. And if all of that happens, we psychologists/counselors can resubmit our application to MBH for the therapy codes that we had already been approved for.

So let's just think this one out, shall we?

1. If the psychiatrist refuses to change billing codes, the patient will lose access to their regular therapist. And since psychiatrists are notoriously difficult to get into (most people in our area have to wait a minimum of 60 days to get into one), patients are likely to have much less access to therapy.

2. This change essentially creates an economic conflict between psychiatry and other mental health service providers. Believe me, institutions that hire psychiatrists are concerned enough about paying their salaries that they feel great pressure to maximize every dollar they can bill for. So psychiatrists will likely feel a pressure to bill the more lucrative service code...but will have to weigh that against what is right for the patient.

3. Providers are likely to think a good long time before referring a client to a psychiatrist, given the financial downside to them for doing so.

4. The change speaks volumes about the unwritten "hierarchy" within the mental health system. If there is a supposed conflict, why should the psychiatric services continue to be authorized but not the therapy services? Who makes this choice?

5. Who makes the choice? Mindless, faceless, fracking bureaucrats who are so bent on saving money (and maximizing profits) that they couldn't care less about good patient care.


Tuesday, March 17, 2009

This just in...

OK, so the pope's new pronouncement, offered just today, is that condoms won't help Africa's AIDS crisis. Actually, this isn't new. They've been saying this for years.

The problem? It's just patently false.

This is one of those situations where ideology is trumped by stubborn little things called "facts." Like the facts from scientific studies that have been done showing the effectiveness of condoms in preventing the spread of AIDS. Like the studies showing that educating people about effective contraception doesn't increase the rate of sexual activity, it only increases the rate of SAFE sexual activity.

So I suppose if you put aside that condom use prevents infections, deaths, and the further destabilizing of families and societies...then, sure, I guess you can argue on ideological grounds that condom use won't help the AIDS crisis. But if this were any other issue...or, better, if some grounds other than religion were to be used to make the argument...people would be referring the pope for psychiatric care.