Therapists respond to managed care

Therapists ready to work with HMOs, consumers

If you think that private therapists have little use for a managed care environment, you may be surprised to hear the findings of a survey released recently by the American Association for Marriage and Family Therapy (AAMFT) in Washington, DC. The study reveals that American therapists are complaining less about lowered fees and are developing services that are more affordable and accessible to their clients.

The survey of 1,215 private practice therapists conducted for AAMFT by GT&A, a consulting group in Clayton, NC, found that therapists are transforming their practices to deliver more flexible mental health services to an increasing number of patients.

32% of clients in managed care plans

Services offered by therapists who participated in the survey include the following:

o 28% offer brief check-up visits (15 minutes).

o 68% offer evening hours.

o 32% offer weekend hours.

o 20% accept credit card payments.

o 30% offer telephone therapy.

o 24% offer bibliotherapy, or guided reading.

o 52% offer sliding fee scales.

In addition, the private practice survey revealed that 32% of therapy clients belong to managed care plans, while 47% of therapists report that their clients pay for therapy services out of pocket.

"What we’re seeing is therapists encourag- ing clients to have greater participation in their own course of treatment. Therapists assign homework and ask clients to help decide what it is they want to accomplish," explains Gayle Tuttle, president of GT&A and executive editor of Practice Strategies, AAMFT’s monthly news-letter. "Those are direct responses to managed care, which requires that therapy have specific goals."

"When I first started in practice 15 years ago, a therapist could see a patient weekly for 52 weeks, and the insurance covered that," says Mark Raderstorf, LP, CCM, CRC, LMFT, president of Behavioral Management in Minnea-polis. "Managed care has required much more accountability. A therapist can see someone for eight to 10 sessions and then must document why the person needs more sessions. It’s required therapists to be more focused in their work and more outcome-oriented."

On the downside, managed care is sometimes shortsighted in terms of allotment of care, he says. "I know of situations where people have been denied sessions when they really needed it, and the result was an exacerbation of their symptoms."

Deep pockets

One survey finding that concerns John P. Ambrose, JD, director of legal and government affairs and general counsel for AAMFT, is that although health plans are paying for fewer therapy sessions, the total number of sessions has not decreased, which means consumers are paying for therapy out of their own pockets. "It says that the public has a demand for mental health, and they are going to get it at any cost. It also may demonstrate that there are issues of public concern about employment — a stigma or fear that if they are in therapy, it will impact their employment status or the opinions of co-workers," Ambrose says.

AAMFT also found that private therapists see a surprising number of seriously impaired patients. "The degree of disability in the caseloads of private therapists was also striking. Nearly 40% of therapists see moderately to severely impaired," he explains.

"For the first time, we have good hard data that the private sector is providing a level of service to people with severe mental disorders. I think there’s a message here that private therapists are really trying to work with managed care. And managed care has to pay attention to the type of disorders private therapists are treating when establishing benefits," he says.