“We know managed care is changing,” said Lawrence B. Lurie, M.D., chair of the Committee on Managed Care, “but we don't know how much.” The committee suspects that the changes in managed care practices may be regional, and so it has embarked on a project to contact the district branches (DBs), state associations (SAs), and APA members to find out what is going on.
Each DB/SA president has now received a letter from Lurie asking for information on local managed care trends. “We are eager to increase collaboration between the committee and the DBs/SAs so that we can enhance our representation of the membership,” Lurie emphasized.
As a point of departure, the committee asked each DB/SA the following questions.
• your area?
• Are reimbursement rates going up? Going down? Staying the same? Are claims being paid on time?
• Are there changes in preauthorization requirements, especially for CPT codes 90801, 90862, 90805, and 90807? Is there any indication that managed behavioral health care organizations (MBHOs) would be open to psychiatrists using medical E&M codes to differentiate their work from that of mental health professionals?
• What, if any, impact have the parity laws had?
• Are pharmacy benefit managers (PBMs) increasing the amount of time psychiatrists spend on prescribing? Altering their choices about first-line treatment? Creating other problems?
• Are your members taking new patients covered by managed care plans? (APA's Practice Research Network found that only 54 percent of APA members are taking new patients covered by managed care. Does this figure have a regional component?)
• Are your members spending more time on administrative duties connected with managed care? Less time? The same? Are there differences in business practices of the managed care organizations (MCOs) that make some companies more attractive to work with than others?
• Are there differences in quality among MCOs? Between local and national/regional MCOs? Between carved-out and noncarved-out systems?
• Are different employers providing widely different coverage in your areas? If so, which employers are providing high-quality mental health coverage? Which MCOs or MBHOs manage those contracts?
Based on this input, the committee, the Council on Healthcare Systems and Financing, and the APA Office of Healthcare Systems and Financing (OHSF) will work together on an agenda for 2004.
“Our office is in regular contact with many of the managed care companies to resolve individual member issues,” Irvin L. (Sam) Muszynski, J.D., director of OHSF, said, “but with this outreach, we hope to broaden the scope of our conversations with these companies. We look forward to hearing from the membership.”
APA members may contact the Committee on Managed Care directly via the managed care caucus’s list serve at [email protected] or the Managed Care Help Line at (800) 343-4671. ▪
