Breaking Free

After being in the field of psychiatry for nearly three decades, I recently decided to change how I am paid for my services. Six months ago I informed my patients that at the beginning of this year, I would terminate my participation in all third-party payment plans, including Medicare. I explained to them that I wanted to practice without the constraints imposed by insurers and experience the sense of freedom that would result.

Some of my patients accepted this, and others expressed their discontent. For those who wanted to stay in my practice, I offered the option of submitting my receipt to their insurer for possible reimbursment or paying me on a sliding-scale basis. More than half of my patients chose to transfer to other psychiatrists whom I had recommended.

Now I have a lighter caseload and am able to see patients with fewer time constraints. An answering machine plays a message about my practice and tells callers how to reach me by pager if necessary; it also records messages for later playback. I have found that patients like the feeling that I have more time for them and that their records have greater confidentiality since no information is transmitted to their insurers.

From the bookkeeping point of view, I no longer have to worry about staying up to date on tax guidelines regarding quarterly filings and maintaining current insurance information on multiple companies for the secretary, who was spending most of her time on the phone with insurers.

A few years ago I was warned by a managed care agency that my documentation did not meet its guidelines. The documentation had been reviewed by a social worker contracted by the agency, and he had gone into areas apparently outside his field of expertise. I was given a chance to improve my documentation along with a recommendation to enroll in an educational activity! Another agency asked me to file my curriculum vitae on the Internet and update it every three months to maintain my credentials. With such treatment by insurance companies, you cannot imagine the glee I felt when I advised them that I was withdrawing from their plans.

Time will tell how my professional future will go, but one thing is certain—I will never go back to being an employee of managed care.