Article archive / February 1, 2013
Originally published: . Volume 4, No. 6. Source pages: 2.
Looking at the Magellan reimbursement schedule from a simple business perspective brings out a few concerns. What people (in this case the Mallegan and our state government) are willing to pay for tells us a lot.
Some specifics jump out. One is the 10-minute office exam, which appears to still be an outpatient therapy service, but only provided by physicians. Reimbursement is $25.73. According to the AMA, in this time the physician will conduct three required components: “A problem focused history; A problem forced examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and /or family’s needs.”
This could be named the “Dr. Laura treatment method.” It might work with a cold or a sprained ankle, but not with psychological needs.
Then there is the low reimbursement for “Health and behavior intervention” which addresses health issues like high blood pressure, without a psychiatric component. Pay is low: $15.30 for the physician and $12.24 for a psychologist, for 15 minutes. But also, still too short. Who can relate to anyone at a meaningful psychological level in 15 minutes? The financial incentives of health and behavior ($61.20 per hour) vs. a more medical model ($154.20 per hour) may well drive everyone toward symptom treatments.
I’m concerned about how the diagnostic decisions are being made. Psychological testing is reimbursed at a fairly low rate (even when physicians are doing it!). But the use of the “diagnostic interview” continues strong. We know from IO psychology that the interview has poor predictive validity. Data gathered this way tends to be disproportionately influenced by negatives, framing, anchors, and so on. Researchers have even found that adding a 2-hour interview to a selection battery actually reduced predictive validity.
The business model tells us one other thing about this reimbursement schedule. The taxpayer is paying for something other than job performance.
If you buy your psychotherapy from a physician it costs more than if you buy it from a psychologist. And if you buy it from a psychologist it costs you more than if you buy it from a social worker or mental health counselor or nurse practitioner. On what scientific grounds does Magellan make these decisions?
For an article in this issue of the Times I had the pleasure of reporting on David Kidder’s stellar performance on outcomes measures. While tracking down the story I was privileged to speak with the premier research scientist in this area, Dr. Jeb Brown.
Dr. Brown generously shared a wealth of information about outcomes-referenced research. His work includes very large and very detailed data bases. He has analyzed this multivariate data with new techniques that allows fresh, new understanding about where the variance in psychotherapy outcomes originates.
Yes, he said, it is in fact the person who does the therapy that makes all the difference in outcomes.
But it is not the type of therapy, the age, the years of experience, or the credentials.
Dr. Brown also shared with me that very often performance based approaches, like outcomes-referenced care, are not very popular with many practitioners or state associations.
But, as scientists, we should let the facts and not politics guide our decisions.
This article is part of a historical newspaper archive. Read the original issue for its original layout, photographs and graphics.