Back in early 2015, Regence Blue Cross Blue Shield announced that they would be cutting provider reimbursement rates by up to 30%. This rate reduction would affect mental health practitioners across the board at both the master’s and doctorate level.
Now, Mental health professionals have always had a difficult time when dealing with insurance companies. Rates are not reimbursed at the same level as other medical services, and until the Mental Health Parity Law, sometimes counseling wasn’t even covered at all. However, a decrease in reimbursement rates is just confusing.
The most distressing issue with this change is how it will indirectly impact the quality of care for patients. Specifically, the difference in reimbursement between a 60 minute and a 45 minute session will be less than $4.00 in most cases. This creates a dilemma for the independent practitioner who must act both as a patient advocate (the nature of our profession) and as a business owner (in order to remain in business, a private practitioner must be financially responsible).
This violates one of the critical rules of running a successful and solvent business: Never spend more in order to earn less.
An example may be in order. Consider the hypothetical example (insurance regulations prohibit disclosure of actual rate reimbursements) where a generic insurance company provides reimbursement of $96 for a 45 minute psychotherapy session and $100 for a 60 minute psychotherapy session. There is absolutely no motivation to see patients beyond 45 minutes under this insurance plan. From a business perspective, it would be irresponsible to waste 15 minutes of pro table time in order to earn $4.00. Put more succinctly, in order to remain solvent, one must value their time at more than 12% of what could potentially be earned.
The bottom line is that this significant reduction in rate reimbursement will create the following problems:
- Savvy and prudent business owners will stop seeing Regence Blue Cross Blue Shield patients for more than 45 minutes. This has already been previously evidenced through practitioner responses to similar rate reductions from Medicare, UnitedHealthcare, Providence, Aetna and United Behavioral Health, to name a few.
- Practitioners with the goal to “do right by the patient” will find out the hard way that by earning less money, they risk not being pro table and may not be able to stay in business. Given the high cost of running a private practice, including medical office space rent, billing, reception staff, insurance, continuing education, licensure and advertising, a non-business-savvy practitioner may soon find themselves “in the red”.
- Mental health services will become increasingly inaccessible to those with a bona fide mental illness. Patients will be “rushed” through the process of psychotherapy in order to “see the next patient”. Since ours is a helping profession, this behavior is in sharp contrast to the ethics of our profession. The lack of accessibility for proper mental health care has drastic consequences to our society, as evidenced by every mass shooting and tragedy where intervention would have made a solid and significant difference in the past. While many would debate this issue, the point is that mental health treatment is more valuable to a society when available than when not.
Without an adequate method to provide quality in service, in the end it is our patients who will pay the price. Mental illness, while not “cure-able”, is manageable with appropriate access to quality services. This change in reimbursement rates will force the continuing devolution of available mental health services and care. I strongly urge a reconsideration of these significant rate reductions prior to their implementation date of December 1, 2015. I fear that the results will end up being very predictive of how much we value (or devalue) services to those with verifiable mental health disorders.
December 2015 Update
This bit best sums up one psychologist’s reaction to Regence BlueCross BlueShield after their effective date of rate reduction:
“I am sorry to hear that BCBS will be going ahead with the rate reduction for 90837. I am particularly disheartened that the committee did that without responding to the multiple letters from BH providers all of whom expressed multiple concerns about this plan to reduce fees. It would have been much more professional and appropriate if the committee could have at least involved us in the discussions around this issue. The manner in which this was handled does not make psychologists, and others, feel like we are cooperating preferred providers with Regence in the delivery of health care services. I also would have expected a more direct communication by the committee directly with us.”
“It also seems to neglect the intent of the rule and spirit of the mental health parity laws enacted by both the State and Federal governments. There is a great deal of discussion locally and nationally about improving the extent and quality of mental health services but this is hard to do when arbitrary decisions are imposed on the community of providers all of which implies that the stigma of mental health services is still evident. It would be our hope that this could change in the future.”
April 2017 Update
Rates from Regence BlueCross BlueShield continue to be maintained at their same (severely) reduced level, plus or minus a few dollars in change. Representatives from Regence maintain that, “… at this time we are not doing any rate negotiations with providers. All rates are standard at this time.”
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