Lees Psychological Services (LPS) was founded in 1998 as a state certified outpatient mental health clinic specializing in the treatment of eating disorders. It started as a small group practice at a time when the majority of therapists, psychologists and psychiatrists had joined large insurance networks following the height of managed care in the early 1990s. After witnessing the way managed care affected clinical practice by overburdening clinicians with ongoing paperwork and telephone reviews on their patients for the approval of a handful of sessions at a time, LPS decided not to join the networks and instead chose to practice as an out-of-network provider. This also secured confidentiality for our patients since personal information about their treatment did not have to be given to insurance reviewers.
Being out-of-network has allowed us to provide treatment without interference from insurance case workers who know nothing about the complexity of our cases but have the power to decide how much treatment patients get and how often. LPS was outside of the norm for not joining the networks, but we have been able to successfully treat several thousand patients in a much more private and effective way because we spent our time focused on treating patients and building our clinical expertise, not on petitioning case reviewers for session authorization.
When we opened in 1998, all outpatient clinics had to be certified by the state in order to receive insurance reimbursement. This meant the state defined specific requirements, such as the policies and procedures a clinic had to have, what information had to be included on our clinical forms, what types of personnel could work in our offices, etc. State surveyors were required to visit clinics and review patient medical records to assure all of the requirements were being followed before they would renew a clinic’s certification. Patients did not have to be informed before or after surveyors reviewed their records, so again, someone not involved in their care had access to their confidential information.
In 2011, the law changed and finally allowed licensed clinicians to practice independently and receive direct insurance reimbursement whether or not they worked in a certified clinic. LPS chose not to renew its state certification in 2012 so all patient records remained private and confidential to any outside reviewers and to decrease the burden and cost associated with remaining a certified clinic. We have never had a problem getting reimbursed from insurance companies since decertifying.
Now, in 2014, we are on the horizon of health care reform and the myriad regulations and changes this is creating. Insurance premiums, deductibles and copayments will be rising substantially for the majority of people in the next several years. In addition to this, there are many new regulations clinicians will face that look an awful lot like the managed care days of the 1990’s. Reimbursement from insurance will eventually be contingent upon additional paperwork by providers and patients for the purpose of collecting data on whether treatment is working. So, again, confidential information about the patient will be reviewed by insurance case workers who will have decision making authority about the treatment of patients they have never met.
Electronic health records have been instituted for the purpose of providing easy access to a patient’s health history and to prevent duplication of services. These are good reasons, but a lot of whether it works has to do with what clinicians who document in the medical record write and who has access to read it. Depending on the hospital system or setting, there is controversy over mental health records being part of the electronic medical record. On the one hand, it seems important for that information to be included so all issues are being considered in a person’s overall care plan. On the other hand, who knows what a therapist or doctor may write about you or your mental health history that anyone with access to the medical record can read.
Health care reform has primarily affected physicians to date and many are choosing to leave the profession rather than try to practice within the constraints being placed on their ability to properly treat their patients. The costs of complying with all of the health care reform mandates has resulted in the majority of independently owned physician practices getting bought out by large hospital systems. As things go, it won’t be long before the same happens to mental health clinics. To receive referrals and reimbursement, clinics will likely have to conglomerate in order to manage their rising costs and reduced insurance payments.
LPS is going to take a different approach, much like we did in 1998. Our values and practices have always been to protect patient confidentiality and focus on the priority of clinical care, since as health care professionals, our patients are the most important priority we have. LPS is going to remain small, independent and dedicated to providing a warm, professional and caring environment where change happens at a natural pace and isn’t defined according to an insurance company’s performance criteria.
We are going to ride out the wave of change being thrust upon us and hopefully benefit from the dissatisfaction that will come with impersonal and convoluted treatment in a large system, higher out of pocket costs for underqualified therapists, not knowing where your confidential mental health information goes once it is entered into an electronic health record and your treatment being evaluated based on the data from your performance in therapy.
LPS will continue to provide high quality, expert care for anorexia, bulimia, binge eating, anxiety, depression, panic, post-traumatic stress disorder and the adjustment to, and coping effectively with, medical conditions. You can be assured that you will get what you pay for – whether you seek treatment here or elsewhere. Feel free to contact us with any questions or for more information about treatment, insurance or payment options. We want to help you!