Psy.D/Ph.D doctoral candidates in psychology, psychiatry, and other behavioral health care disciplines across the country will be face important decisions after graduation. The number one decision involves whether one will seek employment as a private practitioner or employment through a large employee based medical group.
The federal mandate and recent implementation of the “Patient Protection and Affordable Care Act” ( ACA; otherwise known as Obamacare) now provides all enrollees access to mental and behavioral health services as well as substance use and rehabilitation services as part of their insurance coverage (Varney, 2013). Additionally, the Mental Health Parity Law (MHPL), essentially requires insurance companies to provide same health care benefit coverage as other medical coverage and treatments, which will further guarantee coverage to clients. In her article, Obamacare Changes How Therapist Do Business, Varney (2013) explores the impact that the ACA and MHPL will have on new and seasoned psychologists, psychiatrists, marital therapists, and social workers as they contemplate how they will operate their business.
Interestingly, Varney mentions how mental health experts have seen a gradual shift away from “mom and pop” private practices, to mental health consortiums or large interdisciplinary medical groups. Due to the changes in ACA and MHPL, private practice therapists who have typically operated with a “cash & carry” practice, are now faced with countless insurance plans to sift through; as well as the bureaucracy of billing codes and hard to process insurance claims. Additionally, therapists who already process insurance claims may be asked by insurance companies to accept a cut or discount for patients enrolled in ACA and/or participate in the health care exchange program (i.e., pick or choose the type of insurance package).
This paradigm shift in business operations is prompting those in private practice to consolidate resources with other practitioners by joining a consortium where mental and behavioral health services are part of a continuum of care. I cannot imagine the challenges of dealing with the “bureaucratic” red tape of insurance companies and the health care delivery system, but according to Varney, therapists in large mental health consortiums often have bargaining power with the insurance companies and can negotiate directly with them for higher reimbursement rates. As a therapist, perhaps a limitation of working in a large medical group means losing flexibility and autonomous functioning, such as handling the day to day administration, such billing operations, scheduling clients, etc., that is common in private practice. Whether you choose private practice or a large medical group, one will surely have to navigate the complexities of working with insurance companies.
Reference:
Varney, S. (2013), Obamacare Changes How Therapist Do Business. Retrieved from http://medcitynews.com/2013/10/obamacare-changes-therapists-business/.
David J. Wright, MA., MSW
WKPIC Doctoral Intern