Ethical Issues

3 Ways Managed Care is Hurting Your Practice

3 Ways Managed Care is hurting your
3 Ways Managed Care is hurting your

This is not the first time you've heard me share my perspective on the problems of building private practice based on managed care. The original intent of these third-party companies was to ensure equity for those who receive treatment, but the actual results have been far from successful and have caused a myriad of problems. Some have even described managed care as the cause of the mental health care crisis. And while managed care wreaks havoc on the field as a whole, this system is also problematic for private therapy practices. As a clinician, I can certainly attest to this. My guess is that you can too. Here are the 3 main ways that using managed care panels may be hurting your practice:

1) Micromanagement of Treatment

Managed care panels have a way of micromanaging you in a supposed attempt to make you accountable. This means that a therapist often has less say and control in the type, length, and modality of treatment provided to the client, who has also has less input in the process. Think about it: an outside, commercial middle-man is dictating how you, the professional, help your client. It's easy to see how such a system lends itself to inadequacy and substandard care.

The mandatory diagnosing of clients is arguably the most deplorable part of using managing care panels. You are often required to provide a diagnosis, even if you do not believe your client has one. Even worse, some companies only accept certain kinds of diagnoses, which only further restricts your ability to provide ethical and accurate information and care.

2) Business Inefficiency

Communicating with managed care companies is a nightmare. There's excessive paperwork to fill out and phone calls to make. The hassle is never-ending, and it takes away from what you want to do: use your professional skills to serve your clients. Not only is your business inefficient and time-consuming to operate, but by looking at the math, you'll discover that your overall costs are increased as well. Even analyzing things solely from a business perspective, it's evident that using managed care is not a desirable model.

3) Payment Problems

When working with managed care their contracted rates were 40-60% of my full fee. Not only was there a low fee, but there was also the frustration of denied or delayed payments. There would sometimes be problems with the paperwork, or things would get lost in the tedious communication, and I wouldn't get paid for weeks or even months. I wasn't being sufficiently compensated for my work, and I wasn't always being paid in a timely manner. It was disheartening to say the least. It is emotionally and financially draining, and we deserve better.

These are three of the major ways managed care can hurt your practice (although there are certainly more). Thankfully, there's a better way. A way you can work less and earn more. I'm excited to share you with in upcoming posts about how transitioning to a fee-for-service model helped me build a thriving practice.

Click here to access my webinar, "Breaking Up With Managed Care" to learn even more tips and strategies.

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A Day In The Life: Meet Online Counselor Terrie Browning, LPC

What does it take to build and maintain a private mental health practice? Terrie Browning, LPC, DCC, CFC was among the first to respond to my request for therapists to track their activities for a day to shed light on what it takes to be in private practice. Friday, the day she uses  for last minute crisis appointments, online counseling appointments, website meetings, phone consults, and runs errands, was the day she chose to track her activities. Terrie provides in person, and online counseling, in addition to providing court testimony as part of her private practice, Alternative Therapies. Terrie is a Licensed Professional Counselor, Certified Forensic Consultant, Distance Credentialed Counselor, and holds a Masters Degree in Science of Psychology, with specialization in Counseling Psychology.

To learn more about Terrie's practice visit her website TerrieBrowning.com.

A Day In The Life

Novemember 18, 2011 Friday

7am-8am

Woke with my partner. Made coffee and tea and had a conversation about home, bills, tonight’s activities.

8:00-9:00AM

Started some laundry and checked emails for both my private practice and my website. Noted a return email from a potential new therapist for my live consultation website confirming our 11am phone consult. Email my accountant regarding chat system payouts and reporting options for experts.

9:00-9:15AM

Call from client, appointment for marriage counseling. Discuss options and insurance.

9:15-10:00AM

Answered emails to LinkedIn professionals offering a wide range of services, mostly media opportunities for the website (radio, press releases, etc.). Received an email from the editor at MyMetroYou magazine where I write a monthly column, My Healthy Mind. Deadline for January series was early this month, due Monday. Yikes, I haven’t even started it yet! January starts the first of a three part series on “What Makes Love Work”. I make a mental note to complete outline this afternoon.

10:00-10:30AM

Change beds and clean up house before leaving my phone consult.

10:45-11:00AM

Phone call from client whose husband had brain surgery. Anger issues and needed some assistance with conflict resolution.

11:00-11:45AM

Phone consult with expert from CA. A fellow therapist asking about ethical issues with online counseling. I share information I received during my Distance Credentialed Counselor certification I received last year from ReadyMinds in Chicago.

11:45AM-12:25PM

Consult with a close relative about difficult situation of living in a new place and trying to find employment and the stress it is taking on her relationship, feeling of loneliness, frustration and diminished self-worth.

12:25-1:00PM

Skype with my social networking company representing my website.

1:00-1:50PM

Online counseling with return client.

2:00-2:45PM

Work out at gym.

2:45-3:30PM

Meet attorney with whom I work with on alcohol evaluations. Get a call from client with need to come in for crisis appt. Agree to meet in 1/2hr.

4:00-4:45PM

Meet with client in the office.

4:45-5:30PM

Paperwork in office. Billing, faxing to alcohol testing lab for results, rehab for dates for clients alcohol evaluation. Phoned the parent of client admitted to emergency psychiatric ward with suicide attempt. Doing well. Whew, on my mind for last 24 hours. Talk about after care and outpatient services.

5:30-6:00PM

Return calls for appointments for following week. Phone consult with parent; minor child is going to court against his father for psychiatric evaluation and ending parenting time.

6:00-7:00PM

Return home to shower.

7:00-7:30PM

Talk with daughter who wants to transfer universities (her junior year).

7:30-9:30PM

Dinner with best friends for birthday celebration.

10:00-11:30PM

Return home and talk with partner, watch TV, go to bed.

Thank you Terrie, for letting us peek into a day in your life as a private practice therapist!