Lisa M. Rocchio is a clinical and forensic psychologist who is president of the Rhode Island Psychological Association. Since 1997, she has run a multi-disciplinary mental-health practice in Johnston.
The decision by Blue Cross & Blue Shield of Rhode Island to cut reimbursements by nearly 10 percent beginning July 1 for mental health professionals engaged in psychotherapy presents a major economic challenge – both to her business and to her professional association, with some 200 members.
PBN: When did you first learn about the planned cut in reimbursements?
ROCCHIO: On April 26, I received a phone call from Sean Jones, the behavior health specialist brought in by Blue Cross to manage its behavioral division [as assistant vice president of behavioral health strategy and clinical services]. At that time he indicated to me that there were plans for a fee cut. That was the first we heard about it.
Jones was let go by Blue Cross around May 19. I had the opportunity to have a telephone conversation with Sean before he was let go.
I was told that the decrease in fees were being done by Blue Cross to align all of the medical specialty areas; behavioral health compensation was going to be cut along with other medical specialties.
However, because there is no transparency in terms of fee schedules, we have no way of knowing if it is true that all the other specialties are being cut. Indications are that this may not be the case.
One of our concerns is the manner in which mental health professionals were notified of the fee changes. The letter dated May 30 that went out from Dr. Gus Manocchia, officially announcing significant changes beginning July 1, gave us just 30 days notice.
PBN: What does this 10 percent cut in reimbursements mean for the business of psychotherapists in Rhode Island?
ROCCHIO: We have concerns about the impact of these rates, especially given their magnitude, on the size of the network and how it may limit access to behavioral health. It could put small practices out of business.
Blue Cross appears to be shifting the costs of health care onto the providers and consumers. The cuts in reimbursements will have an impact on clinical social workers, psychiatrists, psychologists, family therapists and licensed mental health counselors.
There are questions about whether these cuts are consistent with parity legislation, particularly if behavioral health is being cut in a disproportionate fashion.
PBN: How will such cuts in reimbursements limit access to mental health providers?
ROCCHIO: If fees are reduced in this way, then providers will not be able to participate in the network. Either they will go out of business, or they will not participate with the insurance company, not accepting insurance as payment.
We’ve seen this happen in psychiatry, especially child psychiatrists. The wait time to get an appointment can be very long.
The cuts in reimbursement seem to disproportionately affect mental health providers who are providing psychotherapy, according to the billing codes. What it seems to favor is management of behavioral health through drugs.
PBN: Is there any recourse with Blue Cross?
ROCCHIO: Members of the RIPA board met with Blue Cross early in January. In the past, we have always had a very collegial relationship with Blue Cross. We were supposed to meet with Sean [Jones], and he was let go. We attempted to set up a meeting with Dr. Michael Fruchter at Blue Cross, and then he was gone. We do have a meeting set up with Dr. Manocchia when we will be addressing these concerns.
PBN: Are there additional concerns about a new patient evaluation form being introduced by Blue Cross as a way of measuring patient satisfaction?
ROCCHIO: Blue Cross has been working with consultants who proposed demonstrating the value of what psychologists do by having clients complete questionnaires at each session that therapists would use to evaluate the success of therapeutic relations. The questionnaire would be faxed to the insurance company and data would be tabulated. Based upon this measure, providers with the greatest levels of effectiveness could receive additional compensation.
No one has a problem with quality assessment, but the question is whether these particular measures are the most valid and reliable for providers. Blue Cross is saying that these measures are going to be completely optional. But how optional is it if they are cutting our fees, but saying, if you capture this data, we may provide you with financial benefits?