Butler Hospital’s announcement last month that it plans to shut down most outpatient services could mean more work for mental-health service providers in Rhode Island, as potentially hundreds of the Providence psychiatric hospital’s patients look for new therapists.
For most businesses, an influx of customers would be a good thing. But in the mental-health field, some providers already have more patients than they can handle.
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And, with what many therapists say are meager reimbursement rates from private insurers, some doubt whether taking more patients would improve the bottom line.
“Most of the psychologists I know say they’re swamped with demand,” said Dr. Peter M. Oppenheimer, a psychologist at Feil and Oppenheimer Psychological Services in Barrington. “There’s plenty of work and we’re happy to do it. But there’s only so much you can do with the reimbursement we’re getting.”
It’s become a common complaint among mental-health professionals: Reimbursement rates from insurers, they say, aren’t keeping pace with the costs of doing business – or even the cost of inflation. Butler, which announced it will lay off 45 workers while gutting its outpatient services, blamed the move primarily on inadequate coverage from insurers.
Meanwhile, clinicians say costs are spiraling higher, partly because insurers and regulators increasingly are requiring tighter standards for mental-health practitioners, such as more-detailed documentation and stricter certification requirements.
“These professional practices are also businesses, and the cost of doing business is going up all the time,” said David Elliott, a Providence psychologist and president of the Rhode Island Psychological Association. “But in real dollars, reimbursement rates have gone down over the last several years.”
Elliott estimates that a private-practice psychologist in Rhode Island charges roughly $100 for a 50-minute psychotherapy visit. But insurers reimburse about $65 to $75 for such a session.
The gap between what insurance companies are paying and what practitioners would like to charge has prompted some therapists, including Oppenheimer, to pull out of managed-care provider networks such as Blue Cross. Oppenheimer said he still sees Blue Cross patients, but they pay the bill up front and try to get reimbursed from their insurer later.
“It’s not surprising that more and more seasoned mental-health clinicians in Rhode Island are dropping out of provider pools,” Elliott said.
The outlook for reimbursement increases is mixed.
United Behavioral Health, which handles the mental-health business of UnitedHealthcare of New England, Inc., has a nationwide fee schedule for reimbursement, according to spokeswoman Debora Spano. Although those rates are reviewed annually, she said the company has no plans to change them.
“As of now, United Behavioral Health feels that these rates are very fair and that there is a good provider network available for its members,” she said.
Blue Cross, however, is planning to increase reimbursement rates for mental-health providers in Rhode Island beginning next year, according to spokesman Scott Fraser. He said Blue Cross plans to start notifying providers of the change by the end of this month, saying only that the increase would be “significant.”
But as private therapists drop out of managed-care networks and psychiatric hospitals pare outpatient clinics, some say patients who need treatment for depression, anxiety disorders or substance abuse increasingly lack access to services.
“If you’re looking to get in with a doctor who has an established practice, you’ll probably have to wait four, six, eight weeks,” said Nicki Sahlin, executive director of NAMI (National Alliance for the Mentally Ill) of Rhode Island.
And the chances of getting in at one of the state’s eight nonprofit community mental-health centers are not much better.
“The community mental-health centers used to be the place of last resort,” Sahlin said. “But now it’s very difficult to get in. Unless you’re suicidal right at this moment, you probably will not get seen.”
Mental-health center officials, however, say they will accommodate new patients, although they admit their resources are stretched thin.
James Berson, chief operating officer of the Providence Center, said the mental-health center has only a two-week wait for new patients. But the center’s 13 outpatient therapists have had to work grueling hours.
“We’re asking people to work a heck of a lot harder and at a pace that I’m not sure is sustainable,” Berson said. “Hopefully it will be enough to keep these services afloat. If not, then we’ve got some very difficult decisions to make.”
State or federal programs, such as Medicaid, help fund most programs at community mental-health centers. But their outpatient operations rely heavily on coverage from private insurers, and officials say most do not cover the full cost of treatment.
“The reimbursement rates have not kept pace,” Berson said, adding that payments from insurers generally cover about 85 percent of outpatient treatment costs.
At Kent County Mental Health Center in Warwick, which sees about 2,500 adult and child patients a year, new patients might wait as long as six weeks to start treatment, according to vice president of operations Edward August.
While the center is scrambling to meet swelling demand – exacerbated by the closing of outpatient facilities run by Butler and Bradley Hospital – August said every new outpatient customer is a financial drain on the center.
“From a purely fiscal perspective, it doesn’t do us any good to try to grow the outpatient segment when you’re losing money for the services you deliver,” August said. “But people need the help, so we do what we can.”
It’s also becoming tougher to find qualified psychologists, he said, because many managed-care companies now require three or more years of post-licensure experience before a clinician becomes credentialed.
If reimbursement rates for mental-health services are to improve, the business community will need to play a role, Berson said.
“Ultimately this issue ends up in the lap of the employers,” he said. “They’re the ones that end up paying for these services. A big part of the solution is education – having employers understand that unaddressed mental-health and substance-abuse issues will affect them directly.”
