October 20, 2104
Nice job on your October 2014 article The Most Exciting Time in the History of Psychiatry! You hit the right reference points regarding past achievements and challenges ahead for our field of psychiatry.
As our esteemed colleague Allen Frances points out in his article in the October issue Failing the Mentally Ill http://www.psychiatrictimes.com/authors/allen-frances-md, we as a society (including psychiatrists and the medical community) continue to squabble about where government and insurance money should go to treat mental disorders, how to define them, and who are the truly ill among us deserving of that money.
We certainly do need to talk about where the money is going and who controls this. Why not let the patients and their families choose? Do articles about Direct Pay, health care insurance linked to HSAs, and innovative approaches to patient-family concierge arrangements which will empower poor and seriously mentally ill patients. By the way, why are our fellow citizens called “public” patients?
As you know, the daily work of psychiatrists in independent, private practice requires constant attention to how much they are paid, by whom, and for what. As the old adage goes, “He who pays the piper calls the tune.” We simply must look at how the financing of psychiatric care affects the patient, his family, and the profession. See http://physician-patient.org/pages/the-direct-pay-dp-psychiatric-practice-model/ Moreover, Tara Bishop et al reported that more than 40% of solo and small group private practice psychiatrists today do not take Medicaid or Medicare. See http://www.nytimes.com/2013/12/12/us/politics/psychiatrists-less-likely-to-accept-insurance-study-finds.html?_r=0 Either we move to consumer-directed funding or else psychiatry is a tool of the state. Let’s look into the ethics and consequences.
A Direct Pay practice means that a patient pays at the time of service or contracts for ongoing access to a physician-patient relationship in a concierge arrangement. This need not be a rich man’s business! The government or third party insurance company can easily reimburse patients and families or care provided in a Direct Pay practice. Moreover, Direct Pay for psychiatrists and other physicians mitigates very real threats to privacy and confidentiality posed by managed care medicine which are exponentially increased under the ACA and mandated EMRs, truly enhances a positive doctor-patient therapeutic alliance and sharpens focus on needed patient-family networking and advocacy.
So, I hope you will do Psychiatric Times articles on Direct Pay, new insurance concepts and models featuring patient (family) controlled HSAs and expanding these concepts to publicly funded Medicaid, VA, and Medicare programs. Innovative approaches to concierge medicine for poor and seriously mentally ill patients (now shamefully called “public patients”) will help address Dr. Frances’ concerns about the “shameful neglect” of the severely mentally ill in and by our society.
Lee Beecher, MD