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The merger between state Medicaid programs and managed care mental health carveouts has resulted in many consultation-liaison psychiatrists not being reimbursed for the services they provide, according to an Area 3 action paper approved by the Assembly. The action paper now goes to the APA Board of Trustees for consideration.
In many instances, general hospital psychiatrists are not part of the Medicaid mental health carveout network that contracts with referring nonpsychiatric physicians.
"Typically, consultation-liaison psychiatrists who work at these hospitals see the patient and are not paid for their services," the action paper notes.
Moreover, nonpsychiatrist clinicians contracted by the mental health carveout "do not have the personnel, know-how, or hospital privileges to provide a psychiatric consultation to these patients. In either case, patients are the ones who suffer the most because of this conflict."
The action paper notes that similar problems occur in primary care settings because nonpsychiatric physicians are "uncomfortable or uninterested in referring their patients for psychiatric consultations elsewhere."
Practitioners such as psychologists, social workers, and nurses "may not appreciate fully the medical/surgical complexities of individual patients, nor have the expertise in managing them in the context of complex medical conditions," the paper states.
The authors refer to proposed guidelines for inpatient psychiatric consultations developed by the Academy of Psychosomatic Medicine. They recommended that the guidelines be reviewed by APA's Committee on Managed Care with a report back to the Assembly in the fall.
The proposed guidelines recommend that all state Medicaid managed care proposals specify their coverage of psychiatric consultation services to medical/surgical inpatients.
The guidelines also propose limiting psychiatric consultations to credentialed psychiatrists with privileges at the institution where the patient is hospitalized. "Treatment may then be delegated to other behavioral health care specialists under the clinical supervision of the consulting psychiatrist."
To integrate patients' medical care, the document also urges that the patient be treated for psychiatric problems related to a medical condition in the same clinical facility.
Psychiatrists should be included in developing linkages between mental health and primary care. In particular, they should participate in agreements on coordination of care between the medical care providers and behavioral health care providers required by Medicaid plans, recommend the guidelines.
(Psychiatric News, July 4, 1997)