Shrink Rap News: Helping patients access outpatient psychiatric care
The study, published (Psychiatric Serv. 2014 Oct. 15 [doi:10.1176/appi.ps.2014000051]), illustrates how hard it can be to get an appointment with a psychiatrist, regardless of who the payer is. The authors called 360 psychiatrists who were listed in the Blue Cross Blue Shield (BCBS) online directories in Boston, Chicago, and Houston. Callers posed as people with depressive symptoms seeking initial appointments. In each city, a third of the psychiatrists received a call from a caller saying they were either Medicare, BCBS, or self-pay. Voicemails were left when possible that included the type of payer. Callers followed up for a second round of calls if they did not hear back.
“Obtaining an outpatient appointment with a psychiatrist was difficult in the three cities we surveyed, and the appointments given were an average of 1 month away,” the authors wrote. Between 20%-27% of the phone numbers in the insurance company directories were wrong numbers, which led, instead, to places like McDonald’s and retail stores. In fact, they were able to reach only one-third of the psychiatrists.
The ACA requires Health Insurance Exchanges to have network provider directories that distinguish those providers who are currently accepting new outpatients. Unfortunately, the act left it up to the states to define network adequacy. For example, in Maryland, the definition of what constitutes an adequate network is left to each qualified health plan to define.
The problem with the health plans’ provider directories is that they are inaccurate, making it look like they have more available providers than they actually do. The plans have no incentive to expose the inadequacy of their network directories, while the regulators lack the staff to police them sufficiently. Meanwhile, provider groups benefit from being included on more lists, and plan members fail to effectively complain to the plans, employers, and regulators.
What the industry needs is to move away from these misleading, payer-centered provider directories and move toward transparent, patient-centered provider directories that include elements of crowdsourcing, provider control, and frictionless reporting. Making these changes will give consumers, employers, and regulators more information on provider availability, wait times, and true access to care.
Dr. Daviss is chair of the department of psychiatry at the University of Maryland’s Baltimore Washington Medical Center, chair of the APA Committee on Electronic Health Records, cochair of the CCHIT Behavioral Health Work Group, and coauthor of Shrink Rap: Three Psychiatrists Explain Their Work, published by Johns Hopkins University Press. He is found on Twitter @HITshrink, at drdaviss@gmail.com, and on the Shrink Rap blog.
