Reimbursement for professional psychological services

A brief history of the professionalization of psychology precedes a section of how psychological services became reimbursable. Specific focus is placed on reimbursement for psychological services, especially the distinction between medical and psychiatric diagnoses as well as procedures or services. Specific guidelines for appropriate reimbursement are provided. Future directions for reimbursement for mental health and related services are considered.     

Negotiating for Improved Reimbursement for Dialectical Behavior Therapy: A Successful Project

Dialectical Behavior Therapy (DBT) is an evidence-based treatment for borderline personality disorder that has been widely disseminated to many outpatient treatment settings. Many practitioners depend on third-party payers to fund treatment delivery. DBT requires additional clinical services not often included in outpatient therapy, including a weekly skills group led by 2 clinicians, and the requirement for clinicians to attend weekly consultation team and provide intersession contact for coaching. Standard outpatient insurance rates for individual and group sessions do not provide adequate reimbursement for the additional services of DBT. This paper describes how 2 DBT team leaders collaborated to obtain improved reimbursement for their programs. The 2 teams met with insurers, educated them about DBT, and showed outcomes from their programs to achieve large increases in reimbursement rates. The paper includes client outcome data from both programs.     

Inanspruchnahme, Verlauf und Ergebnis ambulanter Psychotherapie

This paper summarizes the major results of the study ?Optimizing psychotherapy service provision via transparency and outcome orientation: evaluating outpatient psychotherapy“ (TRANS-OP). Between September 1998 and February 2000, all insured persons of a major German health insurance company (?Deutsche Krankenversicherung“) who requested reimbursement of outpatient psychotherapy were asked to participate in the study. Comprehensive data concerning structural, process and outcome criteria of outpatient psychotherapy were collected from 714 participants and from the majority of their psychotherapists during a 2-year observation period. Participants applied for the following treatments eligible for reimbursement in the German health insurance system: psychodynamically oriented psychotherapy (52%), cognitive behavioral therapy (31%), and psychoanalytic psychotherapy (17%). The amounts of sessions claimed for reimbursement were approved almost without exception. Participants in the three treatment modalities did not differ in socio-demographic characteristics, or in initial symptom severity as assessed by standardized measures. Even though courses of improvement of the symptoms varied, therapy outcome after 2 years was similar in the three forms of treatment. In addition, a cost offset was found, i.e. medical costs, especially for hospital days, substantially decreased during the course of psychotherapy. These findings support the effectiveness as well as the economic significance of outpatient psychotherapy across different treatment modalities in routine care. However, allocation of psychotherapeutic resources should be more considerate of individual patient needs and treatment outcome.     

A survey of reimbursement for cystic fibrosis carrier testing

To assess the current status of reimbursement for cystic fibrosis (CF) carrier testing, we surveyed individuals tested in the Mid-Atlantic region. Results show that CF testing was covered by insurance in part or in full for greater than 50% of respondents. The test was nearly always covered when performed during pregnancy because of a positive family history, but it was also covered for more than 50% of pregnant respondents with a negative family history. There were no significant differences in coverage by type of insurance. Many respondents needed to supply additional information about the testing to their insurance company before a coverage decision could be made. Before population-based CF screening programs are initiated, more data are needed on insurance reimbursement for testing, especially when performed pre-conceptually.     

Assessing the Validity of a Theoretically-Based Substance Abuse Scale for Personnel Selection

This paper describes the development of a theoretically-based substance abuse scale to be used for personnel selection. Twenty-eight studies were conducted to validate the predictor. A meta-analysis was conducted using all 28 of the studies (N = 4,118). The mean validity coefficients for bare bones and fully corrected analyses were .25 and .43, respectively. The studies were analyzed according to the type of subject (students, applicants, employees), method used to collect the criteria (self-report, not self-report), and job relevance of the criteria (job-related, not job-related). The method used to collect the criteria was a moderating variable: mean validity coefficients for studies using self-report and nonself-report criteria were .64 and .33, respectively.     

The cherry effect or the issue behind well-being

Cognitive Processing - Humans define well-being on predefined assumptions, based on inner and outer criteria as references. As illustrated, these criteria are subject to constant change, even in a...     

Evolution of an Inpatient Pediatric Psychology Consultation Service: Issues Related to Reimbursement and the Use of Health and Behavior Codes

The purpose of this study was to evaluate an inpatient pediatric psychology consultation service, with particular focus on issues related to financial reimbursement for services. Information was gathered over a four year period (2001–2005) regarding number of consults, referral source and referral question, type of insurance, and reimbursement rates for health and behavior codes versus mental health codes. The financial impact of hiring an insurance verification specialist was also explored. Results indicated that reimbursement rates for health and behavior codes were higher than reimbursement rates for mental health codes. Health and behavior codes were rejected in 31% of cases that they were billed; the primary reason for rejection was that these codes were not a covered service by Medicaid. Hiring an insurance verification specialist was found to be a cost-effective method for improving the financial “bottom-line” for psychology services. Implications for practice are discussed.     

Medicare Advocacy for the Counselor Advocate

Medicare reimbursement for counselors would expand older adults' access to mental health services and increase counselors' professional opportunities. To enhance advocacy efforts, the author reviews Medicare's current role in meeting older adults' mental health needs, examines the program's unique political development, and identifies contemporary values that may influence Medicare's future. Implications for counselor advocacy efforts are discussed.     

Managed Mental Health Care: Intentional Misdiagnosis of Mental Disorders

Managed health care regulations affect the manner in which counselors provide and deliver services. Counselors are challenged by ethical and legal dilemmas when diagnostic codes in the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2000) are not honored for insurance reimbursement. In this article, the authors examine violations of codes of ethics and legal statutes and the consequences related to intentional misdiagnosis of mental disorders for reimbursement. They explore implications for counselors and offer suggestions for professional conduct.     

ON THE BORDERLINE OF FOOD AND DRUG: Constructing Credibility and Markets for a Functional Food Product

This article addresses the subject matter of functional foods by analysing commercialization and marketing of a functional food product. Functional food is an evolving hybrid concept: certain substances in a food product are claimed to have health-promoting or disease-preventing qualities (e.g. Best, 1996). Consequently, functional food advertises a food product with medical qualities, which evokes various debates and difficulties in its definition from the point of view of the medical community, regulatory authorities, food industry and consumers. Globally, the approval of functional foods is a complex matter, as it depends on national criteria and practice. For instance, functional food is not a legal term in many countries, such as the USA, but the health claims of functional foods that are used in package labelling and marketing are strictly regulated. With respect to clinical evidence, the approval criteria of health claims may even resemble the approval criteria of drugs. Through the health claims, functional foods challenge the clear distinction between food and drugs that has been incorporated into regulatory systems for a long time (Kwak and Jukes, 2000, 2001a).     

A Rapid Systematic Review of Outcomes Studies in Genetic Counseling

As healthcare reimbursement is increasingly tied to value-of-service, it is critical for the genetic counselor (GC) profession to demonstrate the value added by GCs through outcomes research. We conducted a rapid systematic literature review to identify outcomes of genetic counseling. Web of Science (including PubMed) and CINAHL databases were systematically searched to identify articles meeting the following criteria: 1) measures were assessed before and after genetic counseling (pre-post design) or comparisons were made between a GC group vs. a non-GC group (comparative cohort design); 2) genetic counseling outcomes could be assessed independently of genetic testing outcomes, and 3) genetic counseling was conducted by masters-level genetic counselors, or non-physician providers. Twenty-three papers met the inclusion criteria. The majority of studies were in the cancer genetic setting and the most commonly measured outcomes included knowledge, anxiety or distress, satisfaction, perceived risk, genetic testing (intentions or receipt), health behaviors, and decisional conflict. Results suggest that genetic counseling can lead to increased knowledge, perceived personal control, positive health behaviors, and improved risk perception accuracy as well as decreases in anxiety, cancer-related worry, and decisional conflict. However, further studies are needed to evaluate a wider array of outcomes in more diverse genetic counseling settings.     

Bradley-Terry-Luce scale of taste qualities of champagne]

In a paired comparison experiment 783 subjects judged five different brands of champagne (three normal and two alcohol-reduced). Each subject judged only one single pair with respect to which one tasted more fizzy ("spritziger"), dry ("trockener"), prickling ("prickelnder") and better ("besser"). Three extended versions of the Bradley-Terry-Luce model are discussed and used to assess scale values for the criteria as well as for order effects. The results can be summarized into three points: (1) Goodness-of-fit for the simple BTL-model is satisfactory for all criteria--except for the judgement "tastes better than". (2) Using four graded response categories instead of dichotomous responses decreases goodness-of-fit considerably. (3) Alcohol-reduced brands are less "dry", but are quite within the range of the other brands with respect to the remaining criteria. It is argued that the particular scaling method used is especially useful for deciding which criteria are appropriate for measurement on a one-dimensional scale and which are not.     

A service-delivery paradigm for personality assessment

This paper describes a human science approach to the delivery of the feedback component of assessment services. The feedback process is now central to a collaborative assessment that is integrated with intervention. Research has suggested that subject, situational, and assessor variables are relevant for feedback, but such research has been unsystematic. A service-delivery paradigm for feedback of assessment findings is described that includes four levels of increasing client participation: information, emotional contingencies, transfer of power, and functioning of an assessment system. Communication of assessment findings has been incomplete historically because motivation for feedback, resource accessibility for feedback utilization, and criteria for adequate feedback have been considered as unrelated ingredients. The components of Antonovsky's Sense of Coherence construct--meaningfulness, manageability and comprehensibility--provide one conceptualization for interaction of these ingredients. It is now feasible to do systematic research on assessment that includes feedback of assessment findings and the service-delivery process.     

On "On what there is"

All sides in the recent debates over the Quine-Putnam Indispensability thesis presuppose Quine's criterion for determining what a discourse is ontologically committed to. I subject the criterion to scrutiny, especially in regard to the available competitor-criteria, asking what means of evaluation there are for comparing alternative criteria against each other. Finding none, the paper concludes that ontological questions, in a certain sense , are philosophically indeterminate.     

Generalized approaches to the maxbet problem and the maxdiff problem,with applications to canonical correlations

Van de Geer has reviewed various criteria for transforming two or more matrices to maximal agreement, subject to orthogonality constraints. The criteria have applications in the context of matching factor or configuration matrices and in the context of canonical correlation analysis for two or more matrices. The present paper summarizes and gives a unified treatment of fully general computational solutions for two of these criteria, Maxbet and Maxdiff. These solutions will be shown to encompass various well-known methods as special cases. It will be argued that the Maxdiff solution should be preferred to the Maxbet solution whenever the two criteria coincide. Horst's Maxcor method will be shown to lack the property of monotone convergence. Finally, simultaneous and successive versions of the Maxbet and Maxdiff solutions will be treated as special cases of a fully flexible approach where the columns of the rotation matrices are obtained in successive blocks.The author is obliged to Henk Kiers for computational assistance and helpful comments.     

“Age-associated memory impairment”: A critique

Abstract

This paper is a critical evaluation of the construct of age-associated memory impairment (AAMI) and the criteria for assigning the AAMI label. It is argued that AAMI should not be regarded as a clinical diagnosis; that the AAMI criteria fail to isolate selective memory impairments, ignore crucial longitudinal information, and are vague, arbitrary, and unreliable; that studies of memory loss should examine a wider range of subjects than those who meet the AAMI criteria-moreover, use of the criteria may impede research; and that treatment studies should await investigations of the biological antecedents of memory loss. Several recommendations address subject selection and assessment issues.