The Affordable Care Act’s effect on Mental Health Practitioners – By Ali Beheshti, J.D.

» Leave a comment

ACARecently, while helping my sister establish an Intensive Outpatient Program for addiction treatment, I have spoken with a number of Mental Health Professionals and have noticed that many of them are concerned about what the implementation of the Affordable Care Act (ACA) means for their practices. Some have heard that the changes in the law are going to be good for their practices, while others have heard it will have a negative effect.  Undoubtedly when these discussions arise I’m the only person in the room with a Law Degree and my opinion on the topic is sought. After a few embarrassing incidents in which I had to admit I had no idea whether the law was going to have a positive or negative impact on mental health practices, I decided to do some research on the topic. After extensively looking into the matter I realized the answer was not as simple as “yes the law will have a positive impact on your practice,” or “no your practice will be hurt by the law.” The truth is that that the ACA’s effect on your practice is up to you. What I mean by this is that, just like any other industry, the professionals that adapt to an evolving marketplace flourish, while those that stay attached to old systems tend to perish (e.g. Netflix vs. Blockbuster, Amazon vs. Borders).

For mental health practitioners to adapt they need to first understand the changes their industry is headed towards. As many practitioners know, in 2008 Congress passed the Mental Health Parity and Addiction Equity Act (MHPAEA), which essentially required insurers to extended policies to cover treatment for mental health and addiction disorders in the same way they cover all other medical benefits (i.e. co-pays, deductibles, and so forth).  The problem with the MHPAEA is that its implementation and enforcement, up until quite recently, have been nearly non-existent. However, with the implementation of the ACA, which extends and enforces the provisions of the MHPAEA, the industry is in for some large scale changes. Obviously there is going to be a large influx of newly insured individuals and even more importantly for mental health practitioners, all insurance policies will have to meet the minimum requirements set forth in the ACA, which includes coverage for mental health treatment. As people realize that their insurance policies cover these treatments it is highly likely more will seek out mental health and addiction treatment programs, which of course is beneficial to the mental health industry as a whole. However, these new individuals, as well as those already seeing mental health professionals, will have new expectations. The most important of which is that they will expect their physiatrists and therapists to take insurance. Therefore, those that don’t take insurance will begin to notice a decline in new patients and even the departure of some of their less loyal patients. While those that do take insurance will see an upswing in patients. Of course it is not all that simple to deal with the giant bureaucratic maze that is the insurance industry and billing services can charge anywhere from 5% to 15% of billings to do it for you. Additionally, insurers rarely pay individual practitioners their full hourly rates. The prospect of dealing with these substantial hurdles will certainly frighten most solo practitioners and those in small private practices (which most physiatrists and therapists are). However, these individuals are in luck because their colleagues in the general medical field that have private practices have faced the same challenges for some time now and have come up with a highly effective solution in the form of Independent Practitioner Associations (IPA).

Mental Health professionals have the benefit of learning from the experience of their colleagues in the medical profession on how to handle the vast changes about to take place in the structure of their own profession. When private practioners in the medical field began to deal with insurers they realized that their negotiating power was quite week on an individual level but that when they banded together through Independent Practitioner Associations their leverage during negotiations grew exponentially. They were able to get more insurers to cover their services and pay the rates that they expected to receive. They also found the power to hold insurers accountable to the laws that govern their highly regulated industry. With all the changes taking place in the insurance industry in regards to coverage of mental health care, there will be measures in place to make sure that insurers are meeting their new obligations under the law. Of course individual practioners do not have either the time or resources to deal with such large tasks and that why it is so important that they learn from their counterparts in the rest of the medical field and begin forming Independent Practitioner Associations as soon as possible.

These associations can be very beneficial to their members in a number of respects. As mentioned earlier, billing services charge anywhere from 5 to 15 percent for their services and individual practioners don’t have much leverage when negotiating with these services on their rates. If, however, practitioners are members of an IPA, then billing services will actually seek out the IPA and offer favorable rates to its’ members in exchange for the fact that they will receive such a large influx of new business. Insurers will follow suit for the same reason. Of course there is some downside to forming an IPA as well. For one, you have to contribute a portion of your earnings to the IPA to receive the benefits afforded to you by it. However, this cost can easily be offset by the lower rates you will to pay for billing services. Another serious downfall of these associations, that was learned the hard way by those in the rest of the medical profession, is that when theses associations grow in power the line between rate negotiation and price fixing, which can lead to antitrust litigation, gets very thin. That is why it is important to make sure you have trustworthy management of your IPA, which should most likely include an attorney that understands antitrust laws. These problems are far outweighed by the benefits of forming an IPA. The sooner the mental health professionals form such associations, the less likely they are to fall behind their colleagues and competitors.

If you have any questions on how to form an Independent Practitioner Association feel free to email me at ali@doctorbeheshti.com with your questions.

Ali Beheshti, J.D.



Post a Comment

Your email is never published nor shared.



Terms & Conditions of Use


By entering this website you agree to the following terms and conditions:

1. No Medical Advice

The content of www.advice.doctorbeheshti.com site is for informational purposes only. Sayeh Beheshti, MD, Inc. (“SBMD“), operates and owns this site. DOCTOR LIFE ADVICE℠ is a servicemark of SBMD. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this site.

If you think you may have a medical emergency, call your doctor or 911 immediately. This site does not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned on the Site. Reliance on any information provided by here, or other visitors to the site is solely at your own risk.

2. Privacy

2.1 Personal Information

If you choose to register with SBMD or access certain functionality on the SBMD Site, you may be required to submit Personal information. “Personal information” means information that we can use to identify or contact you, such as your name, address, telephone number or email address. Some of our interactive tools and services may request you to submit health information, which would also be considered Personal Information. You are responsible for ensuring the accuracy of the Personal information that you submit to SBMD. Inaccurate information will affect your experience when using the SBMD Site and tools and our ability to contact you as described in this Privacy Policy.

2.2 Cookies and Web Beacons

We may collect Non-Personal information about your use of the SBMD Site and your use of other Site through the use of cookies and web beacons. “Cookies” are small data files that are stored on the hard drive of the computer you use to view a web site. Every computer that accesses the SBMD Site is assigned a different cookie by SBMD. “Web Beacons” are graphic image files imbedded in a web page typically used to monitor activity on a web page and send back to its home server (which can belong to the host site, a network advertiser or some other third party) information from your browser, such as the IP address, the URL of the page on which the beacon is located, the type browser that is accessing the site and the ID number of any cookies on your computer previously placed by that server.

2.3 How Information Collected About You Is Used

Information collected by SBMD about you is used by SBMD to:

  • administer your account,
  • provide you with access to particular tools and services,
  • respond to your inquiries you send to us,
  • obtain your feedback about the SBMD Site or our offerings,
  • statistically analyze user behavior and activity including how frequently areas of the site are visited and how many emails are received and opened,
  • provide you with more relevant content or advertising on the SBMD Site; and
  • conduct research and measurement activities, including those described below.

SBMD may combine personal and non-personal information collected by SBMD about you, and may combine this information with information from external sources. We may also use cookies in order to enable us to conduct surveys for our own use and on behalf of our advertisers. These cookies are used to determine whether you have seen certain content or advertising so that we may request your opinions. We may also use cookies to authenticate respondents or to help you pick up where you left off in a survey. If you have cookies disabled you may not be able to participate in some surveys.

2.4 Research and Measurement Activities

Information that SBMD collects about you may be combined by SBMD with other information available to SBMD through third parties for research and measurement purposes, including measuring the effectiveness of content, advertising or programs. This information from other sources may include age, gender, demographic, geographic, personal interests, product purchase activity or other information. We may report aggregate information to our current or prospective advertisers and other business partners.

2.5 Sharing Your Information

Except as described in this privacy policy or as specifically agreed to by you, SBMD will not disclose any personal information it gathers from you through the SBMD Site. We may only release personal information to third parties: (1) to comply with the law; or (2) in special cases, such as in response to a physical threat to you or others, to protect property or defend or assert legal rights. In addition, we may disclose personal information as described below.

2.6 How Do We Secure and Retain Your Information?

We take reasonable security measures to protect the security of your personal information. Despite SBMD's efforts to protect your personal information, there is always some risk that an unauthorized third party may find a way around our security systems or that transmissions of your information over the Internet may be intercepted.

We will retain your Personal Information as long as needed to provide you services. At any time you can remove your Personal Information or instruct us to remove it, but you should be aware that it is not technologically possible to remove each and every record of the information you have provided to SBMD from our servers. We will also retain your personal information as necessary to comply with legal obligations, resolve disputes and enforce our agreements.

2.7 Changes to This Privacy Policy

We reserve the right to change or modify this privacy policy or any of our tools or services at any time and any changes will be effective upon being posted unless we advise otherwise. We encourage you to periodically review this website for the latest information on our privacy practices. If you do not accept the terms of this privacy policy, we ask that you do not register with us and that you do not use the SBMD Site.

2.8 What Choices Do I Have?

Updating and/or Removing Your Personal information

If you do not want your personal information used by SBMD as provided in this privacy policy, you should not register as a member or for any specific tool or application that collects personal information. You can correct, update or review personal information you have previously submitted by going back to the specific tool or application, logging-in and making the desired change. You can also update any personal information you have submitted by contacting us using the contact information listed below.

If you have registered and desire to delete any your personal information you have provided to us from our systems please contact us. Upon your request, we will delete your personal information from our active databases and where feasible from our back-up media to the extent it is feasible to do so. You should be aware that it is not technologically possible to remove each and every record of the information you have provided to the SBMD Site from our servers.

3. Use of Content

SBMD authorizes you to view or download a single copy of the material on this site solely for your personal, noncommercial use if you include the following copyright notice: “©2013, http://advice.doctorbeheshti.com. All rights reserved” and other copyright and proprietary rights notices that are contained in the content.

The content is protected by copyright under both United States and foreign laws. Title to the content remains with SBMD. Any use of the content not expressly permitted by these Terms and Conditions is a breach of these Terms and Conditions and may violate copyright, trademark, and other laws. Content and features are subject to change or termination without notice in the exclsuive discretion of SBMD. All rights not expressly granted herein are reserved to SBMD.

4. Liability of SBMD and any affiliates or associates

The use of this site and the content is at your own risk. When using this site, information may be transmitted over a medium that may be beyond the control and jurisdiction of SBMD and its suppliers. Accordingly, Dr. Sayeh Behesthi and/or SBMD assumes no liability for or relating to the delay, failure, interruption, or corruption of any data or other information transmitted in connection with use of this site.

The SBMD Site and the content are provided on an “as is” basis. SBMD, ITS LICENSORS, AND ITS SUPPLIERS, TO THE FULLEST EXTENT PERMITTED BY LAW, DISCLAIM ALL WARRANTIES, EITHER EXPRESS OR IMPLIED, STATUTORY OR OTHERWISE, INCLUDING BUT NOT LIMITED TO THE IMPLIED WARRANTIES OF MERCHANTABILITY, NON-INFRINGEMENT OF THIRD PARTIES’ RIGHTS, WARRANTY OF ACCURACY, WARRANTY OF AND FITNESS FOR PARTICULAR PURPOSE. Without limiting the foregoing, SBMD, its licensors, and its suppliers make no representations or warranties about the following:

      1. The accuracy, reliability, completeness, correctness, or timeliness of the Content, of the SBMD Site.

      2. The satisfaction of any government regulations requiring disclosure of information on prescription drug products or the approval or compliance of any software tools with regard to the content contained on the SBMD Site.

In no event shall SBMD, its licensors, its suppliers, or any third parties mentioned on the SBMD Site be liable for any damages (including, without limitation, incidental and consequential damages, personal injury/wrongful death, lost profits, or damages resulting from lost data or business interruption) resulting from the use of or inability to use the SBMD Site or the content, whether based on warranty, contract, tort, or any other legal theory, and whether or not SBMD, its licensors, its suppliers, or any third parties mentioned on the SBMD Site are advised of the possibility of such damages. SBMD, its licensors, its suppliers, or any third parties mentioned on the SBMD Site are not liable for any personal injury, including death, caused by your use or misuse of the Site. Remedies under these Terms and Conditions are exclusive and are limited to those expressly provided for in these Terms and Conditions.

5. User Submissions

5.1 The personal information you submit to SBMD is governed by the SBMD Privacy Policy. To the extent there is an inconsistency between this Agreement and the SBMD Privacy Policy, this Agreement would govern. The Site contains functionality (including blogs, message boards, etc.) that allows users to upload content to the Site. You agree that you will not upload or transmit any communications or content of any type that infringe or violate any rights of any party. By submitting communications or content to the Site, you agree that such submission is non-confidential for all purposes. If you make any such submission you agree that you will not send or transmit to SBMD by email, any communication or content that infringes or violates any rights of any party. If you submit any business information, idea, concept or invention to SBMD by email, you agree such submission is non-confidential for all purposes. If you make any submission to the Site or if you submit any business information, idea, concept or invention to SBMD by email, you automatically grant-or warrant that the owner of such content or intellectual property has expressly granted-SBMD a royalty-free, perpetual, irrevocable, world-wide nonexclusive license to use, reproduce, create derivative works from, modify, publish, edit, translate, distribute, perform, and display the communication or content in any media or medium, or any form, format, or forum now known or hereafter developed. SBMD may sublicense its rights through multiple tiers of sublicenses. If you wish to keep any business information, ideas, concepts or inventions private or proprietary, do not submit them to SBMD.

5.2 SBMD Community and Member to Member Areas

If you use a Public Area, such as message boards, blogs, Ask The Doctor, you are solely responsible for your own communications, the consequences of posting those communications, and your reliance on any communications found in the Public Areas. SBMD and its licensors are not responsible for the consequences of any communications in the Public Areas. In cases where you feel threatened or believe someone else is in danger, you should contact your local law enforcement agency immediately. If you think you may have a medical emergency, call your doctor or 911 immediately. In consideration of being allowed to use the Public Areas, you agree that the following actions shall constitute a material breach of these Terms and Conditions:

      1. Using a Public Area for any purpose in violation of the laws;

      2. Posting material that infringes on the intellectual property rights of others;

      3. Posting material that is unlawful, obscene, defamatory, threatening, harassing, abusive, slanderous, hateful, or embarrassing to any other person or entity as determined by SBMD in its sole discretion;

      4. Posting advertisements or solicitations of business;

      5. After receiving a warning, continuing to disrupt the normal flow of dialogue, or posting comments that are not related to the topic being discussed;

      6. Impersonating another person;

      7. Distributing viruses or other harmful computer code;

      8. Harvesting, scraping or otherwise collecting information about others, including email addresses, without their identification for posting or viewing comments;

      9. Allowing any other person or entity to use your identification for posting or viewing comments; or

      10. Engaging in any other conduct that restricts or inhibits any other person from using or enjoying the Site.

SBMD or its licensors have no liability or responsibility to users of the SBMD Site or any other person or entity for performance or nonperformance of the aforementioned activities.

6. Advertisements, Searches, and Links to Other Sites

SBMD may provide links to third-party Site to allow advertisers to respond to certain search terms with advertisements or sponsored content. SBMD does not recommend and does not endorse the content on any third-party websites. SBMD is not responsible for the content of linked third-party sites, sites framed within the SBMD Site, third-party sites provided as search results, or third-party advertisements, and does not make any representations regarding their content or accuracy. Your use of third-party websites is at your own risk and subject to the terms and conditions of use for such sites.

7. Indemnity

You agree to defend, indemnify, and hold SBMD, its officers, directors, employees, agents, licensors, and suppliers, harmless from and against any claims, actions or demands, liabilities and settlements including without limitation, reasonable legal and accounting fees, resulting from, or alleged to result from, your violation of these Terms and Conditions.

8. General

SBMD is based in Newport Beach, California, in the United States of America. SBMD makes no claims that SBMD Site and the Content are appropriate or may be downloaded outside of the United States. Access to the Content may not be legal by certain persons or in certain countries. If you access the SBMD Network from outside the United States, you do so at your own risk and are responsible for compliance with the laws of your jurisdiction. The following provisions survive the expiration or termination of this Agreement for any reason whatsoever: Liability, Indemnity, Jurisdiction, and Complete Agreement.

9. Jurisdiction

You expressly agree that exclusive jurisdiction for any dispute with SBMD, or in any way relating to your use of the SBMD Site, resides in the courts of the State of California, County of Orange, and you further agree and expressly consent to the exercise of personal jurisdiction in the courts of the State of California in connection with any such dispute including any claim involving SBMD or its affiliates, subsidiaries, employees, contractors, officers, directors, telecommunication providers, and content providers. Notwithstanding any other provision, you agree to a final and binding arbitration in Orange County, State of California to resolve any dispute between you and SBMD and/or Dr. Sayeh Beheshti arising from or related to your use of the SBMD Site in any way, shape or form.

These Terms and Conditions are governed by the internal substantive laws of the State of California, without respect to its conflict of laws principles. If any provision of these Terms and Conditions is found to be invalid by any court having competent jurisdiction, the invalidity of such provision shall not affect the validity of the remaining provisions of these Terms and Conditions, which shall remain in full force and effect. No waiver of any of these Terms and Conditions shall be deemed a further or continuing waiver of such term or condition or any other term or condition.

10. Complete Agreement

These Terms and Conditions and the SBMD Privacy Policy constitute the entire agreement between you and SBMD with respect to the use of the SBMD Site, and its content.

×

Disclaimers


DOCTOR LIFE ADVICE IS NOT INTENDED FOR PROVIDING MEDICAL OR PSYCHIATRIC DIAGNOSES OR ADVICE, AND IS NOT A SUBSTITUTE FOR SEEKING THE HELP OF A PHYSICIAN. DOCTOR BEHESHTI, THE AUTHOR OF THE ARTICLES DOES NOT PROVIDE MEDICAL OR PSYCHIATRIC DIGNOSIS, TREATMENT, OR ADVICE ON THIS PAGE.

IF YOU FEEL YOU HAVE A MEDICAL OR PSYCHIATRIC EMERGENCY, PLEASE CALL 911 OR GO TO YOUR NEAREST EMERGENCY ROOM. THIS SITE IS NOT INTENDED FOR PROVIDING EMERGENCY SERVICES OF ANY KIND.

This website contains questions, answers, graphics, drawing, and other content and material, all of which are for informational purposes only, and are public information. Any questions submitted will be reviewed, and if they are to be answered, the content of the question may be edited for purposes of making it easier to read, and to protect the submitters' identity.

The content of this website is not intended for forming a doctor-patient relationship. Whether or not you get a response to your question, you should be aware that you have not formed a doctor-patient relationship with Doctor Beheshti, and she is not liable for your medical and mental health or wellbeing. Use the responses provided on this website at your own risk, and do not use them in place of a physician's advice.

This website is not intended to replace seeking advice from your physicians. Always seek the advice of a physician, psychiatrist, psychologist, or other health care professionals for issues concerning your physical and mental health. If you submit a question which does not get a response, do not consider that as a sign that you should not seek out the care of a physician.

WARNING

ALTHOUGH AT DOCTOR LIFE ADVICE WE RESPECT THE PRIVACY OF ALL INDIVIDUALS, THE CONTENT OF THIS WEBSITE IS COMPLETELY PUBLIC. THE BEST EFFORTS WILL BE MADE TO MAINTAIN YOUR ANONIMITY WHEN YOUR QUESTIONS ARE POSTED ON THE WEBSITE; HOWEVER, PLEASE BE AWARE THAT YOUR QUESTION MAY BE POSTED ON THE SITE WITH MINIMAL MODIFICATION AND WILL BE AVAILABLE TO ANY AND ALL READERS THAT ACCESS THIS WEBSITE. PLEASE TAKE EXTRA CARE TO PROTECT YOUR IDENTITY AND CONFIDENTIALITY WHEN YOU SUBMIT A QUESTION OR INQUIRY. DOCTOR LIFE ADVICE IS NOT RESPONSIBLE IF SOMEONE IDENTIFIES YOU BASED ON THE INFORMATION PROVIDED IN YOUR QUESTION. YOUR IDTENTIFYING INFORMATION PROVIDED BY YOUR EMAIL, SUCH AS EMAIL ADDRESS, NAME, IP ADDRESS, ETC. WILL ALL BE REMOVED AND DELETED FROM OUR EMAIL ACCOUNT BEFORE YOUR QUESTION IS POSTED.

×

Helpful Resources




×

About Doctor Life Advice

Doctor Beheshti

I am a compassionate and well trained psychiatric doctor, and I spend my days talking to others and helping them with their daily issues and problems. I have come to understand that all of us, regardless of our backgrounds and our life stories - every one of which is unique - share similar wants and needs.

I love my job which allows me to hear unique stories and help each of my clients individually. Although I cannot take the place of your doctor, I would love to hear your story too and perhaps provide some advice that will be useful to you, as well as others that will benefit from your story.

I have a sense of humor which comes through in my writings. Please know that I NEVER intend to make light of anyone's painful or sensitive situation. I only use humor because I think sometimes a smile and a little chuckle can go a long way in helping us feel better.

Doctor Life Advice is written and maintained by Sayeh Beheshti, M.D., M.A., a private practice psychiatrist in Newport Beach, CA.


×