What Managed Care could do to be more friendly to Providers:
1. Help us protect the confidentiality of our patients.
2. Don't refer the "consumers" to special groups or "providers" who will cut a better deal with the MCO. Instead, let the "consumers" choose from the list of all "providers" and let the providers compete with each other on the basis of their good clinical services.
3. Have ONE Central Credentialing Database instead of asking us to fill up endless and repetitive forms, one for each MCO corporation, with the same data.
4. Get together and come up with ONE Treatment Plan Form for all. I am glad to say this is now the law in
5. Make it possible for this Treatment Plan Form to be computerized in a way that we can fill, file, save and fax it from our computers.
6. Allow the authorizations for treatment to be flexible because in psychiatry we need to change treatments as the mental status of our patients change. In order to accomplish this allow us to have ONE identifiable contact person ("manager") in each corporation who we can talk to when we need to change treatment plans in short notice.
7. Authorizations for at least ONE year of clinical work each time or at least 24 sessions.
8. Have MCO Medical Directors, who decide to pay or not for a treatment, be as liable as I am for clinical decisions in terms of "medical necessity". Also for him to be under the jurisdiction of the Board of Physicians Quality Assurance as I am..
9. For the patients we do the Initial Evaluation, allow us, psychiatrists, to recommend medication, psychotherapy or both with us, if we find this indicated.. Of course keep open the possibility of us referring for psychotherapy to an allied profession.
10. Pay more for 90805 (Medication and Psychotherapy) than for 90862 (Medication).
11. Make it a rule that inpatients can't be discharged to outpatient psychiatrists without live consultation between the inpatient and the receiving outpatient doctor, and his agreement.
What the APA can do to help a Solo Provider:
1. Sponsor a "Caucus of Psychiatrists Who Work with Managed Care Patients" that is, psychiatrists who work as "providers" for MCOs and the ones who are concerned with the fate of psychiatry under MCOs.
2. Give legal assistance to this Caucus.
4. Have at least two solo or group psychiatrists who work mainly with MCOs "consumers" sitting in the APA Managed Care Committee.