Sunday, October 25, 2020
Alex Papp MD
A respected psychiatric journal, JAMA Psychiatry, recently published a study, in which they showed that an increasing number of psychiatrists in the US have been opting out of accepting payment for services by insurance and will only see patients who pay upfront, out-of-pocket, for office visits. While the frequency of such direct-pay practices has remain unchanged in the past decade in the general medical disciplines, psychiatry is showing this different trend.
The study found that in 2007 about 19% of psychiatric visits were paid by the patients directly; by 2016 it increased to about 27%
The most interesting – and most telling – findings of the study were these two: Self-pay visits lasted significantly longer than insurance-reimbursed visits, and self-paying patients made about twice as many visits during the 12 months of the study (2015-2016) than insurance-covered patients.
The question then arises: Why would someone who pays $200-300 fees for (theoretically) the same treatment and book more appointments than someone who pays only $20-40 copayment per visit? Doesn’t it sound contradictory and illogical?
Not, if you think more about it.
Treatments provided in insurance-based and private-pay-based practices are not the same. Many times, patients in insurance-based practices are treated during “15 minute med checks”. Patients see these doctors less frequently for two reasons: First, the doctor runs a volume-based practice and there is no time for frequent appointments, everybody needs to be squeezed in; and second, patients often find little value in these visits and drop out of treatments early.
Practices that are based on self-pay, such as here at the Point Loma Clinic, allow patients to be seen for longer times (an initial visit last for 1.5 hours; try that with an insurance-based practitioner!) and follow-up visits last for 50-55 minutes until stability is achieved. It is only after stability that appointments are reduced to 25-30 minutes. In addition, visits can be scheduled with greater frequency and with greater flexibility. The result is that patients find much greater value in the service, and even though it costs more, they use it more.
This is clearly far from being an ideal situation. What adds insult to injury for those who have no choice but to use third party coverage is that the insurance companies are making huge profits on their ever-increasing premiums, which covers ever-decreasing services.
It is beyond the purview of this blog to deal with the societal ills that produces this situation, but it is clear that they exist and they should change.
