A perspective on the nation's antitrust policies: Implications for psychologists.

Abstract

In response to significant change in the health care market, federal antitrust agencies recently examined their past policies and future directions for antitrust law enforcement in the health care industry. This article reviews how the federal antitrust laws have been used to both aid and restrict the practice of psychology, psychologists' dealings with managed care, and the limits of antitrust law enforcement efforts. Finally, we argue that narrowly crafted antitrust reform would provide practicing psychologists and other health professionals with some degree of countervailing bargaining power in their negotiations with managed care.

Comparison of public/private health care insurance parameters for independent psychological practice.

“…As example, reimbursement for a diagnostic interview is over three times higher for a Medicare patient than one insured through some MHNet Behavioral Health plans, where the $50.00 hourly rate includes a patient copayment that on some plans is as high as $35.00 (the psychologist bills the insurance company for $15.00 a session). One of the main reasons that reimbursement rates vary greatly among private health care insurance companies is that antitrust laws prevent independent providers from bargaining collectively with managed care organizations (DeLeon et al, 2006).…”

“…In the 1980s/90s managed care implemented a unique organizational cost cutting strategy that involved separating the administration of mental from medical health care through the establishment of behavioral (the preferred term to mental) health care organizations known as behavioral health carve-outs . The three largest, together covering more than 50% of all persons in the managed behavioral health care marketplace, are Magellan Behavioral Health, ValueOptions, and United Behavioral Health (DeLeon, Bock, Richmond, Mays, & Cullen, 2006). Carve-outs have emphasized cost cutting measures like: reducing reimbursement rates; use of subdoctoral providers; gatekeeping (i.e., requiring primary care physician referral); dumping of patients with severe mental disorders into the public sector; high copayments and deductibles; preauthorization of treatment; and other paper utilization review procedures (Bransford, 2005; Cantor & Fuentes, 2008; Cummings, 2006; Gray, Brody, & Johnson, 2005; Sanchez & Turner, 2003; Sturm, 1999).…”