The hospital private practice of psychology: CHAMPUS 1981–1991.

Abstract

This article reviews and analyzes CHAMPUS (Civilian Health and Medical Program of the Uniformed Service) inpatient data from 1981 to 1991. Utilization data are presented by state, year, and profession for inpatient visits. There has been a moderate but progressive growth in the proportion of inpatient visits provided by psychologists over these years, from 3.3% to 19.4%, nationally. In terms of beneficiaries receiving some psychological services, the proportion increased from 7.2% to 26.5%. Visit level in 1991 was highest in Texas at 30.5% and least in Georgia at 12.7% among the 9 states detailed. Psychiatry has seen a 20% drop in the proportion of inpatient visits it has rendered over these years, and fewer psychiatrists provided CHAMPUS services in 1991 than in 1981. These data reflect the fact that the private practice of psychology in hospitals has gained increasing recognition.The main purpose of this article is to document the gradual growth in the private practice of psychology in hospitals over the 1981 to 1991 period. The scope and volume of CHAMPUS mental health services provides a major window through which fee for service (FFS) psychological practice can be studied. The focus here is on the expansion of inpatient hospital practice by psychologists over an 11 -year period, in one of the single largest health programs in the country. To set the stage, pertinent state and then federal legislation are summarized, and a significant change in hospital accreditation standards is noted.The empirical utilization, provider, and cost data on hospital practice presented in this article were derived from the annual accounts of mental health services (claims paid data) under the Civilian Health and Medical Program of the Uniformed Service (CHAMPUS). These data are presented in tabular form, and their implications discussed. State LawPsychology state licensure laws are generally silent on "locus of care." Although freedom of choice legislation has been widely adopted, including 40 states covering 92% of the U.S.

Psychologists in public inpatient psychiatric settings: Ethical dilemmas.

“…Respecting the prerogatives and obligations recorded in hospital bylaws may indicate that a psychologist-administrator cannot engage in the essential administrative and clinical activities that such positions require. Often psychologists functioning in administrative positions have had to appeal to rules and statutes outside the hospital to support their roles, and, by doing so, have risked conflicts with hospital administrative and medical staff, who may interpret such behavior as interfering with normal operations (Dorken et al, 1993). Many psychologists are in the awkward position of attaining a level of clinical-administrative competence but are not privileged to provide those services in public psychiatric inpatient settings.…”

Impact of law and regulation on professional practice and use of mental health services: An empirical analysis.

“…This is our fourth illustration of policy changes having a major impact on practice. In addition, this finding leads us to an initial tentative conclusion that physician gatekeepers exercise greater control or restraint over nonphysician providers than over other physician providers (also see Dörken, in press).…”

A systematic review of the psychology literature addressing hospital practice.

“…These themes included the primary functions of research, assessment, and psychotherapy, recurrent challenges with practice boundaries, and the need for the articulation of the value proposition of psychology in resourceconstrained systems. Psychology has been engaged in a complicated and often fraught dance with psychiatry throughout this period-moving from the safer territory of research and assessment to wresting privileges to practice psychotherapy independently from psychiatrists in the mid-20th century (Landis & Kinder, 1948) and fighting to independently practice in hospitals at all through the early decades of psychiatry-controlled accreditation in the 1970s and 1980s (Dörken, 1993). This document is copyrighted by the American Psychological Association or one of its allied publishers.…”