Psychiatr News September 1, 2006
Volume 41, Number 17, page 13
© 2006 American Psychiatric Association
Psychiatric Practice & Managed Care APA Office of Healthcare Systems
and Financing
|
Psychiatry Leads Specialties in Opting Out of Managed Care
A report from the Center for Studying Health System Change (HSC) released
in May notes that the percentage of physicians who do not have contracts with
any managed care plans has taken its first jump after remaining stable for a
number of years—from 9.2 percent in 2000-2001 to 11.5 percent in
2004-05. Although the increase doesn't seem large, HSC believes it signals a
significant trend.
HSC is a nonprofit research organization that studies the U.S. health care
system and is funded primarily by the Robert Wood Johnson Foundation. A survey
group of 12,000 practicing physicians provides HSC with information about how
health care delivery is changing.
Despite complaints, most physicians continue to contract with managed care
organizations (MCOs). However, according to the HSC survey, 34.6 percent of
psychiatrists have chosen to opt out of managed care. This contrasts with 9.4
percent of primary care physicians and 10.5 percent of all medical
specialists.
The HSC report notes that physicians in solo or two-physician practices are
less likely to contract with MCOs, possibly because of the administrative
burden. It also notes that physicians who have been in practice for more than
20 years are less likely to have managed care contracts than those who have
been in practice for 10 years or less, suggesting that more experienced
practitioners may have a patient base and reputation enabling them to bypass
managed care plans.
According to the HSC, psychiatry is the medical specialty that has always
had the largest number of physicians without managed care contracts. The
reasons include low reimbursements and the utilization management imposed on
psychiatry by MCOs and managed behavioral health companies. HSC also suggests
that the high percentage of nonparticipating psychiatrists may reflect the
shortage of psychiatrists in many areas. 
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