Psychiatr News March 17, 2006
Volume 41, Number 6, page 42
© 2006 American Psychiatric Association
Managed Care Has Progressed
Michael A. Haberman, M.D.
Atlanta, Ga.
Managed Care Has Progressed
Michael A. Haberman, M.D.
Atlanta, Ga.
In the article "Road to Today's Psychiatry Hard but Full of
Promise" in the November 4, 2005, issue, the reporter references remarks
made by APA President Steven Sharfstein, M.D., in a lecture given at APA's
2005 Institute on Psychiatric Services. Dr. Sharfstein is quoted as saying,
"Despite the efforts of payers and their managed care hired guns to
reduce and constrain care, there is a sense of rising expectations in society
for effective psychiatric care."
I write to respond to this. If it is an actual quotation, it is an
insulting and dismissive rebuke directed toward managed care medical
directors. Implicit in such a remark is a lack of understanding of the role of
psychiatrists within a managed care company. Many of these medical directors
are members of APA, including me, and I do not appreciate the
characterization. As an experienced psychiatric clinician and administrator, I
believe psychiatrists play an essential role within MCOs. My own experiences
with managed care reviewers 20 years ago led me to begin some work with
managed care organizations to modify the process. Managed care review
processes have evolved significantly over time.
The problem of health care inflation is well known and must be addressed
since it is our reality. If psychiatrists do not participate in the evolution
of the health care reimbursement system, underlying business decisions might
well bring more draconian measures to stop what many consider a serious
problem for an employer or government-based health care system.
APA should represent all of its members, and APA officers should refrain
from personal attacks. A collegial interchange is always more effective than
name calling or expressing hostility toward people choosing to work in this
setting.
Footnotes
Dr. Haberman is assistant medical director at United Behavioral
Health.
APA President Steven Sharfstein, M.D., responds:
My remarks in San Diego were not specifically focused on managed care
medical directors as Dr. Haberman implies. I know quite a few of them and
count them as friends and colleagues. But in the context of the early 1990s,
when managed care companies, at the behest of the major third-party payers,
cut the costs of care, there was an unprecedented morale crisis for our field.
Clinical decision making was compromised in the effort to contain costs.
We can argue about whether that was necessary then, but the reaction from
the profession and from patients and families led to significant changes in
managed care practices. In the last five years, we have seen more interest in
the field as practice once again is primarily determined by the treating, not
the reviewing, physician. It is to the credit of the current generation of
medical directors in managed care that the process of care and costs is much
more collaborative than it once was, but from time to time there are conflict
and sensitivity. I also believe health care inflation is real, and the
administrative costs excessive in our overly managed system. I have devoted
much of my research and work to finding ways of improving access to effective
and efficient care for all Americans.
Personal attacks are not helpful as we need to understand each other and be
part of the solution, not the problem. APA provides a forum for debate and
discussion.
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