Psychiatr News April 21, 2006
Volume 41, Number 8, page 13
© 2006 American Psychiatric Association
Psychiatry Residents Exposed To Business of Medicine
Mark Moran
Residents learn from an instructional managed care provider contract
with language culled from actual, executed contracts incorporating the kinds
of seriously problematic language that they are likely to confront.
At Cleveland's West Side Market, fourth-year psychiatry residents from Case
Western Reserve University/University Hospitals of Cleveland might be found
bargaining with the vendors for the best price on a pineapple.
"The record is a quarter," said Residency Program Director
William Campbell, M.D., M.B.A.
The historic farmers' market at 25th Street and Lorain Avenue in downtown
Cleveland attracts hundreds of shoppers daily from all over the greater
Cleveland area, but Campbell's pineapple-seeking residents are honing their
negotiating skills—a homework assignment that is part of a unique
12-week seminar for PGY-4 residents titled "The Business of
Medicine."
Campbell believes trainees will look back on the practice gratefully when
it comes time for them to negotiate with managed care companies and employers.
"Negotiating skills are like any other skill set," he said.
"If you learn the techniques and practice, you can get very good at
negotiating deals."
Campbell described the seminar and outlined the rationale for teaching
residents the business of medicine at this year's annual meeting of the
American Association of Directors of Psychiatric Residency Training (AADPRT)
in San Diego.
"Psychiatrists can get themselves into a lot of trouble if they don't
understand basic business concepts," Campbell said. "Residency
graduates are going to face these issues one way or another."
The seminar at University Hospitals of Cleveland consists of weekly
75-minute classes scheduled during the first three months of the PGY-4 year.
Each of the 12 seminars is an instructional module based on a key business
topic relevant to the practice of psychiatry. The Socratic method of guided
questioning is used as the primary instructional model.
Separate classes are devoted to the following topics:
- How to secure a job
- Negotiating techniques
- Managed care organizations
- The pharmaceutical industry
- Health benefit plans
- Managed care contracting
- Professional liability insurance
- Psychiatric practice management
- Legal and risk management considerations for psychiatrists
Three of the seminar's 12 weeks are spent on managed care contracting.
(Campbell will also be teaching a continuing medical education course at this
year's APA annual meeting in Toronto titled "Managed Care Contracting
for Psychiatrists.")
At the AADPRT meeting, he showed attendees an instructional managed care
provider contract with language culled from executed contracts incorporating
more than 100 "landmines"—seriously problematic contractual
language covering issues such as restrictive covenants, hold-harmless clauses,
and the managed care company's definition of "medical
necessity."
"These were contracts that people actually signed," he said.
"Many times the only thing the psychiatrist wants to know is how much he
or she will be paid. So they flip through a 15-page contract looking only for
reimbursement rates.
"Oftentimes the reimbursement is reported as a percentage of the
Medicare rate," he said. "But what people don't know is that this
rate may be a `blended' rate, an average based on rates for all psychiatric
CPT codes. The managed care companies know which codes a psychiatrist
uses the most, and they discount these and bump up the others.
"If we don't help our residents learn these basic concepts, they will
needlessly get into a lot of trouble," he said.
So, too, residents need to know their way around health benefit
packages—a skill they need when talking to their patients about
treatment plans.
"If you know a patient only has 20 visits a year, though you believe
the patient needs to be seen once a week, that's something you need to talk to
the patient about," he said. "And if the patient is unable to pay
for services beyond the limits of the health plan, you need to talk to the
patient about negotiating a fee with you or transferring the patient to
another provider where continuity of care can be assured.
"A service you should provide as a psychiatrist is helping patients
understand what their short- and long-term out-of-pocket costs are likely to
be for the care you feel they need to have."
Campbell said residents also need to be introduced to the issues
surrounding physician interactions with the pharmaceutical industry and
pharmaceutical sales representatives.
"Most residents, and many practicing physicians, probably have no
idea how much data the pharmaceutical industry actually has on them," he
said. "They know prescribing patterns and a lot of background
information [about a physician]. Whatever your view is about whether residents
should have contact with pharmaceutical representatives during training, at
the end of the day when they complete their training, they are going to
interface with these representatives one way or another."
Campbell's residents in the "The Business of Medicine" seminar
receive assigned readings and take part in group discussions and case-based
learning exercises. Campbell is now developing a "Jeopardy" game
in which the relevant business topics will be used as the categories.
The residents also receive homework, like the assignment to visit the
farmers' market and come back with the lowest price on an item of produce.
"The best way to learn a new skill is to put it into action,"
Campbell said. 
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