Welcome to my blog, a place to explore and learn about the experience of running a psychiatric practice. I post about things that I find useful to know or think about. So, enjoy, and let me know what you think.

Saturday, November 9, 2013

MHPAEA Addendum

Yesterday, in Parity or Parody, I posted about the new rules for the Mental Health Parity and Addiction Equity Act (MHPAEA).

A later article in the NY times, Equal Coverage for the Mentally Ill, states that, in fact, insurers ARE required to offer Mental Health and Substance (MH/Sub) coverage. This is not consistent with the government sites I referenced (DOL, CMS), but perhaps those sites hadn't been updated yet to reflect the new rules.

Regardless, I maintain that the excessively complicated details of the Act will make it possible for insurance companies to continue to restrict coverage for MH/Sub care.

I was struck by one paragraph, in particular, in the article:

The effect on costs is uncertain. Insurers fear that the expenses of high-cost inpatient treatment or long-term rehabilitation of patients suffering from mental health disorders or substance abuse will drive up insurance costs, but experts say the number of people receiving high levels of care will be too small to have a significant effect on overall costs. And in the long run, better care could cure enough people to save billions of dollars a year in medical costs, lost wages and reduced productivity associated with alcoholism and other addictions.

Who are we "saving billions" for? The article seems to make the assumption that the interests of insurance companies coincide with those of the government, and the people. Myself, I don't believe insurers care about lost wages and reduced productivity, especially if it means a dent in their bottom line.

And I don't even know where to start with the phrase, "Better care could cure enough people to save billions of dollars a year." Key words here include "could", "cure", and "better".

(Here's a link to the Final Rule. Good luck reading it.)

1 comment:

  1. "High cost" and "cost effectiveness" are two of the most common types of rhetoric used by managed care to restrict access to mental health and addiction treatment. The same rhetoric has lead to a complete abdication of any quality treatment. Large managed care systems frequently advertise themselves as providing quality "behavioral health" care when nothing could be further from the truth. The commonest examples include sending people home with benzodiazepines or opioids to detoxify themselves and admitting and discharging people from inpatient units based on their "dangerousness" rather than addressing their actual mental health and addiction problems.

    And who cares about money? The quote is a sign about just how far managed care rhetoric is ingrained at all levels. What about saving lives? What about alleviating suffering? This is why we all went to medical school. There are currently 14-15,000 people a year dying of opioid poisoning. How much of the current epidemic is the direct result of a cost effectiveness model? It is certainly easier to pretend to treat chronic pain with a pill rather than the comprehensive multidisciplinary approach that is required.