My legislators, ______, ______, ______, and _____have ignored my letters and phone calls regarding the way HMO’s and Managed Care Corporations have made doing business as a private practice psychotherapist very difficult. Things have become worse for employers who pay higher costs for healthcare coverage and for the insured who have less access to services. Not much attention has been given to providers who have faced cost of living and cost of business increases over the years occurring simultaneous to decreases in the amount we are reimbursed. I believe that legislation is the only way to remedy the problems of runaway market forces.
In 1980, I saw a therapist who had a profound impact on my life. I paid her $85.00 per session and my health plan reimbursed me 80%. Within 30 days of sending in my receipt, the health plan sent me a check for $68.00, making my out of pocket expense only $17.00. 23 years later, that very same health plan pays me as a “panel provider” only $68.00 per session. The amount I can earn has decrease from $85.00 to $68.00. Other HMOs and Managed Care Corporations pay $40.00 to $60.00 per patient hour. Ironically, since 1980, healthcare premiums have quadrupled in price.
Some more cost of living facts: In 1980, I paid a plumber $35.00 to fix my garbage disposal, and in 2003, I cannot find a plumber to do the same work for $100. In 1980, the cost of a Grand Slam Breakfast at Denny’s was $1.99 and today costs $2.99 that is up 30%. The cost for a family of four to go to Disneyland was $80 in 1980 and today it costs double at $160.00. My estimate indicates that it would take twice as much working time for a therapist to afford to take his or her family to breakfast and to Disneyland! But that is not all that has increased in Southern California. My auto mechanic tells me that in 1980 a good mechanic could make $6.00 to $10.00 per hour and nowadays earns $18 to $30 per hour. Statistics given by ewengin.com. say that “$50,000 in 1980 had the same buying power as $106,000 in 2002.”
Professional overhead costs have risen as well. Tuition for a Master’s Degree, at the same school I attended, was $2,800 per year in 1980 and today costs $15,810 per year. The typical office space today runs around $2.00 per square foot, around double from 20 years ago. Computers and ISP fees have come into existence. The new HIPPA law also requires significant expenses. We are mandated to take more costly continuing education classes to maintain licensure. Lawsuits by litigious patients have increased.
Things HAVE TO CHANGE and I suggest that legislators do the right thing and begin legislating changes such as upping our fees according to experience, decreasing the required costly continuing education units and require third party payors to reimburse us when we employ interns who work with clients. We need legislation that would allow county mental health contracted private practice therapists to make as much as an agency makes per hour when an intern sees a patient. In comparison, we currently get about 50% of that fee. Please create a law allowing for a billing code for the time it takes to do all the paperwork we are now required to do, a code to bill for the time we set aside for a patient when the patient does not show up and a code to bill payers for failure to reimburse us in a reasonable time. And please create legislation to eliminate blacklisting for therapists who might be what are labeled “high utilizers”.
Legislators, please help my profession by legislating changes so that we can take care of our families by earning what we should be earning. The changes I suggested would also ensure that potential therapists of tomorrow are not persuaded to go into other non-diploma careers that pay more. Please do not allow psychotherapists to be sold down the drain as your children and your children’s children can really benefit by what we have to offer.