Out-of-Network Care More Common in Substance Use, Mental Disorder Treatment

Patients with private insurance who saw behavioral health professionals went out-of-network for their care more often than their peers who received care from medical or surgical health professionals, according to a study published today in Psychiatric Services.

Tami L. Mark, Ph.D., of RTI International, and colleagues analyzed deidentified health insurance claims data from 22.8 million individuals in the Merative MarketScan Commercial Database who had private insurance in 2021. They compared the percentage of out-of-network claims for behavioral health providers with the percentage of out-of-network claims for medical and surgical providers across four settings: inpatient facilities, subacute inpatient facilities, outpatient facilities, and office visits to independent practitioners.

Across all settings, patients with substance use disorder (SUD) were most likely to go out-of-network for care, followed by those with a mental disorder and those who received medical or surgical care. For example, the percentages of out-of-network encounters in acute inpatient facilities such as hospitals were 18.1% for SUD, 4.3% for mental disorders, and 1.5% for medical or surgical treatments. The percentages of out-of-network encounters in subacute inpatient facilities such as residential settings were 35.9% for SUD, 31.7% for mental disorders, and 1.7% for medical or surgical treatments.

“Our finding of greater use of out-of-network behavioral health providers versus medical or surgical providers is consistent with findings from other studies in which researchers used different methodologies (e.g., secret shopper calls, employer surveys, consumer surveys, and provider network analyses) that showed that consumers have limited access to in-network behavioral health providers,” the researchers wrote. “Health plans have strategies to increase providers’ network participation, such as increasing reimbursement rates, reducing the administrative inconveniences of joining a health plan, and reducing the administrative burden of being paid by a health plan.”

For related information, see the Psychiatric News article “Access to In-Network Mental Health Care Still Lags Far Behind Other Medical Care.”

(Image: Getty Images/iStock/megaflopp)

---

Don't miss out! To learn about newly posted articles in Psychiatric News, please sign up here.

Follow Psychiatric News on X!

Follow Psychiatric News on LinkedIn!

Speakers Share Insights on Inpatient Psychiatric Care During COVID-19 Pandemic

Inpatient psychiatric units all over the country are grappling with the need to continue treating patients in the midst of the coronavirus (COVID-19) pandemic. On Wednesday, APA and the National Association for Behavioral Healthcare hosted a webinar with the leaders of three inpatient facilities so they could share their experiences so far.

The leaders were Harsh Trivedi, M.D., M.B.A., president and CEO of Sheppard Pratt Health Systems in Maryland; Ryan Kimmel, M.D., chief of psychiatry at the University of Washington Medical Center; and Frank A. Ghinassi, Ph.D., A.B.P.P., president and CEO of Rutgers University Behavioral Health Care. APA Education Director Tristan Gorrindo, M.D., moderated the webinar.

The speakers stressed the importance of addressing COVID-19 in health systems in a way that does not limit people’s access to behavioral health care. “We’re trying not to reduce our inpatient psychiatry footprint,” Kimmel said. “If anything, we’re trying to increase it.”

The participants outlined strategies they’ve adopted to deliver psychiatric care during the COVID-19 crisis, including the following:

Setting up remote services wherever possible: The participants explained that their systems have worked to rapidly provide outpatient services through telemedicine.

Trivedi said Sheppard Pratt is working to launch a virtual assessment service for patients in crisis. When patients on inpatient wards test positive for COVID-19, Ghinassi said his staff use video technology to allow patients to participate in educational and group activities from their rooms.

Restricting outside visitor access: Ghinassi said his system’s inpatient units and screening facilities have stopped allowing visitors. The only exception to this protocol is pediatric patients, some of whom are as young as 6 or 7. The policy allows visitors on a case-by-case basis, but “as difficult as it is, we have not allowed more than one or two of those visits to actually happen,” he said. “We are making ample access to video technology … to allow the parents to visit virtually, but visiting has, for all practical purposes, ceased on any of our units.”

The system has also started doing temperature scans of everybody who comes in and out of the buildings on a daily basis, Ghinassi said.

Using personal protective equipment (PPE) carefully: Typically, on inpatient psychiatric units, plastic biohazard bags or PPE supplies that could be used as ligatures must be stored where patients cannot access them, Kimmel explained.

“On our inpatient unit we’ve had to develop systems where inside the patient’s room is a locking closet, to which the staff has a key but the patient doesn’t, where we store some of the supplies and the biohazard bags,” he said.

Supporting staff: Communication has been essential for each of the participants and their staffs, they said. Information from the Centers for Disease Control and Prevention and local departments of health changes rapidly, they said, and strong lines of communication with staff are vital. Kimmel said the University of Washington Medical Center has set up a peer-to-peer program to support staff.

“We are all human beings, and we are all relationship-based,” Trivedi said. “Within our messages we ask: How do we take the time to support one another?”

(Image: iStock/baona)

---

APA’s COVID-19 Resource Center Keeps You Updated

APA’s COVID-19 Resource Center brings together a number of useful resources from APA and other authoritative sources to help you deal with the COVID-19