Psychologists can control costs without HMO oversight, study indicates

Managed-care companies may not need to conduct intensive utilization review, argues the author of a study that found psychologists were less likely than master?s-level therapists to exhaust a patient?s maximum mental health benefit.

Rodney Howard, PhD, a clinical manager of The Synton Group Inc. of Lansing, Mich., writes about his study in the latest issue of Professional Psychology: Research and Practice (Vol. 29, No. 3).

The research looked at 300 mental health-care patients enrolled in Physician?s Health Plan of Mid Michigan, an HMO that has a maximum mental health benefit of 20 sessions annually. Synton, which manages mental health benefits for the HMO, typically grants patients an initial six sessions and requires providers to submit requests for additional treatment. The patients in the study were assigned to 60 clinicians?33 of them psychologists and 27 master?s-level providers?who participate on the HMO?s panel.

The patients were granted either six, 10 or 19 sessions (not counting the initial assessment session, which counts as part of the 20-session limit). Under the study parameters, the HMO automatically authorized additional sessions, up to the annual limit, when therapists requested it. A control group of 75 participants entered into treatment under the HMO?s normal procedures, meaning the company didn?t automatically authorize additional sessions.

The psychologists in the study averaged about 9.9 sessions for treatment when authorized the full 19 sessions?only about 2.5 sessions more than those in the control group. But master?s-level providers averaged 12.9 sessions, about 5.5 sessions more than the controls. And when the company was not required a $20 co-payment, the average length of treatment by master?s-level therapists jumped to 14.3 sessions, compared with only 10 sessions for psychologists.

Also, 31 percent of the patients seeing masters?-level therapists exhausted their annual benefit, compared with only 19 percent for psychologists.

'The study clearly suggests that monitoring of psychologists could be reduced without substantial increase in utilization,' Howard writes. 'For the master?s-level provider, this is not the case. When given free reign, their use of sessions was substantially higher than when managed.'

Mirean Coleman, senior staff associate for the National Association of Social Workers, argued that master?s-level social workers have practiced short-term treatment for more than 65 years and are trained to be thorough in their assessment and treatment. 'To measure the quality of services, one should examine outcome measures, not the number of sessions,' she added.

?S. Sleek