Academic health centers rise to the challenge

By demonstrating the value of their services, practitioners at academic health centers respond to changes in the marketplace.

By Lisa Rabasca
Monitor staff

University academic health centers and their flagship teaching hospitals are dramatically restructuring the way they provide patient care because of the challenges generated by the growth of managed-care companies. Psychologists at these centers, meanwhile, are taking advantage of these structural changes, making their services indispensable by improving patient care and efficiency, and creating new referral networks.

'The onus is on psychology to demonstrate that their services are not only needed by their patients but they are also worth paying for,' says Stanley Berent, PhD, director of the neuropsych-ological division at the University of Michigan Medical Center. 'And that?s going to call for a kind of cleverness on the part of psychology to document why what they do is worth paying for.'

From Florida to California, psychologists have found clever ways to generate more patient referrals, trim program costs and increase their reimbursement rates by better demonstrating the value of their services.

Patient outreach

Psychologists at the University of Missouri?Health Sciences Center at Columbia, Mo., for instance, have attracted new patients by working more closely with primary-care physicians and reaching out to rural communities to provide services to patients who have had little access to care in the past. Over the last five years, Missouri?s center began contracting with rural hospitals?a move that has doubled its billing rate without increasing its staff size.

Several times a week, psychologists at the center travel to hospitals in rural communities, says Brick Johnstone, PhD, director of the division of clinical health psychology and neuropsychology in the department of physical medicine and rehabilitation at the University of Missouri?Health Sciences Center at Columbia. Not only does the center receive more patient referrals, it has fewer patient cancellations: Because it is often difficult and expensive for patients to travel to Columbia, Johnstone says, patients are more likely to keep their appointments when psychologists see them at their local hospitals. And, he says, the local hospitals welcome the psychologists because few facilities provide behavioral health services.

Psychologists at the center realize they need to be proactive about attracting clients. 'It is clear that we can?t just wait for patients to come in the door,' says Danny Wedding, PhD, director of the Missouri Institute of Mental Health (MIMH). MIMH is located in St. Louis and is part of the Health Sciences Center at Columbia.

As another way to increase patient referrals, psychologists at MIMH and the center developed a questionnaire and software program that helps area primary-care physicians identify patients with substance-abuse problems. Patients complete the questionnaire while waiting to see their physicians. Their answers are put into a database that flags potential problems. For example, Wedding says, if a patient acknowledges he drinks a six-pack of beer a night, he is referred to a psychologist affiliated with the Health Sciences Center and assessed for alcohol addiction. 'This service is especially important in rural areas where someone is providing a lot of different services and there are few specialists,' says Wedding, the immediate past president of the Association of Medical School Psychologists.

Part of the team

Working with primary-care physicians is easiest when psychologists are an integral part of the primary-care team. Recently, the administration at the University of California, Los Angeles (UCLA) Medical Center made its psychologists full voting members of the medical staff, says Roger Dafter, PhD, assistant director of mind/body medicine services division of head and neck surgery at UCLA. Their new status allows psychologists to be equal partners in the delivery of health care. Previously, psychologists were considered part of the professional staff, along with physical therapists and physician assistants, and were barred from participating in many committees that develop policy.

UCLA, which focuses primarily on specialty care, recently purchased Santa Monica Hospital, which has one of the best known primary-care residency programs in the country, Dafter says. UCLA is establishing a network of 50 primary-care clinics across the region. By diversifying, UCLA has positioned itself to increase patient revenues by becoming the premiere medical provider in the area, Dafter says.

Meanwhile, psychologists at the University of Florida Health Sciences Center also have positioned themselves to become part of a primary health-care team by teaming up with psychiatrists to establish a provider group known as the Shands Behavioral Health Network. The network is associated with Shands Hospital, the university?s teaching hospital.

Psychologists at academic health centers are often put in a position where they are competing with each other, says Bob Frank, PhD, vice president of Shands Behavioral Health Network. For example, he says, psychologists working in clinical and health psychology, family medicine and in the anesthesiology department often find themselves vying for patients. By creating the new network, psychologists are managing internal competition and addressing the pressures of competing interests in a collaborative manner, says Frank, who is also dean of the College of Health Professions.

The network is negotiating with Shands Hospital to provide mental health services and an employee-assistance program for Shands employees and their dependents, Frank says. This new contract would give the behavioral network 8,000 new patients.

Increasing revenues

In addition to finding new patients, psychologists at academic health centers have found they can increase the reimbursement they receive by demonstrating to managed-care companies the value of their services. By emphasizing research that shows the economic benefits of providing psychological services to patients, psychologists can expand the array of tests and treatments managed-care companies will pay for. Shorter hospital stays, earlier interventions and better adherence to medicine regimes are just some of the many benefits behavioral health programs can provide patients, Dafter says.

Berent and his colleagues at the University of Michigan Medical Center recently published a study showing the value of doing early psychological testing on patients with memory problems. The study found that with these tests individuals could be diagnosed up to two years earlier, enabling the psychologist to provide the patient with early interventions for dementia.

If, for example, psychologists can show that a test for progressive dementia has been studied in a scientific way, they can often convince the managed-care representative to cover the service, Berent says. Another way he helps to ensure inclusion of psychological services is by serving on committees and panels that decide which services managed-care companies will cover. For example, he recently participated in a National Institutes of Health consensus panel on children who take anticonvulsion medication. Although he says it was a struggle, Berent was able to convince the panel that psychological testing is a necessary part of treatment for these children.

By hiring staff to call managed-care company representatives to get prior approval for treatment and tests, psychologists at academic health centers have been able to see that patients get the coverage available to them. For example, the Health Sciences Center at Columbia has become very aggressive about pre-certifying their patients. 'There is a great focus on making sure we get paid for those patients who have [insurance] benefits for psychology,' Johnstone says.

Reducing costs

For many academic health centers, saving money by eliminating redundant services and programs is just as important as generating revenues:

? Psychologists at MIMH are working with the state?s social services, family services and youth services departments to identify children who are being treated by more than one agency, Wedding says. This will allow MIMH to eliminate any overlapping or redundant services being provided to these children.

? Shands Behavioral Health Network is setting up an 800 number so patients can access services from one telephone number, Frank says. The network also is realigning personnel so that multiple employees are not performing the same job for different departments.

Frank says he anticipates the network will create substantial cost savings for the University of Florida. 'If you don?t have information, ways to manage the flow of patients, and accountability, you won?t survive,' he says.