Tuesday, June 9, 2009

The Industry Strikes Back: Counter-Testimony on H.3546 from Another Point of View

Last week, several of us testified in favor of H. 3546, a bill to induce the private sector to pay for a piece of the care coordination necessary to provide effective mental health services for children and adolescents in Massachusetts.  No one provided oral testimony opposing the bill;  Blue Cross and Blue Shield of Massachusetts, however, did submit written testimony opposing the bill.  It makes for fascinating reading- here is a summary:
1)  "Blue Cross and Blue Shield already factors in collateral activity in developing reimbursement rates for providers".  Really?  That is not what the folks in my billing office tell me;  we get to charge only for time in the room with the patients;  time on the phone doesn't count in figuring the level of services.  To which encounter do we attach the collateral service, when it happens with the patient out of the room?  In any event, it seldom happens, which implies that their "factored rates" are not enough to make it happen.
2)  "Analyzing the cost impact of coverage for collateral services is difficult because of the significant uncertainty about how they would be provided and billed".  I agree, but I have great faith that the insurers will develop appropriate hoops for us all to jump through.  The service is necessary;  smart people can figure out to prevent fraud.
3)  "Further information is needed to truly understand the efficacy and cost of providing and reimbursing for collateral services... Creating a mandate when so little information is available is unwise..."  This service is required of public players, and they have found it useful.  Surely, the private sector can provide the same level of service, and perhaps generate data on its efficacy. 
The Massachusetts Association of Health Plans offered similar critiques; the ultimate refutation lies in the product that the current system produces.  We all knew that screening for behavioral health problems was a good thing, and many thought that it should be part of the primary care package; it did not catch on in Massachusetts until primary care providers got reimbursed for it.  Similarly, if you only pay us for face time with patients, that will be mostly what you get.  This bill will help, and if it leads to broader discussions of the need for collateral services in other areas, so be it.  In the end, our patients will all benefit.

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