Page 18 - Silver Linings Issue3

important services. They have basically squeezed inpatient care down to very low cost and a very short period of time. They can get away with not paying for things because they are not held accountable by people who buy insurance or the government.
What we can potentially do here is develop more generous benefits that aren’t really that much
more expensive but do improve outcomes meaningfully. We do that by pushing insurance companies towards these evidenced-based treatments that are likely to
make it better for people. But a lot of insurance companies seem to act as if, “well, no one
is making us pay for these things so we just aren’t going to.”
It’s clear that the
reason these
services are not as
available as they
could be is that
payers have decided
to not reimburse
adequately for them. As
a result, they only become available to people who have enough money and can pay out of pocket.
The broken payer system has driven down the availability of a potentially cost-effective, high- quality resource for the general public because they
Are hospitals reimbursed fairly for inpatient and outpatient services?
Usually not because a lot of
rates are determined based on negotiations with larger hospital systems that have always treated psychiatry as a loss center rather than a profit center. If you run a big hospital and it was decided that all of your surgical specialties are going to get paid better than psychiatry, then from the outset
operating at a loss. Once that gets established, insurance companies can go to places like Silver Hill and say we’re paying this big hospital so much less. Yeah, because that big hospital is losing millions of dollars because they don’t care. There’s a lack of transparency in pricing in places where psychiatry actually is being priced according to the cost of delivering high quality care.
Would Silver Hill lose money if residential stays were covered by
insurance?
It would be part of a holistic package where the
hospital says, across
the spectrum, we should get reimbursed adequately for providing high-quality care that lowers people’s chances of going back to the ER
or the inpatient unit and improve their outcomes. It’s a chance
to say all of our care is really helpful and works.
We will present evidence that it works, but it needs to be paid
for adequately and, when it is, it saves money in the long term.
Joel Bernanke, MD, MSc, is a widely published child, adolescent and adult psychiatrist. He received his MD from Weill Cornell Medical School, completed his training in adult psychiatry and a post-doctoral fellowship in research at Columbia University and the New York State Psychiatric Institute, and his child and adolescent psychiatry training at the joint Columbia-Cornell
New York-Presbyterian Hospital training program.
simply decided, based on nothing, that it’s too expensive to cover these services. In reality, it’s potentially making it more
your profit centers are cardiology, gastroenterology and surgery. You never really cared about psychiatry and aren’t motivated to go to bat
to get psychiatry reimbursed for what it’s worth. In your negotiations with insurance companies, you were trying to get paid more for cardiology, not psychiatry.
Then it becomes established that this is how much psychiatry costs, but that’s actually psychiatry
18 expensive for them by depriving people of a critical service.