health insurance

Blue Cross announces 10% cut in behavioral health fees

Posted 6/18/12

PROVIDENCE – Beginning July 1, Blue Cross & Blue Shield of Rhode Island has announced a nearly 10 percent cut to behavior health professionals who treat patients in 45-minute psychotherapy sessions.

The changes were announced in a letter dated May 30 from Dr. Gus Manocchia, Blue Cross senior vice president and chief medical officer.

The letter announcing the cut in reimbursements followed the departure of Sean B. Jones in the middle of May. As assistant vice president of behavioral health strategy and clinical services, Jones had been involved in conversations with the Rhode Island Psychologists Association, a professional association with more than 200 members who are Ph.D.-level psychologists.

“We are very concerned,” said Peter M. Oppenheimer, a psychologist who serves as co-chair of the Coalition of Mental Health Professionals of Rhode Island and is also chair of the legislative committee at RIPA. “Reducing rates to behavioral professionals will create less access to services,” he predicted.

Further, Blue Cross should be making better use of psychologists’ skills, he continued, “to help people with preventive care, to help people with chronic illnesses with preventive health needs.”

Instead, he also expressed worry that the move to cut reimbursements for therapy sessions may be to support a move away from therapy toward drug therapy.

Oppenheimer also expressed frustration that Blue Cross had not been interested in engaging or talking with his group. “We have been ready and willing to work with them in a constructive manner to improve quality and access, and contain costs and make better use of professional resources,” he said. Blue Cross, he continued, “has not been interested in even talking with us. It’s very frustrating.”

In addition, Oppenheimer voiced concern about a proposed metric on patient satisfaction now under consideration by Blue Cross, in which patients would fill out a survey at the completion of each session. Those therapists who achieve the greatest patient satisfaction in the surveys would be eligible for incentive payments.

“Unlike most businesses, my goal is not to have a happy, smiling customer walking out my door every time,” Oppenheimer said.

Blue Cross did not answer questions directly whether these reimbursement reductions were included in the proposed 2013 rate requests, or what were the projected total savings the health insurer hoped to achieve with the reductions in reimbursements.

In its statement in response, Blue Cross spokeswoman Kim Reingold said: “With physician and professional services currently accounting for about 28 percent of our member’s claims, we regularly review our professional provider fee schedules to ensure reimbursements are fair and competitive. While total annual increases in our standard fee schedule have been kept to inflationary levels over the last few years, we still have additional opportunity to more closely align to the Centers for Medicare & Medicaid Services physician fee schedule payment rates. We have made progress and some professional fees continue to be better aligned with the CMS fee schedule payment rates than others, such as those of behavioral health providers.”

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