Archive of entries posted by Gordon Herz

Changes in Psychotherapy Service Delivery in Medicare 2013 – 2015 – Part 1

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In the context of recent reports that Medicare abruptly halted release of much-anticipated data which could have shed light on the performance of Medicare Advantage plans, CMS recently made available its “public use file” on “Provider Utilization and Payment Data” for 2015. Data provide a resource to better understand individual and aggregate delivery of health …

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The Left’s Convenient Hypocrisy on Obamacare

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First, lest my point here be misinterpreted as a condemnation of the Affordable Care Act, let me state emphatically and unequivocally that I support the ACA. Let me take that back just a bit. I support it with all the enthusiasm that any of its strongest supporters do. That is, it is the best system …

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Cognitive Assessment in Private Practice

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Thank you Dr. Tansey for inviting me to talk to your graduate Adult Cognitive Assessment class on assessment in private practice. I thoroughly enjoy talking with the “next generation” of our profession. This was an interested group who asked great questions and are clearly thinking about how they will fit in the future. I hope …

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Are Mental Health Clinicians Fleeing Medicare?

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As a followup to recent “sky is falling” levels of concern about potential large scale flights of practitioners from Medicare, I got curious about how many mental health clinicians provide services to Medicare beneficiaries, and what the recent trends have been. The “provider utilization and payment data” published by CMS at Data.CMS.gov afford an opportunity to …

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OMG The Sky Is Crashing In On Us Again!!

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How quickly we forget. Just a year ago, every health care practitioner participating in Medicare (on average less than 1% of physicians have opted out of Medicare — though of course now we are hearing scare stories of pending “mass exodus”) the annual “will they or won’t they really impose the 25% or so ‘sustainable growth rate’?” …

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It’s Easy For A Payer To Spot An Outlier

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How easy? The following information is based on the 2013 “Medicare Data” (Data.CMS.gov). Can you spot the outliers? That’s right. It’s easy to see that the overwhelming majority of clinicians provided 1000 or fewer 53+ minute sessions in 2013. A few obviously break away from the pack providing 1-2,000 such sessions, fewer still between 2-3,000, …

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45 Minutes is The Most Common Therapy Session Length

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53+ minute psychotherapy sessions can hardly be called ‘outlier’ or ‘atypical’ session lengths, as some insurers may now be asserting. However, 53+ minute sessions are not necessarily the most commonly employed increment for treatment visits. Here’s a look at the 2013 numbers from the large Medicare population (approximately 52 million in 2013). Source:  https://data.cms.gov/. *Number of …

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53+ Minute Psychotherapy Sessions Remain a Standard of Care

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Reports are emerging that insurance companies are directly or indirectly pressuring clinicians to decrease their use of CPT Code 90837 (for a psychotherapy session 53+ minutes in length), or outright refusing to reimburse for these. Clinicians are once again alarmed about potential bias against coverage of reasonable lengths for psychotherapy sessions for appropriate conditions. I …

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Back To The Future Of Reimbursement For Psychological Services

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In February 2014, I estimated that the national average for third party reimbursement for a diagnostic interview could stabilize at around $137 for doctoral providers from 2019-2023, that 45 minutes of psychotherapy would stabilize at about $88 during that same time frame, 60 minutes of psychotherapy at about $131, and psychological testing in the $82-$83 …

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