Psychiatrists at one of Washington, D.C.,’s largest hospitals have decided that, on the basis of early evidence, they don’t want to stick around to see how the federal government’s mental health parity mandate turns out.
On January 1 the Office of Personnel Management, which oversees the Federal Employees Health Benefits Program (FEHBP), began to implement a Clinton administration executive order stating that insurance plans covering the health of 9 million government workers and their families must offer the same coverage for mental health services as they do for physical health (Psychiatric News, June 2, 2000; October 20, 2000).
While this news was welcomed by the psychiatric community, implementation of the mandate has had its downside. The psychiatrists at George Washington University Medical Center decided that on the basis of what they had to endure in terms of additional paperwork burdens and treatment-authorization protocols since the parity program began, they were going to withdraw from participating in all the FEHBP insurance plans, except the university’s own health plan, said Jeffrey Akman, M.D., professor and interim chair of the psychiatry department.
Eliot Sorel, M.D., a past president of the Washington (D.C.) Psychiatric Society (WPS), chairs a WPS-sponsored group called the Partnership for Parity Working Group, which "monitors, assesses, and provides feedback to OPM" on how the parity implementation is proceeding. He told Psychiatric News that "the early signs indicate that the spirit and letter of the parity order are in jeopardy" because of the way it is being implemented by the insurance companies that participate in the FEHBP.
Though deductibles and copayments did go down following parity implementation, focus groups of psychiatrists convened by the parity partnership in March and April raised concerns about more extensive pre-authorization requirements and burdensome paperwork, as well as more frequent and time-consuming utilization reviews of inpatient and outpatient psychiatric care, Sorel said.
Sorel noted that focus-group participants also reported that patients were dealing with "grossly inaccurate provider lists," sometimes including the names of deceased psychiatrists. Participants also reported that few of their patients were aware of the parity implementation, and that there was a decrease in the number of outpatient sessions that managed care companies in the FEHBP were willing to authorize since the parity mandate began.
At this point in the implementation, "[w]hat parity means to the clinicians is very unclear and poorly understood," said Akman. "Allegedly, mental and nervous disorders are to be covered on par with physical illness, but people are unclear as to what this really means or how it is to be implemented."
The WPS parity partnership presented the anecdotal reports of a lack of improvement in psychiatric care to the OPM as part of its evaluation of how the parity implementation is going. Sorel added that meetings between the OPM staff dealing with parity and the WPS psychiatrists have been "open, candid, and at times heated." In these meetings, he noted, the OPM officials have "stressed the importance of having practicing physicians involved in evaluating the parity implementation."
The WPS partnership is not the only group evaluating how parity is unfolding for clinicians and federal workers.
The American Psychiatric Institute for Research and Education (APIRE) is in the early stages of a multiyear assessment of how the federal parity mandate is playing out. The APIRE project is focusing on "the effect of parity on access and management of mental health and substance abuse services and its impact on psychiatrists’ practices and the nature and quality of treatments provided," said APIRE Director Darrel Regier, M.D., who is heading the parity-evaluation project.
Once baseline information is gathered, the next phase of the APIRE project, which will begin around January 2002, will survey psychiatric practices to learn about clinicians’ experiences with FEHBP parity, explained William Narrow, M.D., associate director for classification and diagnosis in the APA Division of Research.
The third phase of the APIRE study will begin early in 2003 and consist of a follow-up survey of psychiatric practices and the gathering of additional clinical information on the care patients are receiving under FEHBP insurance plans compared with baseline. Narrow noted that the evaluations have been structured to occur over several years to allow for the parity program to work out its "growing pains."
In addition, APA is attempting to coordinate its survey efforts with those of other professional associations and a research firm that has a federal contract to evaluate the parity implementation, Regier pointed out. ▪