Lack of reimbursement parity the 'root cause' of provider challenges, exec says

Behavioral health programs around the country are seeing more funding than before the COVID-19 pandemic, but that money could be more of a band-aid than a cure for some of the issues within the field.

Sabina Lim, MD, senior vice president of behavioral health safety and quality and system medical director of regulatory and government affairs at New York City-based Mount Sinai Health System, spoke with Becker's about why behavioral health providers need to be reimbursed better.

Note: These responses were lightly edited for clarity and length.

Question: What are the top issues you're following?

Dr. Sabina Lim: True reimbursement parity for behavioral health services is the number one issue I am following, because I believe this is the root driving cause of most of the challenges faced by behavioral health providers. The answer is not just to provide more grants, start-up funding, or funding of new kinds of services. Lack of adequate access to behavioral healthcare and lack of adequate workforce, for example, are fundamental because most behavioral healthcare providers cannot meet direct costs of care from payments alone.  

If providers cannot meet basic costs, they cannot expand and they cannot hire, or hire competitively. This is because fee-for-service payment methodologies are not aligned to the method and content of how behavioral healthcare is delivered. Over the years, there have been adjustments to the standard fee-for-service methodologies to account for some core differences (i.e., the inpatient psychiatric facility payment system). However, critical crisis services, basic outpatient services, recovery-oriented community services, and outreach and care coordination services remain underfunded and cannot meet direct costs without grants, subsidies or philanthropy.  

This chronic under-reimbursement of behavioral health services is in and of itself an example of the lack of parity for behavioral healthcare.

Unlike other medical practices, psychiatric and some addiction services do not have “physician extenders” because the very nature of behavioral health disorders involves one-on-one work between the provider and the patient, and the provider cannot “delegate” pieces of individual psychotherapy and treatment.

Counseling or psychotherapy visits cannot be completed in 15 minutes.. A payment system that fundamentally is time-based does not permit a financially sustainable outpatient behavioral health practice.

The current payment system primarily recognizes physical procedures, which require equipment, as worthy of higher reimbursement. The system must show monetary value that the “equipment” used in behavioral healthcare is the provider’s mind and relationship to the patient, and that the tools to improve health are not just those that are tangible. 

To truly value behavioral health and achieve true parity, we must fundamentally change the way we reimburse behavioral health providers. This is the only path to a sustainable behavioral healthcare system.

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