When I started my life as a psychiatrist more than 30 years ago, the words "managed care" weren't even a slip on the radar. Almost everyone was personally insured. People who had an HMO were mostly factory workers, and having an HMO or a PPO was generally not considered a good thing. Otherwise, you could go to any doctor you wanted, there were no “referrals”, and both doctors and counselors had immense leeway in the first few weeks of treatment.
At that time there was a joke in our profession that went something like this: "How long does the treatment of [fill in the blank with any issue] take?"
The answer: "Twenty-eight days."
The reason for 28 days is that insurance companies would undoubtedly reimburse up to 28 days of treatment – including inpatient care. After that, many other documents were required. Miraculously, inpatient care miraculously lasted – you guessed it – 28 days.
Of course, no responsible therapist planned his treatments based on this 28-day limit, but we had plenty of leeway for treatment plans. But the late 1980s brought us big changes in health care. Managed Care (HMOs and PPOs) has changed the way we do business. I was too new to the field to have an opinion at the time, but I remember the outrage among my superiors and other experienced advisors.
In retrospect, changing the way insurance works actually helped (forced us?) To improve the way we provided services. For example, a brief solution-oriented therapy that didn't exist as a PhD student is the result of this change.
You may be wondering whether this interesting journey into the past makes any sense. Well, I think we're seeing something like the one I described above.
Americans are innovative. I am confident that the coronavirus pandemic has created a scenario that will permanently change much of our culture. In the 1980s, therapists didn't have to think about being “short” or efficient, but the rise of managed care forced our hands and we got better as a result.
This virus has forced us into telemental health and other ways of offering services that we didn't have to think about until March of this year unless we wanted to. I have encouraged all of my supervisors to pursue telemental health testing in our state, and I've done so myself, both as a clinician and as a supervisor, but I suspect that many veteran therapists simply did not want to mess with a new modality
Imagine that. Again, we had to do something we should have done because it offers options and helps our customers. In my early years I learned to be efficient – doing in one session what my teachers had the luxury of doing in five or ten sessions. I got things done efficiently because managed care forced me to. But shouldn't we have done that anyway?
I will not belittle my predecessors. My teachers and supervisors didn't have to do anything they weren't used to, so only did it when they felt like it. I now realize that this current pandemic is changing the way we do business and that change will not go away if the virus goes away at some point. I assume that some of our customers will never choose to be the way they were before. And maybe they shouldn't. Young therapists will likely look back at this time in history and say, “Why did my teachers need a virus to routinely offer services that would benefit their clients? Insane! "
This will also affect me as a university professor. My students will no doubt ask, "Why do I have to come into the classroom?" long after the pandemic is history.
My clients will ask something similar: "Why do I have to drive all the way around Atlanta every week minding the traffic when I can see you from the quiet of my home office (in my slippers and traffic jams) when I wish ? "
Therefore, I suspect that graduate programs will not offer telemental health as an optional certification in the near future. Instead, programs are being tailored to provide telemental health as an expected option to clients who are a good fit for this modality.
If any of you reading this hold your breath until things return to normal, stop holding your breath. We have a new normal and this will almost certainly be very good for us in some ways, good for the consulting profession, and most importantly, good for our clients.
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Gregory K. Moffatt is a veteran advisor for more than 30 years and the Dean of the College of Social and Behavioral Sciences at Point University. In his monthly Voice of Experience column for CT Online, he seeks theoretical, ethical, and practical lessons from his diverse career as well as inspiration for today's consultants, whether they are just starting out or have been practicing for many years. His experience spans three decades of working with children, trauma and abuse, as well as a variety of other experiences including working with schools, businesses and law enforcement agencies. Contact him at [email protected].
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