Longtime Foe Of Managed Care Thrives In ‘Self-Pay’ Practice

By Henry Saeman, Editor
May 1, 2000



Ivan Miller, Ph.D., a Colorado psychologist who has frowned on managed care since its inception, is in his sixth year of solo practice, claims to be going strong, and expecting even better days ahead.

He asserts that the self-pay market he so intensely advocates keeps gaining converts, and that those who have long insisted the solo practice of psychotherapy is dying or dead are dead wrong.

Miller and a group of 56 psychotherapists–psychologists, social workers, marriage and family therapists and three psychiatrists–have made the necessary practice adjustments to thrive. All the practitioners are “holding their own” in stable practices and the therapists are delivering a first-rate service without compromising quality.

Their practice universe is Boulder County, Colo.–ski country–with a population hovering at 100,000 which includes a share of high-tech middle to upper middle income professionals and the town’s major employer, the University of Colorado.

The group of 56, known as the Boulder Psychotherapists’ Guild, publish an annual directory, a fairly costly enterprise. Their directory includes photos and information about each participating therapist and it boosts each of its members.

Members pay an annual $200 fee plus an $80 monthly fee for distributing 5,300 copies of the directory, conducting an advertising campaign, operating a referral line and sponsoring free community presentations on mental health topics.

But there is more to it. Says Miller: “We figured if the general market knew about the value of psychotherapy and the poor quality of managed care psychotherapy, more people would self-pay. So, this is a cooperative effort to increase the size of the self-pay market.”

The concept has been spreading with reports that self-pay arrangements have expanded in Connecticut, St. Louis, Kansas City and Georgia.

However, Miller recognizes that self-pay can work among middle-income populations and among people who have really come to believe that psychotherapy is a service worth paying for. Miller points to families willing to sacrifice the out-of-pocket expenses to provide psychotherapy for their children but less likely for themselves.

Most of the group’s practitioners add an incentive by providing discounts, such as a 20% reduction off a $90 an hour psychotherapy session, the customary rate for psychologists in the Boulder area. “It’s not the kind of discount that managed care companies routinely impose,” he noted. The discount, Miller said, usually applies to clients who pay at the time of service without involvement of insurance or managed care. “When there is paperwork, there is no discount, and people are usually glad to get the bargain.”

Miller figures 80% of his income derives from self-pay, 20% from insurance. He has signed no contracts with managed care.

“I think it’s safe to say that none of us is getting wealthy, but all of us are happier,” he declared. “Remember a few years ago, the actuarial companies were telling APA that solo practice wouldn’t work at all and would soon be dead.”

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