Because an increasing number of patients are covered through managed care plans, psychiatrists need to understand the managed care system in order to answer their patients' questions and ensure the continued prosperity of their practices. To assist clinicians in these challenging times, The Psychiatrist's Managed Care Primer arms psychiatrists with the information and tools they need to flourish within the managed care environment while simultaneously delivering quality patient care. This monograph provides an overview of the evolution of this industry; detailed explanations of current managed care models, operations, and anticipated trends; and practical advice on key problem areas. It focuses on the pressing issues of utilization management and capitation as well as important regulatory, ethical, and legal issues psychiatrists confront under this system. The potential impact that managed care systems have on their patient referrals, clinical decision-making autonomy, and income is also examined closely. Equipped with the sophisticated understanding of managed care supplied by this primer, psychiatrists can make the important decisions that will ensure the survival of their practice.

In questions of psychiatric ethics, simple "yes" or "no" answers are rare, yet questions arise frequently in the clinical setting. "Should I accept a patient's invitation to a party?" "Is it OK to tell a patient that I, too, have had a depression?" "Can I release sensitive information about my patient without the patient's consent?" "Can I give a psychiatric opinion about someone I've never examined?" A shortage of ethics instruction from medical school through residency has left many psychiatrists facing the increasingly complex field of ethics without a clear guide to ethical decision making and conduct until now. Informed by some of the formal proceedings of the APA Ethics Committee, Ethics Primer of the American Psychiatric Association presents today's ethical dilemmas in eleven informative chapters -- brought to life by the clinical vignettes based on actual cases seen by this primer's distinguished contributors. Boundary violations between the doctor -- patient relationship and any other relationship (e.g., social, sexual/romantic, business) Issues such as informed consent, psychopharmacology, hospitalization, and psychotherapy with children, adolescents, and families Issues such as confidentiality, competence and consent, quality of life, abuse and neglect, and use of restraints with geriatric populations Involuntary hospitalization rife with conflict and controversy where many ethical principles clash (e.g., beneficence, autonomy, informed consent) Reconciling ethical conduct (as delineated in guidelines of the AMA, APA, and Sabin) with managed care's cost containment and rationing of medical services Confidentiality, how this fundamental ethics principle can clash with the business ethics of managed care and insurance companies Gifts from patients and industry when and why they are or are not acceptable The often uncomfortable duty to report colleagues who engage in fraud or deception, from speaking privately with a colleague to referring a concern to a departmental committee, supervisor, or local APA ethics committee (and applicable legal mandates) Emergency care ethics how to ensure proper treatment for psychiatric patients who come to the emergency room with physical illnesses forensic psychiatry, including codes of ethics, boundary issues, and management of allegations of ethical misconduct When consultations and second opinions are needed Including an appendix with selected material from The Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry, this clinical guide and reference is sure to stimulate the discussion so integral to maintaining the dynamic tradition of ethics. As such, it is essential reading for every psychiatrist -- whether in training or in established clinical practice -- who aspires to a richer appreciation for the wisdom and subtleties of the guidelines and principles of medical ethics.

Because of growing enrollment in managed care plans, psychiatrists are finding it necessary to sign contracts with managed mental health care programs in order to receive third-party payment. These contracts often lead to complications and form a key area of concern for clinicians. The Psychiatrist's Guide to Managed Care Contracting helps psychiatrists make sense of the legal issues arising from their managed care contracts. In a step-by-step manner, this useful guide develops the framework for the crucial decisions that must be made and highlights the strategies a psychiatric practice can employ to shape the contract in its favor. It reviews standard contract provisions and the issues involved so that potential problems can be identified early in the negotiating process. The Psychiatrist's Guide to Managed Care Contracting also details the essential groundwork and preparation that should be completed before a psychiatric practice enters negotiations, including practice assessment, financial planning, marketing, and the development of administrative support. Equipped with this knowledge and advice, psychiatrists can negotiate from a position of strength and develop a favorable contract that ensures the survival and prosperity of their practice.

A Psychologist's Proactive Guide to Managed Mental Health Care offers a concise overview of the evolution of managed mental health care and its impact on the working lives of clinical and counseling psychologists. Although many books explore the ramifications of managed care for psychotherapy, this is the first to take a broad perspective and examine the ways in which the new health care delivery system is affecting all aspects of practice--not just treatment but also assessment and training--as well as mental health research. The authors include some of the country's most noted psychologists with extensive experience in managed care. Their tone is optimistic rather than pessimistic; as they look at developments others have only deplored, they see potential roles and opportunities for growth for psychologists. In an era of dramatic health change, all those practitioners who are concerned about how to make managed care work for them rather than against them, will find this Guide essential reading. ALTERNATE BLURB A Psychologist's Proactive Guide to Managed Mental Health Care offers a concise overview of the evolution of managed mental health care and its impact on the working lives of clinical and counseling psychologists. While many books explore the ramifications of managed care for psychotherapy, this is the first to take a broad perspective and examine the ways in which the new health care delivery system is affecting all aspects of practice--not just treatment but also assessment and training--and mental health research as well.

How can behavioral health clinicians provide managed care in an ethical, professionally satisfying way while also dealing with managed care organizations (MCOs)? This concise yet powerful volume will jump-start clinicians in their search for effective answers. Unlike other managed care guides, which tend to view the clinician-managed care relationship as inherently adversarial, this groundbreaking pocket guide (another in American Psychiatric Publishing's Concise Guides series) views resource management as a basic function -- indeed, an ally -- of ethical clinical practice. True managed care both improves the quality of clinical care and protects community resources. It even stimulates patients to become more active managers of their own care. The author, speaking from extensive first-hand experience as both network provider and MCO administrator, asserts that clinicians must know how to manage care themselves to effectively persuade insurance companies to pay for treatment. Toward that end, the author details the practical tools clinicians need in just five chapters: Chapter 1, Managing Care Ethically, discusses basic principles and methods for making clinical decisions about behavioral health care when resources are limited and methods for communicating these decisions to patients and MCOs. Chapter 2, Managing Nonacute Care, applies the principles and methods from Chapter 1 to providing non-acute, usually outpatient, services. Chapter 3, Managing Acute Care, applies the principles and methods from Chapter 1 to providing acute crisis or inpatient services. Chapter 4, Marketing to Managed Care Organizations, details strategies for negotiating contracts to often unreceptive MCOs who consider their networks full, showing how clinicians can enhance their market value by filling MCO needs. Chapter 5, Managing Utilization Review, offers insights on overseeing the clinical work of colleagues and shaping the health care system, assuming that care managers are professionally obligated to help patients receive the care they need and deserve without intruding on the clinician's role, and that the best management manages least, taking responsibility for efficient resource utilization and ongoing system improvement. This practical guide is more than just a handbook for successfully navigating MCO procedures and market dynamics; it also shows that the outcome of truly managed care can be just as satisfying and effective as care provided with infinite resources. Invaluable to clinicians in everyday practice, this remarkable guide with its unique insights, collaborative approach, and case examples will also find a wide audience among clinical administrators in private and public MCOs who train network clinicians and utilization managers.

Until recently, behavioral health was defined within the strict dichotomy of inpatient and outpatient care -- a dichotomy that failed to mirror the range and complexity of human experience and clinical needs. Today's integrated system renders this dichotomy obsolete. Instead, service delivery integration processes offer an organized system of care rooted in a common vision and defined by processes intended to promote continuity and quality of care, coordination of efforts, efficiencies of operation, and seamless patient movement through an otherwise bewildering array of health care services. Unique in the literature, this volume brings together distinguished clinicians and policymakers who focus on the operational aspects of developing state-of-the-art integrated delivery systems. History and concept -- Why we need integrated health care delivery systems, including a model of service delivery integration that incorporates current barriers (e.g., ambiguous roles and responsibilities and lack of strategic alignment; how to design integrated delivery systems improving clinical outcomes, achieving fiscal and operating efficiencies, and aligning clinical and fiscal incentives) Structural foundations -- Access to the system of care for patients, payors, and employers; how to design level-of-care criteria; eight strategies that help clients move along the continuum; how to define level of care in today's managed care world; and the process of following therapeutic processes (i.e., philosophies, procedures, and practices used to create or support recovery and wellness) across the continuum Administrative and management processes -- How to reorient staff toward minimizing barriers and making the patient central to the system; documentation/information management and reimbursement (rates and rate structures, risk assumption); current research and its enormous potential to improve every aspect of care; quality assessments based on examining the driving forces behind the needs for monitoring and evaluating quality and outcomes; and the relation of behavioral health care systems, which seek to fully integrate clients and families into the fabric of their community and culture, to other systems A case vignette that highlights -- from the consumer's viewpoint -- the vital role of self-help during an episode of hospitalization and a discussion of future directions in integrated behavioral health care round out this remarkable volume. With its wealth of strategic and "nuts and bolts" information -- useful for alliances and single entities alike -- on how to harness operational forces in establishing an effective integrated behavioral health continuum, this volume will be welcomed by those who deliver direct services (psychiatric professionals) and those who administer and manage the integrated financing and delivery of quality care from public (U.S. government agencies) and private (managed care and insurance providers) sectors alike.

In this book, 30 eminent contributors, from diverse psychological disciplines, address central issues in psychological assessment. Topics include ethical considerations in personality assessment, assessment of racial and ethnic minorities, and assessment of the elderly. The book maintains a practical, context-based approach throughout, and will appeal to both students and psychologists.