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Is VA Medicare Only the Beginning? Threat to LCSW Reimbursement
Are clinical social workers at risk of being removed from provider lists? Is Virginia Medicare only the beginning?
The BackgroundTrailblazers is the Financial Intermediary for Medicare in the state of Virginia. Each state has its own Medicare Financial Intermediary and the role of the Financial Intermediaries is to manage the actual payments from Medicare to the
providers (physicians, LCSWs, psychologists, nurse practitioners, etc.) within that
state. Each Financial Intermediary has a Professional Advisory Committee for each state that it serves.
The role of the Professional Advisory Committees is to interact with the Financial Intermediaries regarding such issues as the services for which Medicare reimburses, the definitions of those services, and who is to be reimbursed for those services.
As the Clinical Social Work Federation appointee to Trailblazers, I have for the past two years been serving as clinical social work representative on the Professional Advisory Committee.
LCSWs will no longer be representedIn early August, the committee director notified me that LCSWs would no longer serve on the committee.
I am concerned that social workers now do not have a voice on the Professional Advisory Committee; I am also concerned that my first knowledge of any idea to remove LCSWs from the committee came only after the decision had been made. (Psychologist representatives have also been removed from the committee.)This is not the first time that social workers have been unfairly discriminated against. Several years ago, lawmakers at the federal level made a decision that specifically precludes LCSWs from being reimbursed for providing services to residents of nursing homes if those residents are receiving skilled nursing services under their Part A Medicare benefit. Nonetheless, psychologists continue to receive reimbursement for these same services. Social workers have not been able to reverse this adverse decision where skilled nursing services are involved.
I am convinced that LCSWs cannot depend on other disciplines or on lawmakers to make decisions that are in our best interest about reimbursement for services we are both capable of and licensed to provide.American Psychiatric Association draft excludes social workers
In 2004, during my service on the Virginia Trailblazers Professional Advisory Committee, a review of the reimbursement of psychiatric services was brought before the Committee. Periodic reviews, approximately every 3 years, are standard. The American Psychiatric Association responded to this particular call for review with a draft proposal to change the reimbursement of psychiatric services. The draft they proposed excluded reimbursement to LCSWs for certain services for which we have traditionally been reimbursed and are licensed to provide.
Fortunately, with LCSW representation on the committee, there was an opportunity to review the draft prior to its adoption and to submit changes that would protect the reimbursement of LCSWs for all services previously reimbursed.
Although many physicians are very appreciative and speak highly of their social worker colleagues, I can state with conviction that not all of them value the services social workers provide to clients. As an LCSW providing psychological evaluation and treatment to elderly individuals in the outpatient settings and in nursing homes, I often interact with physicians of various specialties, including psychiatrists. At times psychiatrists and other specialists have been adversarial, expressing to me that they discourage their patients from working with an LCSW.
Is this a conspiracy…?The paranoid side of me imagines a conspiracy.
Medicare wants to pay out less money, and one way to do that is to decrease the number of providers and types of services they are reimbursing. Physicians are understandably threatened by this Medicare goal. One way for them to help Medicare save money, and simultaneously protect their own reimbursements, is to set up an environment in which physicians are the decision-makers reducing reimbursement to other disciplines. Removing social workers and psychologists from the Professional Advisory Committees would be a step toward achieving such a goal.
It does sound paranoid, but perhaps my fear is not without foundation. A psychologist who owns a practice providing services to nursing home residents has told me that he himself was directly informed by a Medicare representative that Medicare was working to get psychologists and LCSWs out of nursing homes. In the context of the decision to remove LCSWs from the Professional Advisory Committee, “paranoia” begins to seem like a reality-based response.
For those of us being reimbursed for providing services to younger clients and clients not in nursing homes, this problem may seem remote; it does not affect us. But remember that Medicare is by far the largest payer to providers of health care services of any kind in every state in the nation.
Even more important, Medicare sets the standard on which all other payer
providers base their reimbursement structure. While the rates may not be identical, the fee-for-service amount that Anthem, Kaiser, CareFirst, Sentara, Magellan or any other payer pays to a provider is based on what Medicare pays its providers. If Medicare stops paying LCSWs for services, others will follow: that door is closing.
We can depend on no one but ourselves when it comes to representing our best interests. When we have been lax in the past, the result has been a loss of reimbursement for services for which we are licensed to provide – as with the skilled nursing facility residents, a loss that- and I'm so tired of hearing it- would take an act of Congress to change.
Now we have a situation in which our opportunity to represent ourselves in an important reimbursement arena is diminishing. We must respond quickly and forcefully if we are not to lose our grip on our livelihood. Each of us needs to look within and decide if our livelihood is personally important enough for us we choose to protect it. And those of us who choose to protect it must make a solid commitment to do that through action, not just thought or word.
GWSCSW members who wish to become involved should contact Steve Grasberger at sgrsbrgr@aol.com