Few therapists will do so -- but we could get away with concierge fees like doctors. My old primary care doctor took insurance AND had a low concierge fee. I was happy to pay it.

My old business partner and I used to half-joke about having a "Cigna Fee". At that time Cigna was being so much of a pain with billing and third party credit card payments that we were paying significant money to an outside biller in hourly fees to sort their mess out. I think we could have gotten away with it -- the plan was to have a fairly low one-time or once per year fee about equal to an hour of a biller's time.

#psychology #counseling #socialwork #psychotherapy @psychotherapist @psychology @socialpsych @socialwork #union #unionizing #pay #healthcare #reimbursement #ShermanAct #APA #ACA #NCSW #inflation #wages @psychiatry

TITLE: Greater Handgrip Strength Linked to Lower Risk for Depression in
Dose-Reponse Relationship—Longitudinal Study of 115,601 Older Adults
From 24 Countries

Thank you Dr. Pope.

-------- Forwarded Message --------

The new issue of British Journal of Psychiatry (2023, vol. 222, #3, pp.
135-142) includes a study: “Dose–response association of handgrip
strength and risk of depression: a longitudinal study of 115 601 older
adults from 24 countries.”

The authors are Rubén López-Bueno, Joaquín Calatayud,  Lars Louis
Andersen, José Casaña, Ai Koyanagi, Borja del Pozo Cruz, and Lee Smith.

Here’s how it opens:

Depression is considered a contemporary chronic condition that can
impair normal mental and physical functioning; the manifestation of
depression varies among individuals, but often involves lack of energy,
low mood, sadness, insomnia and an inability to enjoy life.Reference
Cui1 The incidence of depression disorders increased by 50% over the
period from 1990 to 2017 worldwide, and the COVID-19 pandemic has
increased the prevalence of depression compared with pre-pandemic
levels.Reference Santomauro, Mantilla Herrera, Shadid, Zheng, Ashbaugh
and Pigott2,Reference Liu, He, Yang, Feng, Zhao and Lyu3

Importantly, depression has been observed to increase the risk of
all-cause and cardiovascular mortality in middle-aged and older
adults.Reference Meng, Yu, Liu, He, Lv and Guo4,Reference Wei, Hou,
Zhang, Xu, Xie and Chandrasekar5 It has also been associated with
significantly increased risks for hypertension, myocardial infarction,
stroke, physical impairment and suicidal attempts, and is one of the
leading causes of global disease burden in terms of disability-adjusted
life-years, years lived with disability and years of life lost.Reference
McLaughlin6,7 Thus, because depression represents a major public health
concern, studies aiming at examining preventive factors to tackle the
increase in depression are required. In fact, early prevention is
estimated to reduce 20% to 25% incident depression in high-income
countries, which warrants the implementation of preventive
measures.Reference Reynolds, Cuijpers, Patel, Cohen, Dias and Chowdhary8

In this regard, there is a growing body of research examining the
association between muscle strength, using handgrip as an estimator, and
depression in healthy middle-aged and older adults.Reference Zasadzka,
Pieczyńska, Trzmiel, Kleka and Pawlaczyk9,Reference Luo, Yao, Zhang, Ge
and Zhang10 Handgrip strength is an easy-to-use, fast and reliable
indicator of both sarcopenia (age-related loss of muscle mass) and
dynapenia (age-related loss of muscle strength). As both have been
associated with depression, the plausibility of a regulatory role of
skeletal muscle on brain function affecting this condition
exists.Reference Chen, Liu, Woo, Assantachai, Auyeung and
Bahyah11–Reference Carvalho, Maes, Solmi, Brunoni, Lange and Husain14
Interestingly, exercise also seems to play a key role in the
aforementioned relationships, as it can improve muscle strength and
muscle mass, downregulates systemic inflammation and improves
neuroplasticity, neuroendocrine and oxidative stress responses.Reference
Aagaard, Suetta, Caserotti, Magnusson and Kjaer15–Reference Kandola,
Ashdown-Franks, Hendrikse, Sabiston and Stubbs17 Furthermore, handgrip
strength has also been observed as a more useful single marker of
frailty (a clinical syndrome in older adults characterised by an
increased risk for poor health outcomes such as falls, disability,
hospital admissions and mortality) for older people of similar age than
using chronological age alone.Reference Syddall, Cooper, Martin, Briggs
and Sayer18

Another excerpt:

A total of 115 601 participants (mean age 64.3 years (s.d. = 9.9), 54.3%
women) were followed-up for a median of 7.3 years (interquartile range:
3.9–11.8) and 792 459 person-years. During this period, 30 208 (26.1%)
participants experienced a risk of depression.

When modelled as a continuous variable, we observed an inverse
significant association for each kg increase of handgrip strength and
depression up to 40 kg in men and up to 27 kg in women.

REPRINTS & OTHER CORRESPONDENCE:

Joaquin Calatayud joaquin.calatayud@uv.es

Ken Pope

~~~
Merely Forwarded by:
Michael Reeder LCPC

#psychology #counseling #socialwork #psychotherapy
@psychotherapist @psychology @socialpsych
@socialwork #healthcare #APA #ACA #NCSW #health #depression

These wages no doubt look pretty good to some people. A few points about that:

a) Psychotherapists are paying off student loans for masters and doctoral degrees.
b) These are pay rate examples for self-employed psychotherapists. Rent, utilities, overhead, vacations, and sick time all come out of our own pockets. These rates are not take-home pay -- we are contractors, not employees.

I now know people in their 30s making $85K in public relations and marketing who feel underpaid. I have a former Medicaid client now making $120K (and gods bless, they deserve every penny). Other therapists I talk to point out:

-- moonlighting teachers command $90/hr. for tutoring

-- hairdressers, dog groomers and tutors get paid in cash and don’t have to carry liability insurance or be on call

-- "$65-$75 per head for cut & blow dry in my suburban area. Approximately a 30-45 min service. No waiting 30-45 days to be paid. Cash in hand. No notes to keep. No files to maintain. No clawbacks. Not on call for emergencies."

-- "Ins fees for 90834 range from $48 for the market place plan to about $80-$84 for BCBS. The average fee appears to be about $67 to $77." [This varies by area of the USA.]

Doctors, nurses, and other healthcare professionals have plenty of problems -- but seem to do better in pay negotiations. Teachers are underpaid, but largely get to benefit from unions. Psychotherapists need either the ability to organize/unionize -- or national associations with the money and capabilities to fight for better wages and take on big-money insurance interests.

-- Michael

#psychology #counseling #socialwork #psychotherapy @psychotherapist @psychology @socialpsych @socialwork #union #unionizing #pay #healthcare #reimbursement #ShermanAct #APA #ACA #NCSW #inflation #wages #insurance #healthinsurance

@Email2TootBot

Email2Toot ROBOT -- CHECK ACTUAL AUTHOR BELOW:
.
.

TITLE: Declining Psychotherapy Reimbursement in Inflation-Adjusted
Dollars & the Inability of Psychotherapists to Collectively Bargain or
Really Have Any Power at All in Their Reimbursement

(Posted for anonymous author by Michael Reeder LCPC -- I did not write
it myself but wish I did :) )

~~~

My Medicare reimbursement for 45 minutes of psychotherapy in 1990 was
$86.82 (in my region -- I have billing records back to 1985, but
Medicare did not contract with psychologists until 1990). Currently it
is $91.38 (Santa Barbara County), but minus 2% sequestration, it is
actually $89.55.

You can find your region's version by searching 2023 Medicare Physician
Fee Schedule (using the name of your state -- and also searching
reimbursement rates by year). ____

Using the US Bureau of Labor Statistic's inflation calculator____

https://www.bls.gov/data/inflation_calculator.htm

which BTW is the most conservative with regard to inflation.

$86.82 in 1990 had the same buying power as $204.05 today. $89.55
divided by $204.05 equals 44% -- i.e., a pay cut of 56%.____

In year 2000, in my region Medicare paid $95.89 for 45 minutes of
psychotherapy (then coded 90806, now coded 90834). ____

Using the CPI inflation calculator, $95.89 in year 2000 had the same
buying power as $169.89 today. In my region, Medicare currently pays
$105.02 for 90834 -- but reduced 2% for sequestration, actually pays
$102.92. $102.92 divided by $169.89 = 61%, so only a 39% pay cut. That
also tells us that reimbursement dropped 17% between 1990 and year 2000.____

The biggest impediment to negotiating with insurers is a legal
precedent from the late 1970's that prohibits psychotherapists from
engaging in collective bargaining. Theoretically under the Sherman Act
of 1890, we might form 'trusts' to set fees and control the market.____

As absurd as this sounds, it has become even more absurd since the
advent of managed health care in the 1980's and our ability to
participate as Medicare providers in 1990. ____

Insurers create contracts in which they unilaterally set reimbursement
rates, documentation requirements and other working conditions. Although
we are all given the same contract, and are thus treated as a class of
workers, we are legally prohibited from negotiating contracts as a group
of workers.____

Last week, I wrote (again) to APA's legal team, asking them to
prioritize this issue. Historically, professional associations beg off,
arguing that they lack the resources to take on trillion dollar a year
private insurance corporations, much less the federal government.____

Please let your professional associations know that the right to
collective bargaining is a crucial issue, and in the context of
reimbursement that is less than half what it was in 1990, perhaps the
criterion issue for the survival of our profession.____

#psychology #counseling #socialwork #psychotherapy
@psychotherapist @psychology @socialpsych
@socialwork #union #unionizing #pay #healthcare #reimbursement
#ShermanAct #APA #ACA #NCSW #inflation #wages