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AAP National Conference: How to overcome barriers to integrating mental health services :

October 23, 2016

Early in his career, Jay Rabinowitz, M.D., FAAP, saw his share of ear infections and colds. As time went on, however, he began seeing more and more patients with mental illness and behavioral problems.

He and his partners did their best to refer patients to mental health providers in the families’ insurance network, but the process often was frustrating and time-consuming.

“So we decided to take the bull by the horn and say ‘let’s try to do this ourselves. Let’s do it in our own office,’” said Dr. Rabinowitz, senior pediatrician at Parker Pediatrics and Adolescents in Parker, Colo. “This is something that would benefit our patients, would benefit our providers and would benefit our practice.”

Dr. Rabinowitz will talk about his practice’s experience and offer some advice during a session titled “Integrating Mental Health Services in the Primary Care Office,” which will be held from 7:30-8:15 a.m. Monday (F3008) in Room 303 of Moscone South.

Parker Pediatrics and Adolescents now has three licensed child psychologists on staff. Communication between providers happens naturally since they see patients in adjoining exam rooms and run into each other in the hall, Dr. Rabinowitz said. The psychologists also scan their notes into patients’ electronic health records, and pediatricians make a point to stop in and say hello to patients during their visits with the psychologists.

While his office isn’t unique, hiring mental health professionals still is uncommon, said Dr. Rabinowitz, a member of the AAP Section on Administration and Practice Management.

“When you talk to some family doctors and other pediatricians, there are people doing this but it’s quiet,” he said. “The reason it’s quiet is nobody knows quite how to deal with the reimbursement part, and so they don’t want to talk about it.”

Dr. Rabinowitz hopes to reassure attendees that adding mental health staff to a primary care practice is feasible financially.

“You’re not going to make enormous profit, and you’re not going to make as much as your well visits and your acute care, but you won’t necessarily lose money,” he said.

The benefits go beyond the bottom line, he added.

“You’re doing a lot of good for patients,” he said. “It brings patients to the practice. It brings reputation to the practice. … It rounds out the practice, and it’s hard to put a dollar sign on that.”

During the session, Dr. Rabinowitz plans to share some of the procedures and forms that his office uses. However, those interested in an integration model need to research state rules and regulations as well as their insurance contracts to see what’s allowable.

If they find it’s feasible to hire mental health staff, they need to make a commitment.

“There will be some errors, and you have to learn from your errors,” Dr. Rabinowitz said. “… It’s OK to fail a little bit while you’re doing this process to make it work right.”

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