Funding of Pediatric Psychosomatic Medicine Services

Funding has been cited as a major problem for pedi-atric psychosomatic medicine services, and a longstanding disagreement exists over who should be financially responsible for psychiatric consultation services in the pediatric setting (Campo et al. 2000). A survey by Anders (1977) found that cross-departmental financial support between pediatrics and psychiatry for consultation services was rare. More recent surveys suggest that these issues persist and that the majority (40%) of pediatric consultation-liaison funding comes from departments of psychiatry (Shaw et al. 2006).

Although funding from patient fees appears to have increased in recent years, reimbursement rates for psychiatric consultation services average only 30%, limiting the extent to which hospital-based pediatric psychosomatic medicine services can be financially self-sufficient. Campo et al. (2000), in a survey of 45 U.S. general children's hospitals, reported that one-half of psychiatry programs operated at a deficit and required subsidy. Many program directors have commented on the difficulty of negotiating with managed care companies to obtain reimbursement for psychiatric services. Pressure to generate billing income by seeing more patients potentially reduces time available for nonbillable liaison activities.

Confusion often occurs as to whether psychiatric services for hospitalized medical patients should be paid by the medical part of the patient's health care plan or by the psychiatric benefits, which are often carved out to paneled providers who may not be cre-dentialed by the hospital. Frequently, neither side is willing to pick up the payment, and the consultant is left with the dilemma of whether to provide services that will not be reimbursed (Goldberg and Stou-demire 1995). These complicated payment arrangements interfere with continuity of care for patients after discharge from the hospital. In addition, it should be noted that psychologists providing inpatient mental health consultations are often limited in their ability to bill for their services, because they cannot use traditional evaluation and management codes.

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