Clinical psychologist: Island short on mental health professionals
By Pedro Correa Henry
Special to The Star
Amid an investigation by the Senate Community Initiatives, Mental Health and Addiction Committee, led by Independent Sen. José Vargas Vidot, a clinical psychologist during a hearing on Monday called for the upper chamber to draft legislation that aims to retain human behavior professionals in Puerto Rico and develop systems to retrieve data on the island’s mental health status across the board.
During the public hearing held in Miguel A. García Hall, Dr. Marelsa Banuchi Maldonado said the lack of psychologists and psychiatrists in Puerto Rico is due to various healthcare insurance plans not meeting the established fees for services under the Centers for Medicare and Medicaid Services.
“The Fee for Service under Medicare that is supposed to be paid to providers is from $110 to $180 per hour; however, healthcare insurance companies only pay us from $30 to $50 per hour,” said Banuchi Maldonado, who noted later that 40% of the revenue per session is invested in the administrative assistant’s payroll and income tax.
Banuchi Maldonado, who has 13 years of professional experience in clinical psychology, said the other 60% is divided between the clinic’s operational and administrative expenses.
“After those expenses, human behavior professionals end up with a smaller salary than their administrative assistant,” she said.
She said further that most private clinics attend to mental health patients who are enrolled in the government’s Vital Plan, which is insured by APS Healthcare.
Banuchi Maldonado said the Puerto Rico Health Insurance Administration (ASES by its Spanish acronym) released a normative letter requesting that health insurance companies who had Vital Plan beneficiaries pay providers at least 70% of the established Medicare fee for service.
“However, when we asked APS Healthcare about that decree, the company said those fees did not apply because their contract was for capitated services,” she said. “According to the APS Healthcare website, they actually cover 1.3 million people between their clinics and integrated health services providers.”
“This means that if there are 3.2 million residents in Puerto Rico, APS Healthcare addresses mental health issues from a third of the population,” Banuchi Maldonado added. “This number is shocking; if it is true, we must evaluate the services and their quality through this corporation.”
Dr. Carlos Rodríguez Mateo, the administrator of the Mental Health & Anti-Addiction Services Administration (ASSMCA by its Spanish initials), said he shared Banuchi Maldonado’s concerns.
“For 27 years as a provider of physical health services, it has always been pointed out that insurers have had an iron grip on this system that has provided mental health services.”
“We have to re-examine the control that insurers have, where providers, at a given moment, complain that they are in unilateral contracts, abusive contracts, contracts where the rates are already preset,” he said. “This is one of the factors that has resulted in many health professionals, especially mental health professionals, not being available to provide services and so they leave the island for better opportunities.”
The ASSMCA chief added that attempts have been made to stem the white coat outmigration from the island, such as a 4% tax break for healthcare providers; however, he said, although it was signed in the previous four-year term, “it could not be implemented because the Financial Oversight and Management Board has not allowed it.”
The public hearing took place as part of the legislative process for Senate Resolution 77, which orders the aforementioned committee to conduct continuous investigations about diverse problems and threats that affect the sustainability and development of communities in Puerto Rico.
The resolution, penned by Vargas Vidot, also seeks to pursue continuous investigations of prevention programs, services and public policies that involve homelessness, mental health and problematic substance use on the island.