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Outpatient Psychiatric Clinics. To Be or Not To Be. The Fundamental Problem. How do we manage outpatient clinics to meet the needs of people we serve while remaining financially viable?. What we learned. Providers value outpatient services Similar to a “clinical home”

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Outpatient psychiatric clinics

Outpatient Psychiatric Clinics

To Be or Not To Be


The fundamental problem
The Fundamental Problem

How do we manage outpatient clinics to meet the needs of people we serve while remaining financially viable?


What we learned
What we learned

  • Providers value outpatient services

  • Similar to a “clinical home”

  • Services are accessible, person-centered, person-directed, evidenced based, continuous, culturally appropriate & coordinated


Challenging trends and developments
Challenging Trends and Developments

  • Community based treatment is increasing

  • As options increase, so does fragmented care

  • Managed care is the largest payer of services

  • Workforce shortage


Challenging trends and developments1
Challenging Trends and Developments

  • Deinstitutionalization of state hospital

  • Recovery, resiliency & evidenced based approaches

  • Integrating primary health, behavioral health & substance abuse treatment


Challenging trends and developments2
Challenging Trends and Developments

  • Focus on treating co-occurring disorders

  • Developing & utilizing performance improvement activities

  • Large demand for BHRS and services in natural environments


Challenging trends and developments3
Challenging Trends and Developments

  • Alternatives to incarceration

  • More uninsured individuals seeking treatment

  • Mental health parity


Impact on services
Impact on Services

  • High “No Show” rates

  • Reimbursement for psychiatrists does not cover costs

  • Psychiatrists have become “Medication Managers”


Impact on services1
Impact on Services

  • Full-time staff replaced by independent contractors

  • Required services that are unbillable

  • Large deficits


Impact on services2
Impact on Services

  • Sources to offset deficits have shrunk

  • Clinics downsizing and closing


What can we do
What can we do?

  • In depth evaluation by the state into the feasibility and viability of outpatient psychiatric clinics

  • Make changes to develop a new system for delivering outpatient services in the public sector


Change regulations
Change Regulations

  • Allow service to be delivered in the community

  • Establish flexible staffing patterns

  • Change the role of the psychiatrist


Change regulations1
Change Regulations

  • Promote flexible treatment planning

  • Move away from annual licensing visits

  • Eliminate time limited waivers


Ensure financial stability
Ensure Financial Stability

  • Increase rates, especially for psychiatric services

  • Reimburse for nonbillable services

  • Support Full-time staff

  • Alternative payment or mixed payment options



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