Will Walmart Change the Face of Mental Health Care?
Walmart’s recent roll-out of an in-store mental health clinic in Texas has provoked curiosity and skepticism. Mental health advocates hope for a success that could mean a mental health clinic in every Walmart across the nation. Could this action finally end the stigma of seeking psychotherapy? Could it fill the void left by too few providers, especially in rural areas? Perhaps. A quick search on Beacon Health Options (the subcontractor Walmart enlisted to run their first clinic) reveals a D- rating from the Better Business Bureau, giving rise to fears regarding the quality of service. An equally compelling issue is this: How in the world will they make any money?
As a psychologist in solo private practice I can tell you that there is no shortage of people seeking the services of a mental health professional. I get several calls per day, mostly from people who, sadly, cannot afford to pay me. I allocate several hours each week in my practice to treat those who cannot afford my substantial full fee. But the demand from those with little or no coverage far outstrips the time that I can work for substandard wages.
Mental health coverage in this country has been de-funded to the point of extinction. Even people who have otherwise decent insurance often have mental health coverage only for in-network providers. And often with huge deductibles that are not met until the end of each calendar year. Yet providers are leaving these networks in droves due to inadequate, and declining, reimbursement. I left these networks long ago. And newly minted psychologists, often with school debt exceeding $175,000, cannot rely on insurance company reimbursement to pay off this debt, let alone cover their overhead and provide for their families. The end result is that early career providers set up a practice, get established, and then work to leave the networks as soon as possible.
And it is not just the private insurers. If you think that Medicare and Medicaid are not participating in this erosion of mental health reimbursement, you are wrong. The practice arm of the American Psychological Association says that
“Medicare reimbursement rates for psychologists have been falling steadily for years. In 2001, Medicare paid $102 for a 45-minute psychotherapy session (the most common mental health service). Today, the program pays just $84.74 for the same service, a more than 30 percent decline, adjusted for inflation. …These deep reimbursement declines are leading psychologists to leave the program, reduce their Medicare patient loads, and stop taking new Medicare patients.”
They point out that, as a result more than 70 percent of older adults who meet the criteria for anxiety or depressive disorders are not receiving treatment. If not only private practitioners, but also large hospital clinics, cannot make money taking Medicare, Medicaid or seeing those without any insurance, how will Walmart?
Psychotherapists, particularly those with doctorates and fellowship training, are increasingly accepting only private pay. Many of them work on a sliding scale for some clients but, again, this cannot possibly fill the overwhelming need for mental health care in this country. Just as with pre-existing conditions, coverage for mental health has been all but eliminated for much of the populace– even those with insurance. This exclusionary tactic employed by insurers must be changed, just as it was with pre-existing conditions. Individuals need a guaranteed benefit that will be adequate to address their mental health issues, from grief to opioid addiction. And they deserve the right to choose from highly educated and skilled providers. Until there is legislation mandating broad mental health coverage that includes raising the reimbursement under Medicare and Medicaid, I doubt that even Walmart’s limited service clinics can survive.