The newly formed CliniciansUNITED, an associate membership of Service Employees International Union (SEIU) Local 509 in Massachusetts, is seeking to influence public policy and practice to protect and improve access to and availability of services from behavioral health clinicians who provide psychotherapy and other mental health services.
SEIU Local 509 represents more than 17,000 human service workers. CliniciansUNITED is currently accepting members and is open to psychologists and other clinicians who work in private practice or in larger groups or publicly funded agencies.
Melody Hugo, clinician organizing campaign director, SEIU Local 509, says one of the first goals is to draft and pass legislation to enact a state anti-trust exemption, allowing clinicians to organize to improve declining reimbursement rates and the reimbursement system for services.
“We were approached by clinicians across disciplines who were really concerned about the power of insurance companies and access to care, and the driving down of rates,” Hugo says. “One of the biggest barriers to organizing, specifically around reimbursement rates for clinicians, is the anti-trust laws. Because these clinicians are seen as independent practitioners and having their own businesses, they would be considered to be colluding if they talked to each other about rates.”
“Clinicians have really been looking for an outlet to have these conversations and be able to work with each other toward improving mental health care,” Hugo says. “At the end of the day, the driving down of rates is limiting access.”
With the current anti-trust laws, Hugo says clinicians can only talk about insurance rates if they are public knowledge. Clinicians also can’t talk about the rates they set themselves, for people who pay out of pocket, she says.
Richard Melito, Ph.D., is among psychologists who are supportive of CliniciansUNITED. Melito, who has a private practice in Newton, Mass., first came into contact with SEIU when he worked at a state-supported community health center in the 1980s. Amidst diminishing funding for the center, Melito says the staff found itself working more for less.
“There was a great deal of demoralization for the staff,” Melito says. “A lot of us weren’t in it for the money – we just wanted a decent wage. We felt demoralized, overworked and underpaid.”
“A number of us got together and said, ‘Why don’t we think about unionizing?’” Melito says. “At that point, it was sort of unheard of for professionals to do that. But I come from a family that was very involved in unionizing in the ’30s and ’40s in New York City, so maybe it was a natural thing for me to think about.”
Initially, Melito says some clinicians were hesitant. “At first, I think a lot of people thought, ‘We are professionals and have an obligation to the client.’ They didn’t see how it could work together,” he says.
But after workers spoke to the SEIU and won the right to unionize, Melito says the experience was a positive one.
“By doing that, we had a little bit more power,” he says. “It boosted morale, and I think that translated to better relationships with the administration and also made us better available to clients. I thought it had a positive effect all along and I think it also forced management to be more creative in thinking of how to generate income.”
That experience has led Melito to support CliniciansUNITED. Melito says that while insurance company reimbursement rates were relatively stable for a long time, psychologists have recently seen them decline.
“I am not sure why,” he says. “I think they’re reducing reimbursement rates because they can.”
Additionally, in Massachusetts, the Behavioral Health Integration Task Force was created under Chapter 224 of the Acts and Resolves of 2012, and is making recommendations to improve the quality and efficiency of health care delivery and payment systems – including the integration of primary care with behavioral health – as the next chapter in health reform.
“The health care map is changing,” Melito says. “The task force is making recommendations that could change the whole complexion of how services are delivered, so I think it’s important to be able to organize so we can have more influence in what is going to be happening, rather than standing by as an onlooker.
“It will give us more leverage not only for ourselves, but also for our clients,” he says. “The environment seems to be changing more now so it’s important to be in a position where you can have a say and not sit by and passively accept what’s been handed down.”
By Pamela Berard