Psychiatrists for medically complex patients: bringing value at the physical health and mental health/substance-use disorder interface.
BACKGROUND
In their current configuration, traditional reactive consultation-liaison services see a small percentage of the general-hospital patients who could benefit from their care. These services are poorly reimbursed and bring limited value in terms of clinical improvement and reduction in health-service use.


METHODS
The authors examine models of cross-disciplinary, integrated health services that have been shown to promote health and lower cost in medically-complex patients, those with complicated admixtures of physical, mental, social, and health-system difficulties.


CONCLUSIONS
Psychiatrists who specialize in the treatment of medically-complex patients must now consider a transition from traditional consultation to proactive, value-added programs and bill for services from medical, rather than behavioral, insurance dollars, since the majority of health-enhancement and cost-savings from these programs occur in the medical sector. The authors provide the clinical and financial arguments for such program-creation and the steps that can be taken as psychiatrists for medically-complex patients move to the next generation of interdisciplinary service.
Kathol
Roger G
RG
Dept. of Internal Medicine and Psychiatry, Univ. of Minnesota, USA. roger-kathol@attglobal.net
Kunkel
Elisabeth J S
EJ
Weiner
Joseph S
JS
McCarron
Robert M
RM
Worley
Linda L M
LL
Yates
William R
WR
Summergrad
Paul
P
Huyse
Frits J
FJ
D015897:Comorbidity; D003362:Cost-Benefit Analysis; D006304:Health Status; D006801:Humans; D008605:Mental Health Services / Q000191:economics; D010348:Patient Care Team; D016730:Program Development; D011570:Psychiatry / Q000191:economics / Q000379:methods*; D011602:Psychophysiologic Disorders / Q000191:economics / Q000453:epidemiology* / Q000628:therapy*; D012017:Referral and Consultation / Q000191:economics; D019966:Substance-Related Disorders / Q000191:economics / Q000453:epidemiology* / Q000628:therapy*