Hospital-based psychologists are sorely undervalued, not just for the care they provide their patients and the insights they offer their clinician colleagues, but for the substantial savings they can provide their institutions.
Under the current fee-for-service model in health care, a typical one-hour therapy session with a psychologist nets their hospital or institution about $150, not enough to hire a psychologist on even a modest salary, making it difficult if not impossible for health care systems to employ them.
Yet the potential for cost savings by increasing the number of psychologists in health care systems is undeniable.
Take the example of Lauren Rynar, a colleague of mine who is an assistant professor in supportive oncology at Rush University Medical Center in Chicago and a specialist in health psychology, who recently treated a 74-year-old man with cancer and anxiety.
Due to the long-term effects of his cancer, he had multiple complications like heart problems that required careful monitoring. He was so anxious about his conditions that he called clinic nurses three or more times each week and scheduled duplicated or unnecessary check-up appointments with specialists for the same concerns. His anxiety about his medical status, while understandable, was taking nurses’ time and chalking up unnecessary billed visits with physicians.
Rynar initiated cognitive behavioral therapy, a form of a therapy that has been demonstrated to be effective in health-related anxiety, with the patient. Across 15 sessions, she was able to significantly reduce the number of calls and appointments, and the patient reported significantly reduced anxiety.
Those 15 sessions with a psychologist likely resulted in a total billed cost to the patient and his insurance of about $2,250. Each hour of a nurse’s salary costs about $43, and each session with a physician specialist costs about $500. A conservative estimate of the cost savings resulting from Rynar’s services would be $4,300, well above her actual charges. Extrapolating the cost savings across a full year, investing $2,250 in psychological treatment saved the health care system more than $28,000.
In another example, Christina Khou, a colleague and expert in chronic health management, treated a patient with a family history of breast cancer who, because of her phobia of medical visits, was delaying her regular mammogram and breast cancer screening. After working with Khou for 10 sessions, the patient had a mammogram, which detected localized, early-stage breast cancer with a 99% chance of survival.
Khou’s charges across the 10 sessions were approximately $1,500, and may have saved this patient’s life. Without the psychological intervention, the cancer may have spread or become more advanced before it was detected, resulting in more costly treatments and complications. The average cost of surgery alone to treat early-stage breast cancer is about $60,000, much less than the $134,000 to treat late-stage cancer.
I recently treated a patient who had made inappropriate sexual comments and inappropriately touched nurses while in the ICU for a heart procedure. Several nurses requested to be transferred to other patients. The unit director and legal team were involved, and staff nurses said they didn’t feel safe.
When the patient was admitted to my unit, the acute rehabilitation floor, I spent two and one-half hours developing and writing a behavior plan and educating nurses and other staff to ensure they knew how to use behavioral techniques like assertive communication and repositioning to keep themselves safe.
The result was dramatic: there were no instances of inappropriate sexual touching or comments during this patient’s seven-day stay in my unit. There was one instance of inappropriate touching a nurse’s arm and side, who immediately responded assertively to redirect the patient.
The man’s insurance wasn’t billed for any of that time, earning the hospital no money. Yet sexual harassment or assault by hospitalized patients increases the risk of staff turnover, resulting in considerable psychological and economic cost. The average cost of hiring and onboarding a new nurse is more than $36,000, priceless compared to unbilled time as a psychologist and reduced threat to staff safety.
Two British authors have argued that more mental health care would “cost nothing” when its impact on physical health care spending and welfare benefit spending are accounted for.
To be sure, the costs that psychology services prevent — like future health complications and trauma — aren’t always realized directly by the hospitals or clinics that pay psychologists’ salaries.
Insurance companies as well as hospitals can benefit from psychology services in the form of improved patient and staff satisfaction, fewer medical complications, lower staff turnover, and improvement in the management of patients with chronic illnesses. These services may even dramatically reduce costs across the health care system, even once the costs of salaries and benefits are taken into account.
With the current fee-for-service model, this goal isn’t attainable. Switching to a value-based payment model that accounts for the total costs and benefits of services service, including future cost savings, would make it possible.
Until then, everyone pays the price.
Abigail S. Hardin is an assistant professor of psychiatry and behavioral sciences at Rush University, a licensed rehabilitation psychologist, author of “The Covid-19 Survival Guide: How to Prepare for, Manage and Overcome a Coronavirus Infection” (KDP, 2020), and a current Public Voices Fellow with the OpEd Project.