OPC Steering Committee 042804 - Laserfiche WebLink

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health , developmental disabilities and substance abuse services system to maintain , at the very least , the current level of client access to psychiatrists . As reform proceeds , area/county programs will continue to divest of the responsibility to provide direct client services . In some instances , divestiture may occur without appreciable disruption of psychiatric services to public sector clients . For example , there is an adequate number of private psychiatrists who are willing to assume the responsibility or current area program psychiatrists are able to move to other organizations , existing or new , to provide services to public sector clients . In other cases , however , there is reason to be concerned that psychiatrists may leave public sector work and not be readily replaced by other psychiatrists - whether because they are laid off or because they conclude that given an uncertain professional future they are bette r advised to pursue other career opportunities . Consequently , area /county programs should consider the following issues in proceeding with divestiture of currently employed psychiatrists : 1 . Area Programs should analyze the likely availability of psychiatrists to provide services for their clients , whether by currently employed individuals or by others in the catchment area . In general , contract services relying on " locum tenens " psychiatrists or psychiatrists newly moved into the area should be avoided , since these may not provide a stabl e pool of psychiatrists . 2 . When there are not likely to be psychiatrists available other than those currently employed by the area program , divestiture of those staff physicians should be delayed until measures are in place to ensure continuity of psychiatric services , and consideration should be given to requesting a waiver to continue to employ current psychiatry staff. 3 . When the area program psychiatrist ( s ) is/are the only psychiatrist ( s ) available in the catchment area , strong consideration should be given to requesting a waiver to continue their employment . 4 . If an area /county program determines that psychiatric services cannot be divested at the present time , the program must ensure that adequate safeguards are put in place to segregate the activities of the psychiatrists as service providers from the LME functions that the psychiatrist might perform . Such functions might include utilization management and clinical specialist reviews as part of customer services . This communication should in no way be construed as a retreat from the fundamental requirement for area programs to divest of direct service responsibility . It is , however , an acknowledgement of the differential impact that current reimbursement streams and rate structures , both public and private , have on the practice of psychiatry . Any questions regarding this communication should be directed to Joan Kaye at 919 - 733 - 7011 orjoan . kaye@ncmail . net . cc : Carmen Hooker Odom Jim K lingler Lanier Cansler Dick Oliver James Bernstein Kaye Holder DHHS Division Directors Wayne Williams DMH / DD/SAS Executive Leadership Team Richard Slipsky Rob Lamme DMH / DD /SAS Staff