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Psychiatrists for Medically Complex Patients: Bringing Value at the Physical Health and Mental Health/Substance-Use Disorder Interface

Received May 26, 2008; revised September 10, 2008; accepted October 6, 2008. From the Dept. of Internal Medicine and Psychiatry, Univ. of Minnesota (RGK); the Dept. of Psychiatry, Thomas Jefferson Univ. (EJSK); the Dept. of Internal Medicine and Psychiatry, Albert Einstein College of Medicine (JSW); the Dept. of Internal Medicine and Psychiatry, Univ. of California, Davis (RMM); the Dept. of Psychiatry and Obstetrics/Gynecology, Univ. of Arkansas (LLMW); the Dept. of Psychiatry and Family Practice, Laureate Institute for Brain Research ((WRY); the Dept. of Psychiatry and Internal Medicine,, Tufts Univ. (PS); and the Dept. of General-Internal Medicine, Univ. Medical Center, Groningen, The Netherlands (FJH). Send correspondence and reprint requests to Roger Kathol, M.D., 3004 Foxpoint Rd., Burnsville, MN 55337. e-mail: roger-kathol{at}attglobal.net
© 2009 The Academy of Psychosomatic Medicine

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. METHOD: 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. CONCLUSION: 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.

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