by Jennifer A. Katze, M.D.
[Winter 1997; Vol. 24 No. 4]
This year the Health Care Finance Ad ministration (HCFA) has vowed to take a far more aggressive stance against the rampant level of Medicaid and Medicare fraud, which it believes is bankrupting the system. So HCFA reviewers no longer just review charts during site-visits to our psychiatric hospitals. Now they take a precious day of our patients’ extremely short stays and follow patients bodily throughout an entire day to each and every activity, including therapy sessions. Staffs’ attempts to discourage this is politically incorrect for, as you might well understand, the hospital wants HCFA reimbursement.
On one such site visit recently, a HCFA reviewer bird-dogged a patient throughout her day. But when it came time for her individual psychotherapy session, she told the reviewer that was private, that the reviewer couldn’t join her for the therapy. The reviewer took umbrage, adamantly pointing her finger at the patient and saying, “But you promised!”
Apparently this patient heard such words before when being asked to acquiesce to intrusions into her private life. This seemed a rerun for her because she immediately flew into a fiercely disorganizing and disruptive rage, which took a toll on her and the entire unit as well.
This incident was not a therapeutic experience for this patient, and it runs counter to all that we espouse about a treatment milieu and the safety we intend for it to provide. Such intrusions into personal privacy are not benign, but HCFA is a mighty force because it holds major purse strings. Those who have the money seem to feel they can do whatever they please, and it seems that we may just let them. Or not.
Dr. Katze, a psychiatrist in private practice in Towson, Maryland, has published widely on the subject of confidentiality.