Teaming up: Pointers on Successful Collaboration with Physicians

by Communications and Corporate Relations & Business Strategy Staff

Keith Hulse, PhD, collaborates with a neurologist and a pulmonologist in his role as co-director of the Sleep Disorders Center at Fort Sanders Regional Medical Center in Knoxville, TN. He sees his own caseload of patients, providing evaluation and follow-up for patients suffering from sleep/wake disorders from insomnia to abnormal sleep behaviors.

If he suspects that a patient might benefit from a prescription in addition to psychotherapy, he confers with his medical colleagues and asks them to see the patient. Conversely, if one of the physicians has a patient who needs a psychological or behavioral evaluation or intervention, they’ll ask Dr. Hulse to assess the patient.

Dr. Hulse represents a growing trend in the current health care marketplace, where increasing opportunities exist for psychologists to collaborate with primary care and other physicians. These collaborations can help facilitate integrated services delivery and more comprehensive care.

Primary care physicians treat many, if not the majority, of mental health problems. Given this marketplace reality, some psychologists see a substantial need for even greater collaboration with primary care physicians.

“Patients need psychological services integrated into their health care more broadly,” says Susan H. McDaniel, PhD, professor of psychiatry and family medicine, director of the Wayne Center for Family Research, and associate chair of family medicine at the University of Rochester Medical Center “And physicians need our help to deal with the challenges of psychosocial care.”

Psychologists collaborate with physicians to provide a range of services and to treat patients with a variety of disorders. For example, they help patients make lifestyle changes, such as smoking cessation, or manage their medical illness, such as by adhering to a diabetes treatment regimen. Psychologists also consult with other primary care providers about how to handle challenging patients and how to successfully encourage a reluctant patient to see a psychologist.

When it comes to effective venues for collaboration, practitioners find a number of potential advantages to practicing onsite with a physician compared to being offsite at a separate location. For one thing, the physician and psychologist are readily accessible to each other for consultation. The onsite arrangement also can facilitate patient care by allowing the physician to introduce a patient to the psychologist. This in turn can lessen both a patient’s reluctance to seek care and the effort required to see the psychologist at a different location. 

Psychologists who collaborate with physicians and others offer several pointers for building effective working relationships:

Keep the lines of communication open. Good communication is the key to coordinated care. Establish what information the physician expects you to provide about a patient and what information you will need from the physician when a patient is referred to you. Schedule time regularly to talk about patients and other work-related matters. Dr. Hulse and his medical colleagues meet for lunch once a week. He says it’s important to take time to build and maintain the relationship needed to collaborate successfully.

Be mindful of different styles. When you move into a collaborative arrangement, you may need to accommodate a new work style. Understanding how physicians may approach patient care differently than psychologists was a key accomplishment for Lee Hersch, PhD, of Fishersville, Va., who has developed relationships with numerous physicians over 25 years in practice.

“Learning the culture of medicine was a very important step for me in developing collaborative relationships with physicians,” says Hersch. Early in his career, he wrote five-page diagnostic and development histories on each patient. “I soon learned that the doctors wanted no more than one page providing the bottom line: diagnosis, symptoms, prognosis and treatment plan,” Hersch observes.

Be willing to expand your expertise. Collaboration with a physician may require additional training or consultation. One of a psychologist’s roles in collaborating will be to educate the physician about processes such as psychotherapy and assessment. In the same vein, psychologists who collaborate with physicians consider it important to be open to learning about topics that expand their knowledge and expertise.

Protect patient confidentiality. Physicians are not accustomed to the higher confidentiality obligations imposed on psychologists by laws and ethical standards. Be sure to address all necessary privacy concerns prior to releasing confidential patient information to or discussing it with a physician. For example, if you are sharing patient information with a physician when collaborating on that patient's treatment, you typically would not share any psychotherapy notes with the physician or leave them in a file that is accessible for the physician.

For further information on your confidentiality obligations as related to the Health Insurance Portability and Accountability Act (HIPAA) and state law, visit the HIPAA Compliance section.

Historically, psychologists who worked with physicians faced challenges in getting reimbursed for their services. Psychologists were reimbursed for mental health diagnoses, but not physical health diagnoses.

The introduction of health and behavior CPT codes in 2002 — following years of work by the APA Practice Directorate to develop and gain approval for the codes — recognized psychologists’ expanding role in providing health services. The new codes were designed to facilitate reimbursement for psychologists who help patients address physical health problems, from cancer to sleep disorders to stress.

The codes have opened the door to collaboration for practitioners such as Dr. Hulse. “The CPT codes are critical to my collaborative practice in sleep medicine,” he says.

Medicare carriers in all states except Florida now reimburse for the health and behavior codes. The Practice Directorate continues working to expand coverage of the health and behavior CPT codes by private insurance.

The APA Practice Organization encourages practitioners to use the health and behavior codes in situations where they apply. For assistance in using the codes, see additional information at Practice Central or contact the government relations office in the Practice Directorate at 202-336-5889.

If you collaborate with physicians, we’d like to know. E-mail us with your experience with collaboration and how it has affected your practice.