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Book Review   |    
The Essential Guide to Group Practice in Mental Health: Clinical, Legal, and Financial Fundamentals
Jay M. Pomerantz, M.D.
Psychiatric Services 1998; doi:
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by Simon H. Budman and Brett N. Steenbarger; New York City, Guilford Press, 1997, 318 pages, $45

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This book will have a place on my desk close to DSM-IV and the Physicians' Desk Reference; it is that useful for clinical practice in the late 1990s. Just as the other two books have periodic updates, I expect this guide to group practice to have future editions.

These sentiments come not from a newcomer to mental health group practice, but from someone actively involved in a large multidisciplinary group (within a larger, multispecialty organization) doing at-risk contracting for the past seven years. The value of the book to a clinician just starting out in group practice, small or large, incorporated or not, is potentially much greater.

The theme of this book is "collaboration." The authors have scanned the literature and talked with leaders of various successful group practices to find out the administrative and clinical methods that foster collaboration. The use of a "collaborative cube" to represent the three important axes of an organization—scope, integration, and governance—is innovative and useful. The book contains detailed information on legal structures, business plans and budgets, financing, ways to collect appropriate clinical and financial data to facilitate management, bidding on at-risk contracts, and employing consultants.

A major and very thoughtful section of the book deals with designing collaborative clinical services. That is the part of the book that gets it on my desk. The ideas of time-effective treatment, parsimony, and the life-span developmental model are not new, but somehow seem especially clear in this chapter. I also appreciate and want to have close by me Dr. Steenbarger's field interviews with various leaders of successful collaborative models. Fortunately, there is no attempt to gloss over problems.

My only criticism of the book is that it does not sufficiently warn mental health professionals about accepting a separate path for themselves. Recent history reveals neglected and underfunded separate state hospitals for mental patients. Likewise, the current behavioral health carve-out phenomenon, featuring both separation of service delivery and fierce price competition, has resulted in a decline in the percentage of the health care dollar devoted to behavioral health—10 to 12 percent under indemnity insurance versus a current 3 to 4 percent under managed care. The introduction of subcapitation for competing mental health groups, detailed in the book, may provide even fewer behavioral health dollars.

What will be left for patients and providers? In any future edition of the book, Budman and Steenbarger might include a section that discusses and illustrates strategies to avoid carve-outs of behavioral health. Can local, collaborating mental health professionals operate under a budget within physician hospital organizations, provider sponsored organizations, multispecialty independent practice associations, and health maintenance organizations? Will such local, integrated arrangements forestall the continuing downward spiral in money for behavioral health? Even more to the point, how does one facilitate clinical collaboration within multispecialty "supergroups" to ensure optimal, cost-effective care of the psyche and the soma?

Budman and Steenbarger's book is helpful, whether one takes the direction they recommend or another route to collaborative practice. The Essential Guide to Group Practice in Mental Health is must reading for anyone who subscribes to Psychiatric Services.

Dr. Pomerantz is in private practice in Longmeadow, Massachusetts, and is a lecturer in psychiatry at Harvard Medical School.

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