The Michigan Psychoanalytic Institute (MPI) was faced with a dilemma about three years ago: The Treatment Clinic, which had offered low-fee psychotherapy and psychoanalysis for over 50 years was turning away patients. Because of the Affordable Care Act, more people had health insurance, including mental health coverage, so their co-pays elsewhere were much less than our lowest fee.
Our then president and Education Committee (EC) chair, Aisha Abbasi, with the director of the Treatment Clinic, Al Garmo, began to gather information about other clinics associated with institutes and presented their findings to MPI's EC and the Faculty Executive Committee. They concluded that our model, which turned away insured patients, was no longer viable. It kept us from offering help to many in the community, and would ultimately cause our Treatment Clinic to become insolvent. Clearly, the clinic needed to start participating with insurances.
At this point, Dushyant Trivedi, an institute member, offered to help the clinic work toward formal accreditation as an outpatient psychiatric clinic (OPC) generating more referrals and increased reimbursements.
A small group of interested members, composed of Abbasi, Trivedi, Sally Rosenberg, Lorrie Chopra and I, explored the viability of such a project and eventually presented a proposal and business plan to the EC. The EC was enthusiastic in its support, but stipulated $50,000 to $100,000 in start-up funds had to be raised to get it going.
In a generous and optimistic offer, Mel Bornstein, a training and supervising analyst, and long-time institute member, with his wife Audrey volunteered to meet the need by donating $50,000 as seed money to establish the Mel Bornstein Clinic for Psychoanalysis and Psychotherapy (MBC) in Farmington Hills, Michigan. Mel's love for psychoanalysis and Audrey's love for Al enabled us to proceed. The Bornstein's gift became the clarion call to the institute's members and friends to raise more than $150,000, including a $7,500 grant from APsaA's American Psychoanalytic Foundation, to help underwrite what will become the first Blue Cross Blue Shield approved outpatient psychiatric clinic in the country affiliated with a psychoanalytic organization.
The first task was to create a Board of Directors to formulate a plan. The board promptly acted to establish the clinic as a 501(C)3 nonprofit supporting organization, meaning that once revenues exceeded operating costs, all profits would go directly to underwrite the activities of the institute. As such, the clinic is not an affiliate of the Michigan Psychoanalytic Institute, Society or Foundation. It is a freestanding entity whose proceeds support the institute in a totally separate administrative structure. This protects the institute and associated organizations from all liability.
Next, we had to determine how to position the clinic to receive insurance reimbursement for psychotherapy. Our colleagues in Milwaukee introduced us to a billing service in Wisconsin that processes insurance claims, and would expedite credentialing the clinic, as well as individual therapists, to qualify for reimbursement. Simultaneously, we engaged the consultative services of Michael Lott, the retired executive director of a large mental health and social services agency in the Detroit area, who had overseen the growth of his agency to operate on a $40 million plus budget. He had helped establish what we envision, a for-profit supporting component of the nonprofit agency, an outpatient psychiatric clinic, that over time, contributed $3 million annually to the agency's budget. His advice has been priceless in shepherding this process along.
Another critical decision was to seek accreditation by the Commission on Accreditation of Rehabilitation Facilities (CARF), a national body whose approval will permit us to participate in more insurance plans for reimbursement. This enables us to generate more revenue and help more people in our region receive high-quality psychotherapy.
We are working closely with a consultant (recommended by Lott and committee member Mary Adams) to guide us in the sometimes arduous and detailed process of paperwork and compliance with standards dictated by CARF. Moreover, we have held in-service sessions on record keeping with our therapists that adhere to the CARF guidelines without compromising the principles of dynamic psychotherapy.
In addition to our offices in Farmington Hills, we have classrooms and a satellite of our Treatment Clinic in Ann Arbor, about 45 miles away. We have initiated the process of seeking CARF accreditation for the Ann Arbor clinic.
Therapists staffing the Treatment Clinic have all been involved in seminars and courses offered through our extension services. Some have already been employed contractually by the Treatment Clinic, which MBC will replace in Farmington Hills. More have signed contracts. Three of our staff are candidates at the Michigan Psychoanalytic Institute, including our medical director. Many analysts at MPI have stepped forward to provide pro bono supervision to the therapists. We intend to hold in-service training and regular staffing, all with a dynamic framework. As contractual employees, they are paid a portion of fees either directly by patients or their insurances, a standard practice of reimbursement for contractual services.
Start-up costs have been considerable, as they are in any enterprise. All risks and possibilities must be explicated and anticipated, as best as possible. We have had to budget carefully and realistically, with Lott's wise guidance. He has helped temper what has often been overly conservative planning for highly ambitious projects. We anticipate it may take up to four years to realize consistent profitability. Once the costs of building a business are covered and the unanticipated expenses are met, we expect our institute will have a steady source of much-needed outside revenue.
We recognize as our membership ages and the generosity of those we have relied on for so long are no longer available, we must build structures to provide steady revenue. Moreover, central to our mission, is providing a source of high-quality dynamic psychotherapy to more people in our community than ever before. We hope our clinic, bearing the name of our beloved Mel Bornstein, will be a permanent fixture of the psychoanalytic community.
We are available for discussion and consultation should others be interested in a similar endeavor at their institute or center. You can contact Aisha Abbasi at 248-910-0351 or or me at 248-353-7310 or . You can also visit our website at .