Dinah, ClinkShrink, & Roy produce Shrink Rap: a blog by Psychiatrists for Psychiatrists, interested bystanders are also welcome. A place to talk; no one has to listen.
Tuesday, June 02, 2015
Medicare Spending on Mental Health is Up! And Why is This a Surprise?
In today's edition of USAToday, there is an article titled Mental Health Spending is Up, New Medicare Data Shows.
The article notes:
Medicare providers got more for mental health and specialty care including sports and sleep medicine in 2013, according to new payment data released Monday that shows which healthcare providers received the most money.
Among the biggest changes:
• Spending on psychiatry was up 9.3%, to $853 million
Okay, so I want to point out that in 2013, psychiatry changed how we code and there was the introduction of new CPT codes. At the time, the complexity and absurdity of breaking down minute-by-minute break down of each session into psychotherapy versus evaluation/management seemed absurd, but we all eventually fell into breaking our appointments down into a set of codes that captures what we do. It meant that bills sent to Medicare reflected an E/M portion plus a psychotherapy portion, and the result was a much higher amount that could be billed/charged then under the old "50 minute psychotherapy with medication management code."
So if you suddenly increase the amount that a service is compensated, why is it surprising that mental health spending went up? Just sayin' .....
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Come on, Dr Miller, you know what is a primary dynamic to Medicare increases for mental health care, and that is disability. And I think you equally know, it is not only a shame, but outrageous that over 90% of patients who get a disability determination on day 1 still have it 10 years later, and that is just astounding to see, with what I have witnessed in my various travels in CMHCs these past 10 years, much of it as a Locums the last 5 years alone.
Bipolar disorder and PTSD do not inherently mean someone is not only disabled, but impaired for life. But, we have colleagues who genuinely not only believe this attitude, but sell it. And there is the real disability, impaired colleagues who rob people of the basic need for hope and faith.
At least you have a new post. Guess APA was either that long or that exhaustive?!
I just wonder what the long-term implications are. Reactive cutbacks in psychiatry payments? Increased oversight and management of psychiatrists? Nothing? Be interesting to see how this pans out.
I greatly applaud your attitude about realizing that a "MI" diagnosis doesn't mean the person is impaired for life. Unfortunately, many psychiatrists aren't as careful as you and Dinah are regarding prescriptions and put a person on multi medications that end up being very disabling which result in the disability claims.
By the way, your post makes me recall the story of someone who was diagnosed with BP disorder and had a great paying job. When she felt the medications were impacting her cognitive ability and worried that would effect her ability to continue in her job, she complained to her psychiatrist who essentially had the attitude she had to settle for a lesser job or go on disability. Instead, this person chose to go off of meds without any support and was able to manage although she admitted it wasn't always easy. She also made lifestyle changes that seemed to help.
I think you are right. It has more to do with coding changes than anything else.
Also Medicare is now paying 80% of outpatient mental health visits instead of 50%. With lesser co-pays, more patients may be attending more outpatient mental health visits - I have several in my practice that seem to be doing this. Of course, it is quite difficult to find private practice psychiatrists who take Medicare!
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