Monday, June 9, 2014

AMA Delegates Debate Extension of 'Medicaid Payment Bump' to Psychiatry

Psychiatry should be included in increased Medicaid payments to physicians providing primary care mandated by the Affordable Care Act, said psychiatrist Jerry Halverson, M.D., during hearings at the annual policymaking meeting of the AMA House of Delegates in Chicago.

Halverson (pictured at left) and others argued that psychiatrists—some of whom act as primary care providers to Medicaid patients who have severe and persistent mental illness—and neurologists should also be included among physicians receiving increased Medicaid payments under the ACA. (The law calls for increasing Medicaid payment to Medicare levels for physicians who predominantly bill for evaluation and management services.)

Debate at the AMA yesterday centered around a Council on Medical Services report that recommends that the AMA advocate for inclusion of OB-GYNs among clinicians receiving the "Medicaid bump" in payment based on prior AMA policy that classifies OB-GYNs as primary care physicians. But Halverson and others argued that psychiatrists and neurologists should also be included. "Overall, psychiatry has a disproportionate number of patients in the Medicaid population," he said. "Medicaid is a safety-net program that is intended to protect the most disabled and vulnerable children and adults struggling with severe chronic illness and severe disabilities, such as mental illness. Medicaid is now the dominant source of funding for treatment and support services for both children and adults living with severe mental illnesses.

"The pay for specialty psychiatric services is lower than the rate paid for general medical services in Medicaid, and this results in lower participation rates for psychiatrists, ultimately contributing to worsening access to psychiatrists," Halverson said. "Should psychiatrists receive this Medicaid bonus payment, more are likely to participate in Medicaid.... OB-GYNs, neurologists, and psychiatrists all provide a significant amount of services to Medicaid patients that are considered to be primary care. These physicians should not be denied pay parity on technical or arbitrary grounds."

Said APA President Paul Summergrad, M.D., "Psychiatry is by definition a disproportionate-share specialty. Having Medicaid pay psychiatrists at Medicare rates will be especially beneficial for the ability of community mental health centers and hospital-based clinics to provide care by psychiatrists who are often the only physicians for these complex patients. Our AMA delegation should be commended for bringing this issue forward.”

Halverson testified yesterday at reference committee hearings at which reports and resolutions are debated before being sent to the full House of Delegates for consideration; the House will debate the report and other issues of concern to psychiatry at meetings through Wednesday.

Look for additional Alerts and upcoming editions of Psychiatric News for more coverage of issues discussed at the meeting.

(Image: Mark Moran)


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