Some Health Reform Ideas Should Be Rejected, APA Says

In an effort to influence far-reaching health care reform legislation taking shape in Congress, APA has strongly urged legislators to avoid including provisions that would negatively impact psychiatrists and their patients.

APA sent its comments in May to the Senate Finance Committee, whose chair, Sen. Max Baucus (D-Mont.), has led health care overhaul efforts in that chamber. APA voiced support for enacting comprehensive health reform before the end of the current Congress, including efforts to improve accountability and quality while lowering health care costs. The comments addressed aspects of health reform in general, though these reforms are also likely to specifically affect Medicare or other government-funded health care programs.

APA found some provisions discussed for inclusion in eventual health reform bills troubling. Those provisions include penalties for physicians who do not participate in a quality-care reporting program and cuts in specialists' pay as a way to expand primary care reimbursements.

Specific concerns also were raised about a possible expanded role for the Physician Quality Reporting Initiative (PQRI), under which physicians can voluntarily report on performance measures to Medicare in exchange for a financial incentive. Some reform proposals have called for payment cuts to clinicians who do not “participate successfully” in the PQRI program. Such a provision “may have unintended consequences and should not be included in the final health reform package,” APA emphasized.

APA's letter pointed out that only three PQRI measures apply directly to the mental health field, while an additional one applies to substance use care. In addition, physician participation is undercut by the program's provision of just a 2 percent bonus to participants, which does not offset the administrative costs of reporting the data the government wants.

APA raised the possibility that any PQRI-related penalty may result in more psychiatrists opting out of Medicare.

As designed, the PQRI program does not fit the practice patterns or solo-practitioner approach of a substantial number of psychiatrists, Barry Perlman, M.D., past chair of APA's Committee on Government Relations, told Psychiatric News.

“We were thinking that it was very important that psychiatrists not be penalized for nonparticipation,” Perlman said.

APA also is concerned that health reform legislation would be designed to increase the number of primary care and generalist physicians through a“ budget-neutral” funding approach that takes funds from other specialties to reward primary care clinicians. Funding bonuses for certain clinicians by cutting payments for others “would have severe consequences for access in specialty areas, particularly for individuals seeking mental health care,” according to APA.

Lizbet Boroughs, associate director of APA's Department of Government Relations, told Psychiatric News that by June, a month after APA sent its letter, congressional leaders were no longer openly discussing the use of payment cuts to specialists to offset increased payments to primary care physicians.

More likely, she suggested, is a short-term increase in overall physician costs to the government as the Medicare payment program is reorganized to increase primary care clinician pay, while finding cost savings that eventually would return reimbursement to physicians closer to current levels.

The APA letter also urged that any reform include psychiatrists as eligible for primary care bonuses when treating Medicare patients with a primary diagnosis of mental illness. Currently, general psychiatrists are included as primary care doctors by the government only under the National Health Service Corps, which at least one reform proposal would greatly expand.

Psychiatrists should be included under “transitional care” and“ chronic care management” programs that may be created as part of national health care reform, APA said in its comments. For instance, including psychiatrists in the care of patients with mental disorders treated in primary care settings would “improve outcomes and significantly reduce costs for Medicare,” stated the letter.

See Growing Chasm Separates Parties on Health Reform for information on the Senate's health reform bills. Key features of a health reform draft proposal in the House of Representatives that is in line with President Obama's goals is posted at<http://waysandmeans.house.gov/media/pdf/111/tri.pdf>.▪