Psychiatry Could Benefit From Education, Workforce Changes

Psychiatrists are likely to see benefits accruing from some of the features of the $938 billion reorganization of the nation's health care system enacted in March, including some who will qualify for expanded physician reimbursements. However, other features of the new law were opposed by APA over concerns that they would reduce reimbursements for some psychiatrists.

APA and several other physician groups endorsed the final version of the health care overhaul that passed Congress in March through two separate measures (PL111-148 and PL111-152), because it provides vastly expanded access to private and public health insurance, among other major elements. Receiving less attention during the long and contentious legislative battle, however, were the ways in which some elements of the legislation will impact psychiatrists and other physicians.

Specifically, several changes to Medicare will increase some reimbursements. The measure reestablishes—effective later in 2010—the expired national average “floor” on Medicare's geographic adjustment of physician payments, which is commonly known as the geographic practice cost index. Reestablishing this floor will result in increased reimbursements for many rural physicians. Another Medicare payment increase to adjust for rural physicians' practice expenses for much of 2010 and 2011 also is expected to benefit many physicians. Taken together, the two Medicare changes included in the health care law are expected to benefit physicians who live in or are considering relocating to rural areas in 51 localities in 42 states, Puerto Rico, and the Virgin Islands, according to an APA analysis.

Among new Medicare programs included in the law is a financial-reward initiative for Accountable Care Organizations (ACOs) that take responsibility for the costs and quality of care received by their patients over a set period of time. The measure encourages the creation of such Medicare ACOs, which can include groupings of physicians, hospitals, nurse practitioners, and physician assistants—among other health care providers—with the goal of meeting quality-of-care targets and reducing the costs of their patients' care relative to spending benchmarks. ACOs that succeed in these goals will receive a share of the Medicare savings they achieve.

The establishment of ACOs, which are a newer concept than medical homes, was supported by APA. ACOs were included in only one of the legislative versions of the health reform and so the concept maintained a low profile during the extended congressional wrangling over the complex legislation. It's also a program that APA plans to follow closely, because it is relatively new and has not been widely implemented in large health care systems.

A Medicaid initiative included in the new law would allow states to add so-called health or medical homes to their versions of the joint federal and state insurance program. These health homes will aim to improve patient health and reduce costs by assigning a single physician to coordinate all aspects of a patient's care. The program will be targeted at Medicaid enrollees with chronic conditions, including those with serious and persistent mental illness.