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
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
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
"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
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
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>.▪