AMA delegates address health plan physician network “inadequacy”—a situation in which plans list providers in their networks who are not available.
Members of the AMA House of Delegates last month approved a resolution directing the AMA, along with interested specialty and state societies, to study and report back next year on the state of knowledge regarding integration of physical and behavioral health care, including pediatric and adolescent health care, and to provide recommendations for implementing models of physical and behavioral health care integration.
The resolution was brought to the House by the delegation from Colorado, with support from the Section Council on Psychiatry.
Psychiatrist Jerry Halverson, M.D., tells AMA delegates that more than 80 percent of patients in primary care settings who have co-occurring psychiatric disorders are either undertreated or receive no mental health treatment.
“It is well documented that persons with medical conditions who have co-occurring mental disorders and those with primary mental disorders who also have chronic medical conditions are often medically complex and typically incur significantly higher than average total health care costs,” said psychiatrist Jerry Halverson, M.D., speaking in support of the resolution. “In primary care settings, more than 80 percent of patients who have co-occurring mental disorders are either undertreated or receive no treatment for their mental illness at all. There are now over 80 randomized, controlled trials that provide a robust evidence base for the collaborative care model. Evidence shows that it is vital to have a psychiatrist as part of the collaborative team.”
Sharon Hirsch, M.D., vice chair of the Section Council on Psychiatry and a delegate from the American Academy of Child and Adolescent Psychiatry, also told the house that integration was vital for the care of children because of the severe shortage of child psychiatrists.
“Child psychiatrists can work as consultants or we can work with pediatricians in a contracted role,” she told Psychiatric News after the meeting. “And we can work in a supervisory role with psychologists, social workers, and other allied professionals. There are a lot of ways we can extend our expertise in integrated care models.”
“But people tend to forget about children’s mental health,” she added, noting for instance, that in Illinois in the Federally Qualified Health Centers (FQHCs, which use federally funded models of collaborative care), children’s mental health services are not included, but are carved out to the community mental health center.
Because of the inadequate supply of child psychiatrists, legislators are “bombarded” with demands for access to medications, she noted, resulting in perennial state efforts to extend prescribing privileges to nonmedical professionals. But Hirsch said that integrated care is a way to recast scope-of-practice issues in a way that addresses access concerns by extending the expertise of child psychiatrists while safeguarding quality of care.
APA President Paul Summergrad, M.D., said the support by the AMA House of Delegates “represents an important next step to improve the quality of and access to psychiatric and general medical care provided to patients and families throughout the United States.” He added, “We look forward to working closely with our colleagues at the AMA on this project, which is an APA priority.”
In other news from the AMA meeting relevant to psychiatry, delegates were strongly supportive of a resolution brought by the Section Council on Psychiatry to address the problem of health plan network “inadequacy” and efforts by health plans to restrict access to specialists. The resolution asks the AMA to advocate for adherence to existing statutory and regulatory measures for ensuring network adequacy and to work with state medical societies to advocate for such regulations in states where they do not exist.
Section council representatives stressed that insurance plans are appearing within the new health exchange networks that offer “thin and ultra-thin” networks—provider lists with very few specialists. Moreover, patients also face “phantom networks,” a phenomenon in which plans list providers in their networks who are not available to treat patients or in some cases who are deceased.
Psychiatrist Paul O’Leary, M.D., in reference committee hearings on the resolution, said that the problem of network inadequacy and health plan efforts to restrict access to specialists is a problem for both clinicians and patients. He said it can be especially problematic for young physicians starting out in practice and seeking to be included on panels or receive referrals.
“The issue gets even more serious when you look at the length of time it takes to get onto an insurance panel and how poor the reimbursement rate is for psychiatrists, with some companies only paying $40 for an hour of therapy,” O’Leary told Psychiatric News. “If patients are seeking mental health treatment and get referred by the insurance company to a list of providers that has significant number of providers on it, patients feel as though they have a choice and tend not to complain. However, if the list truly reflected which providers were still taking new patients or even accepting that insurance, it would reduce the list to almost nothing, causing patients to question the network and complain [about lack of] choices. Instead patients are forced to spend hours calling different offices hoping to find a psychiatrist who will see them. Then when they keep calling and calling and no one has any opening, patients get disheartened and give up.
“A true network would help patients get care faster and not be frustrated or have to waste time searching,” he said. “Since the insurance companies have minimal pressure to reflect the actual network coverage available, they also have no incentive to add new doctors to their network. Additionally, reimbursement does not reflect true market value of our services, which is especially true in psychiatry.”
The resolution, which received supportive testimony from physicians in several disciplines, was referred to the Board of Trustees and is expected to be considered by the AMA’s Council on Medical Services, which is preparing a report for the House of Delegates’ November meeting.
Delegates at the June meeting also voted on the following issues of interest to psychiatry:
Post-Taser medical assessment: Delegates approved a resolution calling on other organizations and medical specialty societies to develop a standardized, postexposure medical protocol for use of conducted electrical devices (or Tasers) and to support the incorporation of such a protocol into law enforcement procedures and training. During reference committee hearings, Jennifer Piel, M.D., J.D., a delegate from the American Academy of Psychiatry and the Law, spoke in support of the resolution and said that Tasers are frequently used at the time of arrest or in prison settings with individuals who have mental illness. She said post-Taser medical assessments should include an evaluation of mental status, with appropriate follow-up treatment.
Methadone as an analgesic: The House approved a resolution recommending that methadone not be designated as a preferred analgesic by insurance payers and that the AMA send letters to all of the states that currently have methadone on their preferred drug list stating this new policy.
School-based mental health services: Delegates approved a Board of Trustees report recommending that the AMA recognize the importance of developing and implementing school-based mental health programs that ensure at-risk children access to appropriate mental health services.
Protection of physicians in physician health programs: Delegates adopted a resolution that amends AMA policy on physicians who are participating—either voluntarily or by order of the state medical board—in a physician health program. The resolution adds language stating that “participation in a Physician Health Program in and of itself shall not count as a limit on the ability to practice medicine.” Section Council on Psychiatry member Paul Wick, M.D., said insurance companies have been known to exclude physicians from health networks solely on the basis of participating in a health program, even though in many cases physicians who are in such programs—either for substance use or behavioral or other problems—are competent to practice medicine. ■
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