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Tuesday Nov 10, 2015

AAFP to Congress: Primary Care Plays Vital Role in Mental Health

It's no secret that among health care employers, family physicians have been the most highly sought-after type of physician in this country for the past decade. But what some may not know is that psychiatrists are close behind, ranking as the third-most highly recruited specialty.

The shortage of psychiatrists is so acute that nearly 4,000 places in this country have been designated as mental health care health professional shortage areas(kff.org) It would take more than 2,700 mental health professionals to adequately address the problem in these areas where, on average, only half of the need for mental health services is being met.

With a dearth of these subspecialists, primary care physicians provide the majority of mental health services in the United States. Unfortunately, payers and policymakers often are not attuned to this reality. That lack of awareness creates an additional barrier for patients who need help because of the difficulties primary care physicians face regarding payment for mental health services.

Last week, AAFP leaders were on Capitol Hill to speak with legislators and congressional staff about a number of issues concerning family physicians, including payment, meaningful use, funding for primary care programs, the newly created Primary Care Caucus and mental health reform. On Nov. 4, AAFP Board Chair Robert Wergin, M.D., and I met with Sen. Bill Cassidy, M.D., R-La. -- a gastroenterologist -- and Joe Dunn, the legislative assistant to Sen. Chris Murphy, D-Conn.

Sens. Murphy and Cassidy are the authors of S. 1945, the Mental Health Reform Act(www.congress.gov), which is one of two major mental health reform bills under consideration by Congress. The other, H.R. 2646, or the Helping Families in Mental Health Crisis Act(www.congress.gov), was introduced in the House by Rep. Tim Murphy, Ph.D., R-Penn., who is a clinical psychologist.

The AAFP has not yet endorsed either bill, but both include policies the Academy supports, including the integration of primary care and behavioral health. During our meetings with Cassidy and Dunn, we voiced our support for such integration while also emphasizing the important role family physicians play in mental health care and the need to eliminate barriers to care created by inadequate reimbursement in primary care settings.

Too often, payers have carved out mental health care as the purview of psychiatrists and psychologists despite the fact that nearly one-third of primary care visits by adults 75 and younger involve mental health issues.

Faced with payers who won't pay adequately -- if at all -- for mental health services, primary care physicians have been forced into creative billing. Rather than submit a code for depression that is likely to be rejected, primary care physicians often code for the symptoms of the disease instead and get paid for things such as treating insomnia or fatigue. Unfortunately, this scenario perpetuates the fallacy payers have bought into, because claims data thus indicate far less mental health care is provided in the primary care setting than is actually given.

Furthermore, the combination of inadequate reimbursement, physician shortages and other factors leads to shortcomings in both diagnosis and treatment. Mental Health America estimates that only 49 percent of patients with clinical depression and 52 percent of those with generalized anxiety disorder receive treatment.

The bill that Sens. Murphy and Cassidy are sponsoring would make an important change to Medicare and Medicaid, allowing patients to access mental health and primary care services at the same location on the same day. The bill also would allow for the creation of grants related to models of care, early intervention and more.

It remains to be seen what will transpire with either of these bills, but our recent meetings made it clear that the Academy plans to play an active role in the debate on this important issue.

John Meigs Jr., M.D., is the president-elect of the AAFP.

Posted at 03:39PM Nov 10, 2015 by John Meigs, M.D.

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