FPs Should be Paid for Mental Health, Counseling Services, Say NCSC Delegates

Delegates to the National Conference of Special Constituencies, or NCSC, here on May 5-7 called on the AAFP to lobby for a national standard of reimbursement of family physicians for mental health services and educational and preventive services, such as obesity counseling.

Tina Tanner, M.D., a women's delegate from Shelby, Mich., and co-author of a resolution seeking appropriate payment for mental health services, said in testimony May 6 before the NCSC Reference Committee on Practice Enhancement that roughly half her workday at a community health center is spent providing mental health services because funding is inadequate for her local mental health program.

"I have people denied services (through the mental health program) all the time, yet I can't get reimbursed for providing that service," said Tanner. "According to Michigan, I have to be a psychiatrist, social worker or psychologist. My response is that I'm all three, all the time, every day."

Tanner also submitted a resolution regarding education and preventive services after seeing her health center's results in a pilot program treating 9-year-olds dealing with childhood obesity. Tanner testified that participants in the pilot have shown significant reductions in body mass index. However, the program is paid for through grants. Without those grants, Tanner said, she would not get paid for the service because insurers, including Medicaid, have rejected claims for ICD-9-CM diagnosis codes 278.00 and 278.01 for obesity, unspecified, and morbid obesity, respectively.

"I'd like to see us get reimbursed for what we're doing because we're seeing significant impact on our community," she said. "I've seen that this works. We'd like to see AAFP take a stance and lobby for these codes. This is a significant part of our work, and it's important work because it does prevent a number of medical conditions down the road. We'd like to get paid at the start rather than when we have 18-, 19- or 20-year-olds with diabetes."

Lori Carnsew, M.D., of Liberty, S.C., a co-author of the resolution, said physicians should be reimbursed for counseling related to issues such as obesity because this counseling takes more time than what typically is allotted for a well-child visit.