Improving outcomes for Medicare beneficiaries with chronic conditions

APAPO submits letter to Senate Finance Committee outlining policy recommendations to improve care.

The APA Practice Organization (APAPO) provided input to a newly formed Senate Finance Committee working group on policies to improve outcomes for Medicare beneficiaries with chronic conditions. On June 22, APAPO submitted a letter (PDF, 167KB) to Senators Isakson, R-Ga., and Warner, D-Va., co-chairs of the working group, with policy proposals to more effectively and efficiently address the health care needs of Medicare beneficiaries with chronic conditions.

The bipartisan Senate Finance Committee chronic care working group was formed in May 2015 to analyze current law, discuss alternative policy options and develop bipartisan legislative solutions to improve care for Medicare patients with chronic conditions. The invitation requested that policy proposals meet three bipartisan goals: increase care coordination among individual providers across care settings who are treating patients with chronic diseases; streamline Medicare’s current payment systems to incentivize the appropriate level of care for patients with chronic diseases; and facilitate the delivery of high-quality care, improve care transitions, produce stronger patient outcomes, increase program efficiency and contribute to an overall effort to reduce the growth in Medicare spending. 

APAPO’s comments included psychology’s top legislative priorities, as well as additional suggestions to improve access to quality and effective mental health services for Medicare beneficiaries with chronic conditions, and to help further the integration of mental health services within the health care service delivery system.  

  1. Eliminate unnecessary requirements impacting patient access to psychologists’ services.
    APAPO recommended removing unnecessary physician supervision requirements in Medicare by including provisions of the Medicare Mental Health Access Act (S. 1064, 113th Congress) introduced by Sen. Sherrod Brown, D-Ohio, in any new chronic care legislation. 
  2. Stimulate chronic care management services by allowing psychologist reimbursement.
    Psychologists provide many crucial care management services, and spend considerable time working with other health care providers, family members, caregivers and social service agencies to assist patients. Despite this, Medicare does not reimburse psychologists for chronic care management or transitional care management services. 
  3. Make psychologists eligible for incentives for the adoption of electronic health records.
    When the Health Information Technology for Economic and Clinical Health (HITECH) Act was enacted in 2009, psychologists and other mental and behavioral health providers were excluded from receiving Medicare and Medicaid incentive payments to adopt electronic health records in their practices. APAPO recommends making psychologists eligible for the electronic health record incentive payments to promote integration of mental health services into primary care settings, reduce adverse drug interactions, reduce duplicative tests and triage patients more effectively.
  4. Fully integrate health and mental health services and include multiprofessional care.
    Most individuals who receive mental health treatment get help from a primary care provider, rather than from a mental health professional. However, data suggests that typical primary care intervention for patients with mental health problems falls short due in part to the limited knowledge of primary care providers about mental and behavioral health problems. Consequently, it is critical that psychologists and other mental health professionals be part of an integrated health care team in settings where the greatest numbers of patients in need are located. Medicare policies are in place to encourage clinical psychologists to practice in accountable care organizations (ACOs). Engaging psychologists in ACOs and other coordinated care models should help ensure beneficiary access to appropriate mental and behavioral health services.
  5. Enact bipartisan legislation to treat and reduce obesity.
    APA and the APA Practice Organization (APAPO) sent letters to the Senate and House bipartisan sponsors of the Treat and Reduce Obesity Act (S. 1509/H.R. 2404) in support of legislation that gives the Centers for Medicare and Medicaid services the authority to expand the provision of Intensive Behavioral Therapy (IBT) for Obesity to additional health care providers, including psychologists. The letter also promoted the role of psychologists in the diagnosis, assessment and treatment of health risk behaviors related to obesity.
  6. Eliminate barriers to providing important telehealth services.
    While psychologists are able to provide a number of psychological services via telehealth to Medicare beneficiaries, the current requirements are still restrictive and impede the ability of a significant percentage of older Americans to access needed care. Specifically, the geographic restriction that a Medicare beneficiary be located in either a health professional shortage area or rural county to receive telehealth services should be removed, as should the exclusion of the patient’s home from the list of eligible originating sites. Lifting geographic and eligible site restrictions would significantly improve patient access for many beneficiaries.
  7. Adjust Medicare payment formula to end erosion of payments for psychologists
    Medicare beneficiary access to needed mental health services is now jeopardized due to a steady and steep erosion in psychologist reimbursement rates. As a result, psychologists are leaving Medicare, reducing their patient loads, and refusing to take new patients. Congress should adjust the Medicare payment formula to ensure fairer and more appropriate reimbursement for clinical psychologists to enable them to remain in the program.

“The Medicare program must better address the high rate of comorbidity of mental health disorders with chronic general medical conditions,” said APA Executive Director for Professional Practice Katherine C. Nordal, PhD. “We look forward to working with the Senate Finance Committee working group to ensure that mental health services are an integral part of the service delivery system.”