Magazine article Clinical Psychiatry News

Future of Psychiatry May Depend on Integrated Care

Magazine article Clinical Psychiatry News

Future of Psychiatry May Depend on Integrated Care

Article excerpt


SAN ANTONIO -- Questions about how health care reform will affect the practice of medicine are nothing new, but there is particular uncertainty for the field of psychiatry, according to the president-elect of the American Psychiatric Association.

One reason for the uncertainty is that payment streams for psychiatric and substance use care are distinctive and poorly understood, and the scope of the relative sectors--including public, commercial, state, and self-pay--are unique in the field of psychiatry, Dr. Paul Summergrad explained at the annual meeting of the American College of Psychiatrists.

According to a 2011 article in the New England Journal of Medicine, the greatest percentages of U.S. medical spending overall were from "private insurance" and "Medicare, out-of-pocket, and other private spending" (37% and 35%, respectively), but for mental health, Medicaid spending exceeded both of these (28% vs. 27% and 22%, respectively), and "other state and local spending" was also higher (18% vs. 6% for medicine overall).

For substance abuse, other state and local spending dominated at 36%, followed by Medicaid spending at 21% (N. Engl. J. Med. 2011;365:973-5).

"If you look at the total dollars that come into our world, they look different from the outset than they do for anyone else in medicine," Dr. Summergrad said, noting that patients with substance abuse, for example, fall mainly outside of the commercial insurance system. Also, within Medicaid the largest payer, the percentage spent on mental health services is about three times higher than for commercial insurance.

The impact of the Affordable Care Act through mandated parity rules for coverage of mental health and substance abuse services could provide for tremendous expansion of services within the insurance realm, he said.

Another reason for the uncertainty is a lack of understanding about the substantial extent and effects of medical and psychiatric comorbidities on the total cost of medical care, and the fact that most ambulatory psychiatric care is provided by physicians other than psychiatrists, said Dr. Summergrad, Dr. Frances S. Arkin Professor and chairman of psychiatry at Tufts Medical Center in Boston.

"This is both a challenge and an opportunity; it's an opportunity to really improve the care of the patients, and not just individuals who have severe psychiatric illness," he said, noting that those improvements could come not only in terms of the quality of care, but in terms of the cost-effectiveness of care a factor that could benefit both patients and the care system, including psychiatrists. …

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