Mental Health Billing--psychiatrists vs nonpsychiatrists

[whopper]

According to studies primary care physicians who are non-psychiatrists see more patients for mental health reasons than psychiatrists do.

Anyone know of any major differences in billing? Any good articles you can point out?

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[whopper]

Answered my own question in time for the project I'm working on.

PCPs it turns out treat about half of mental illness that is currently being treated. Unfortunately about 60% of patients with mental illness don't get treatment. Psychiatrists only do about 25% of mental health treatment.

PCPs it turns out usually aren't compensated by managed care for treating mental illness and often times when they are, they don't know how to code properly for billing. This in turns causes a problem because several PCPs then don't screen for mental illness on routine checks and miss pts who need mental illness tx. Also causes a problem because most patients go to their PCP for treatment and the PCP now has less incentive to treat that pt.

The billing when managed care does cover is about the same rules and regs for psychiatrists.

 

[Jollygooddoc]

Answered my own question in time for the project I'm working on.

PCPs it turns out treat about half of mental illness that is currently being treated. Unfortunately about 60% of patients with mental illness don't get treatment. Psychiatrists only do about 25% of mental health treatment.

PCPs it turns out usually aren't compensated by managed care for treating mental illness and often times when they are, they don't know how to code properly for billing. This in turns causes a problem because several PCPs then don't screen for mental illness on routine checks and miss pts who need mental illness tx. Also causes a problem because most patients go to their PCP for treatment and the PCP now has less incentive to treat that pt.

The billing when managed care does cover is about the same rules and regs for psychiatrists.

This is exactly why I am considering combined residency in FP/Psych. In England, it is slightly better, because GPs are paid for BOTH diagnosing an illness AND treating it. So, you are good if you recognise depression, but if you treat it yourself (without referring to a consultan psych), then you get paid more. Of course, I am simplifying things talking about depression here. But, take functional disorders. The majority of my GP colleagues know that functional and factitious disorders exist, but when it actually comes to seeing a patient with one... I think the years of medical training somehow force you to think that there should be a tangible physical cause for everything, and when you cannot find one, you just can't make yourself admit that it might be something psychological. So, you keep prescribing steroids and ABx to someone with factitious asthma; you moan to your colleagues about "that heart-sink patient"; and you avoid thinking about it all... So, I thought that as a FP with Psych boards I might make a pretty good doc. I am not quite so sure about the good buck, though, by the sound of it...

 

[whopper]

Go for it.

I was thinking about doing a combined myself. I still love the medical aspects of health care. I love treating patients over the long term and getting to know them as friends (of course within professional boundaries of course).

Family Practice does that a heck of a lot. Still, I'm glad I went into Psychiatry--because I love that field too.

Several FP practices I've seen employ 1 psychologist or psychiatrist for the same reasons you & I mentioned. Several FP docs I've seen say about 1/4 to 1/3 of their patients have some type of psyche issue. May not be a full blown Axis I but it is a mental health issue.

A GI clinic I used to work with as a medstudent told me they need a psychiatrist because several of their patients on interferon for Hep C treatment get manic or depressed--and suicidal and they don't know how to deal with it. Problem is, with the shortage of psychiatrists, they can't find one.

A pathetic thing was several of these pts on interferon often ended up on the psyche crisis center and inpt unit and none of the attendings correlated it was interferon causing the psyche sx. Very disappointing.

Works both ways. Several PCPs miss the mental health stuff. Several psychiatrist miss the medical health stuff.

I don't know if I will end up doing my own practice but I do wish to work as a consult for a FP/GP/IM doc because I don't want to limit my exposure to medicine. I'd also love to have a psychologist work with me.

 

[cellioholic]

This is exactly why I am considering combined residency in FP/Psych.

Wow, I commend you for taking on such a noble task. I thought about it this year when I was applying. That was until I realize to be a good FP/Psych doctor I would have to keep up with the current literature for both professions my entire life. I don't know if I'm motivated to read that much literature on a weekly basis. It's hard enough being in one profession already.

In England, it is slightly better, because GPs are paid for BOTH diagnosing an illness AND treating it. So, you are good if you recognise depression, but if you treat it yourself (without referring to a consultan psych), then you get paid more.

I don't know if the US is ready for the "paid for performance" system like they have in UK. If that were the case, what's to prevent a doctor from finding all the people who have schizoid personality d/o and taking them on as patients. They wouldn't really come see you. If they came to see you, they wouldn't really complain about anything. It's like have the healthiest population. You could probably bill them for treating their personality d/o by calling them and leaving messages. BTW, would someone with a schizoid personality d/o even have an answering machine if they don't really want to talk to anyone?

 

[Jollygooddoc]

I don't know if the US is ready for the "paid for performance" system like they have in UK. If that were the case, what's to prevent a doctor from finding all the people who have schizoid personality d/o and taking them on as patients. They wouldn't really come see you. If they came to see you, they wouldn't really complain about anything. It's like have the healthiest population. You could probably bill them for treating their personality d/o by calling them and leaving messages. BTW, would someone with a schizoid personality d/o even have an answering machine if they don't really want to talk to anyone?

I am sorry, but you are actually paid for treating your patients; ie, seeing them, screening them, diagnosing them and treating them. I do not know how billing system works in the US, but as far as I am aware there is no evidence-based treatment for schizoid PD - you, of course, can waste your time by calling them and leaving msgs, but I doubt anyone would pay you for that - certainly, not in the UK.

Can you please leave sarcasm out?

 

[Anasazi23]

I'm not sure if cellioholic was being sarcastic or not, but what he/she raises is actually a real concern for the proposed pay-for-performance style of billing.

There is a real concern that since pay is determined by objective improvement, that docs will fill their practices with primarily healthier patients, as relapses and the like will "hurt their statistics."

I really don't know much about this proposed mechanism...just what's posted in the Psychiatric News.

 

[cellioholic]

Jollygooddoc, I wasn't trying to be sarcastic. I was merely trying to point out the flaws in a paid-for-performance system.

We can used your example of depression too. If someone saw a depressed patient with low SES, poor family support, had tried various psychotropic drugs and continue to relapse even with ECT treatment, why would a doctor take that person on as a patient?

Some surgeons in the US don't take on hard cases b/c it has the potential of raising their mortality rate. So, would a psychiatrist or any GP that has their performance statistics as public knowledge and their paycheck at stake take on difficult cases?

 

[Jollygooddoc]

Jollygooddoc, I wasn't trying to be sarcastic. I was merely trying to point out the flaws in a paid-for-performance system.

We can used your example of depression too. If someone saw a depressed patient with low SES, poor family support, had tried various psychotropic drugs and continue to relapse even with ECT treatment, why would a doctor take that person on as a patient?

Some surgeons in the US don't take on hard cases b/c it has the potential of raising their mortality rate. So, would a psychiatrist or any GP that has their performance statistics as public knowledge and their paycheck at stake take on difficult cases?

Sorry, I may have misinterpreted your comment. You are being paid for *treating* the patient here, not necessarily for *curing* them. The system recognises that you are not omnipotent and God-like, and you are not penalised if, despite your efforts, the patient fails to improve. Of course, you would need to show that the treatment you have been carrying out is consistent with the current clinical guidelines. If it is, you are covered - and you get your payment.

Why would a doctor take on a patient that does not get better? Well, you do not know how well they are going to get until you actually try to get them better. And, as a GP you have limited say in what kind of patients you want/don't want on your list. You pretty much cover everyone living in a certain area, unless you *really* don't want to deal with someone. Then, you can petition to have them removed from your list; sorry, you "invite them to de-register" with your practice. This is usually a pain in the neck, though, as you practically have to show that any therapeutic relationship between the two of you is long gone and the damage is irreparable. Although, if the patient wants to switch to a different GP, s/he can just walk away with no questions asked...

Sorry, got distracted

 

[tennreb]

Jollygooddoc, I wasn't trying to be sarcastic. I was merely trying to point out the flaws in a paid-for-performance system.

We can used your example of depression too. If someone saw a depressed patient with low SES, poor family support, had tried various psychotropic drugs and continue to relapse even with ECT treatment, why would a doctor take that person on as a patient?

Some surgeons in the US don't take on hard cases b/c it has the potential of raising their mortality rate. So, would a psychiatrist or any GP that has their performance statistics as public knowledge and their paycheck at stake take on difficult cases?

I know a surgeon that charges by the pound. Not literally, but he jacks up his rates and then gives a discount for patients with a lower BMI.

 

[whopper]

I know a surgeon that charges by the pound. Not literally, but he jacks up his rates and then gives a discount for patients with a lower BMI.

Not a bad idea. IMHO a fair health compensation system would give patients for keeping within weight, not smoking & excercising.