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2014 - A Pivotal Year for Mental Health Care

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Wednesday, January 1, 2014

It is the first day of 2014 and I have been seeing patients in my office for most of it. I did take a break to go out and buy a new music system for the office and I am cranking (as in walls shaking) out some serious 90's music as I, ahem, also crank out this little blog. BTW the pic associated with this blog is my first attempt at a "selfie." If a picture is worth a thousand words then this one speaks volumes about this doctor's frustrations with the current state of our country's mental health system. With all this in mind, let's examine some elements of 2014 that are likely to become hot buttons in mental health, or what I call the 1 + 2 = 3 scenario. 

1. Affordable Care Act (ACA): Signed into law in March of 2010 by President Obama, there are few who actually understand each of the ramifications of this law (I don't pretend to be one of these few). What is clear to me is that many more people are likely to carry health insurance as a result of implementation of the so-called "individual mandate" of the ACA. In my opinion, the ACA will become a huge issue this year because the U.S. Supreme Court upheld its constitutionality by ruling that the cash penalty of not carrying insurance is in fact a "tax" and not a fine.

What remains to be seen is how many people will choose the option of simply paying the tax rather than buying the often more expensive insurance. The ACA's math works out only if the majority of Americans opt for the insurance route, since this spreads around risks associated with staying healthy across the population.

2. Mental Health Parity Act: This was signed into law way back in 2008 by President Bush but it took an executive order by President Obama to get the law more fully implemented. In effect, the intent of the law was to place mental health on the same playing field as physical health problems. For example, if a cardiologist recommends cardiac rehabilitation and some heart medication it tends to be paid for. If a psychiatrist recommends psychotherapy and medication, many insurance companies try to block payment or persuade the doctor to alter the course of treatment through a variety of tactics. Unfortunately, the Mental Health Parity Act has done little, at least from my perspective, to place mental health care on par with physical health care.

3. 1 + 2 = 3: (1) Mental health providers are becoming increasingly fed up with insurance; (2) the above two solutions having done little to nothing to fix the problems associated with accepting insurance, leading to; (3) growing numbers of psychiatrists are refusing to accept any form of insurance. To illustrate this point, a USA Today article published just 3 days ago cited this JAMA article (short for the Journal of the American Medical Association) that specifies only 53% of psychiatrists currently accept insurance, as compared with nearly 90% of all other doctors. Now that is a big (insert explitive here) deal!

The Bottom Line: Unfortunately, I predict that 2014 will result in more of the same. Supply and demand dictates that the best psychiatrists will be the ones who will be able to stay in business without accepting insurance. With fewer and fewer exceptional psychiatrists choosing to accept insurance as a form of payment, patients who cannot afford to pay "out of pocket" will be forced to see psychiatrists who may have inferior credentials. Many psychiatric physicians have never passed their board certification examinations despite practicing for years (to find out if a psychiatrist is board certified click here).

In my opinion, excellent mental health care is becoming an increasingly scarce commodity and unless insurance companies become willing to pay what a good psychiatrist is worth we are headed towards a two-tiered system in which those with the money to pay cash will receive far superior mental health care compared with those who can't.

I'm turning up that 90's music. Love that Buffalo Tom!

-Dr. Tim