April 2, 2014

“Doc Fix” Bill Protects Medicare Patients’ Access to Psychological Services

Medicare payment cut averted for one year, but APAPO says payment system must be repealed

WASHINGTON — Patients receiving treatment for mental and behavioral health conditions through Medicare can continue to access services thanks to congressional action to pass the “Doc Fix” bill. The Protecting Access to Medicare Act of 2014, signed into law by President Barack Obama yesterday, postpones for one year a sustainable growth rate (SGR) cut in payments to Medicare providers, including psychologists, which was scheduled to take effect on April 1.

“We’re pleased that Congress passed this legislation. This one-year fix avoids a big cut in reimbursement rates which would have made it hard for psychologists to continue providing mental health services under Medicare,” says Katherine C. Nordal, PhD, executive director for professional practice of the American Psychological Association Practice Organization (APAPO). “Congress still needs to take the sustainable growth rate formula off the books permanently, though, and it’s unfortunate they didn’t do it this time.”

Research shows that Medicare beneficiaries with both untreated depression and a chronic medical condition, such as diabetes or congestive heart failure, have total treatment costs that are 50 to 100 percent higher than beneficiaries who do not have depression. It is estimated that about $5 billion of the total cost of heart failure can be attributed to depression. 

Payments to clinical psychologists under Medicare have declined roughly 22 percent in the last six years. The reimbursement rate for the most common mental health service, a 45-minute psychotherapy service, has declined by more than 35 percent since 2001. Additionally, a 2013 APAPO member survey found that 26 percent of responding psychologists who were previously Medicare providers left the program, primarily due to low reimbursement rates, and half of psychologists who left Medicare did so in the last five years. 

APAPO wants to ensure that Medicare patients can access mental health services and will work with Congress to repeal the SGR formula and replace it with a cost-effective payment model.

The American Psychological Association Practice Organization is an affiliate of the American Psychological Association, the largest scientific and professional organization representing psychology in the United States. APA's membership includes nearly 130,000 researchers, educators, clinicians, consultants and students.