Matthew J. Press

Acceptance of Insurance by Psychiatrists and the Implications for Access to Mental Health Care

IMPORTANCEnThere have been recent calls for increased access to mental health services, but access may be limited owing to psychiatrist refusal to accept insurance.nnnOBJECTIVEnTo describe recent trends in acceptance of insurance by psychiatrists compared with physicians in other specialties.nnnDESIGN, SETTING, AND PARTICIPANTSnWe used data from a national survey of office-based physicians in the United States to calculate rates of acceptance of private noncapitated insurance, Medicare, and Medicaid by psychiatrists vs physicians in other specialties and to compare characteristics of psychiatrists who accepted insurance and those who did not.nnnMAIN OUTCOMES AND MEASURESnOur main outcome variables were physician acceptance of new patients with private noncapitated insurance, Medicare, or Medicaid. Our main independent variables were physician specialty and year groupings (2005-2006, 2007-2008, and 2009-2010).nnnRESULTSnThe percentage of psychiatrists who accepted private noncapitated insurance in 2009-2010 was significantly lower than the percentage of physicians in other specialties (55.3% [95% CI, 46.7%-63.8%] vs 88.7% [86.4%-90.7%]; P <u2009.001) and had declined by 17.0% since 2005-2006. Similarly, the percentage of psychiatrists who accepted Medicare in 2009-2010 was significantly lower than that for other physicians (54.8% [95% CI, 46.6%-62.7%] vs 86.1% [84.4%-87.7%]; P <u2009.001) and had declined by 19.5% since 2005-2006. Psychiatrists Medicaid acceptance rates in 2009-2010 were also lower than those for other physicians (43.1% [95% CI, 34.9%-51.7%] vs 73.0% [70.3%-75.5%]; P <u2009.001) but had not declined significantly from 2005-2006. Psychiatrists in the Midwest were more likely to accept private noncapitated insurance (85.1%) than those in the Northeast (48.5%), South (43.0%), or West (57.8%) (P =u2009.02).nnnCONCLUSIONS AND RELEVANCEnAcceptance rates for all types of insurance were significantly lower for psychiatrists than for physicians in other specialties. These low rates of acceptance may pose a barrier to access to mental health services.

Medicare's New Bundled Payments: Design, Strategy, and Evolution.

The Centers for Medicare & Medicaid Services (CMS) is increasingly paying for health care through alternative payment models (APMs) that reward value and quality. Currently, more than 20% of Medicare fee-for-service payments flow through APMs, putting the Administration’s goals of 30% by 2016 and 50% by 2018 within reach.1 These APMs include accountable care organizations (ACOs), bundled payments, and advanced primary care medical homes. In this Viewpoint, we discuss the role of bundled payments.

Association Between Hospital Participation in a Medicare Bundled Payment Initiative and Payments and Quality Outcomes for Lower Extremity Joint Replacement Episodes

IMPORTANCEnBundled Payments for Care Improvement (BPCI) is a voluntary initiative of the Centers for Medicare & Medicaid Services to test the effect of holding an entity accountable for all services provided during an episode of care on episode payments and quality of care.nnnOBJECTIVEnTo evaluate whether BPCI was associated with a greater reduction in Medicare payments without loss of quality of care for lower extremity joint (primarily hip and knee) replacement episodes initiated in BPCI-participating hospitals that are accountable for total episode payments (for the hospitalization and Medicare-covered services during the 90 days after discharge).nnnDESIGN, SETTING, AND PARTICIPANTSnA difference-in-differences approach estimated the differential change in outcomes for Medicare fee-for-service beneficiaries who had a lower extremity joint replacement at a BPCI-participating hospital between the baseline (October 2011 through September 2012) and intervention (October 2013 through June 2015) periods and beneficiaries with the same surgical procedure at matched comparison hospitals.nnnEXPOSUREnLower extremity joint replacement at a BPCI-participating hospital.nnnMAIN OUTCOMES AND MEASURESnStandardized Medicare-allowed payments (Medicare payments), utilization, and quality (unplanned readmissions, emergency department visits, and mortality) during hospitalization and the 90-day postdischarge period.nnnRESULTSnThere were 29u202f441 lower extremity joint replacement episodes in the baseline period and 31u202f700 in the intervention period (mean [SD] age, 74.1 [8.89] years; 65.2% women) at 176 BPCI-participating hospitals, compared with 29u202f440 episodes in the baseline period (768 hospitals) and 31u202f696 episodes in the intervention period (841 hospitals) (mean [SD] age, 74.1 [8.92] years; 64.9% women) at matched comparison hospitals. The BPCI mean Medicare episode payments were

Electronic communication improves access, but barriers to its widespread adoption remain

30u202f551 (95% CI,

Two-Year Costs and Quality in the Comprehensive Primary Care Initiative

30u202f201 to

Instant Replay — A Quarterback's View of Care Coordination

30u202f901) in the baseline period and declined by

Encouraging Patients to Ask Questions: How to Overcome “White-Coat Silence”

3286 to

Medicare Payment for Behavioral Health Integration

27u202f265 (95% CI,

The CMS Innovation Center — A Five-Year Self-Assessment

26u202f838 to

Catheter-Associated Urinary Tract Infection: Does Changing the Definition Change Quality?

27u202f692) in the intervention period. The comparison mean Medicare episode payments were