Are Mental Health Clinicians Fleeing Medicare?

As a followup to recent “sky is falling” levels of concern about potential large scale flights of practitioners from Medicare, I got curious about how many mental health clinicians provide services to Medicare beneficiaries, and what the recent trends have been. The “provider utilization and payment data” published by CMS at afford an opportunity to take a look at this.

Analyzing the number of individual clinicians from the CY 2012, 2013 and 2014 data (non-duplicated NPIs billing Medicare) yields the following.

After a 1.1% decrease in the number of psychiatrists from 2012-2013, there was 0% change from 2013 to 2014, for an overall decrease of 1.1% in the number of psychiatrists providing services from 2012-2014.

The number of psychologists providing services to Medicare beneficiaries increased 2.4% from 2012 to 2013, and 3% from 2013 to 2014, with 5.5% more psychologists providing services in 2014 than in 2012.

The number of social workers treating Medicare beneficiaries also increased in both 2013 and 2014, with a 3% increase from 2012 to 2013, and a 7.4% increase from 2013 to 2014. Almost 11% more social workers provided services in 2014 relative to 2012.

During the same period (2012-2014), the number of enrollees in Medicare increased by 6.4%.

No, mental health professionals have not been fleeing Medicare, at least from 2012 to 2014. There’s been a 1% decrease in psychiatry, with a 6% increase in psychologists, and 11% more social workers.

Given that 2015 may be a “watershed” year in terms of — at least perceived — increases in reporting requirements, essentially flatlined reimbursement, and the shift to “value-based” models looming, the 2012-14 period could serve as a meaningful baseline from which to measure whether flight from the system materializes…or not.

Of note, the relative numbers of clinicians providing services do not directly reflect who is providing what types of services. For example, as I’d previously written, in 2012, psychiatrists were 46% of the mental health clinicians serving Medicare beneficiaries, but only provided about 15% of the “standard” 45 minute psychotherapy visits. In contrast, social workers were about 28% of the Medicare mental health clinicians in 2012, and provided almost half (48%) of these treatment visits. Psychologists, about 26% of the Medicare mental health clinicians, provided about 35% of all 45 minute sessions. “Other” (non-mental health-specific clinicians) provided about 2% of these visits. So any potential flight of mental health clinicians from Medicare would have differential effects on service provision — and Medicare beneficiaries.




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