The exact 2017 numbers are not available yet, but it is all but certain that, for the first time, more than 10 million psychotherapy sessions were provided to Medicare beneficiaries in 2017.

The 2016 data are available: 9,866,628 therapy sessions were provided that year. Given the rate of increase in recent years, the 10 million annual session mark very likely was exceeded in 2017.

These numbers represent “psychotherapy only” type sessions, not therapy that would have been provided in the context of “medication plus therapy” sessions.

Who’s Providing Therapy?

Clinical Psychologists and Licensed Clinical Social Workers continued to provide the bulk of psychotherapy in Medicare in 2016, together providing more than 92% of the more than 9.8 million sessions provided.

There has been shifting in the relative proportions of therapy provided among the professions over time, with a reduction from almost half (49.4%) of the therapy being provided by clinical psychologists from 2013 to 2015 to just under 48% in 2016, and an increase from about 39% provided by LCSWs from 2013 to 2015, to almost 45% in 2016. Psychiatry continues its decreasing trend in total amount of psychotherapy provided, from about 7.2% from 2013 to 2105, to about 5.6% in 2016, a decrease of about 25% over these four years in number of sessions provided (almost 729,000 sessions in 2013, slightly over 549,000 sessions in 2016).

Format of Therapy

I reported in 2016 that the 45 minute session (technically a session from 38 to 52 minutes) was the most commonly provided session length. Perhaps surprising to some, the 30 minute session (technically, 16 to 37 minutes) was the second most common session length provided in 2013, the first year the code became available. There was a decrease though of about 8% in the number of 30 minute sessions provided from 2013-2015, while there was a 48% increase in the number of 53+ minute sessions provided during the same period.

The trend toward decreased use of the 30 minute session appears to have reversed, with a nearly 4% increase in the number of this session length provided in 2016 compared to 2015 (2.13 million in 2016, 2.05 million in 2015). And, the rate of decrease in use of the use of the 45 minute session appears to have slowed, if not essentially halted, with only about 10,000 (.25%) fewer such sessions provided in 2016 (4.09 million) than in 2015 (4.10 million). Increased use of the 53+ minute session continues, though the rate of growth appears to have slowed, with about 14% more such sessions (3.64 million) provided in 2016 compared to 2015 (3.19 million).

In 2016, the 45 minute session remained the most common session length, followed by the 53+ minute session, with the 30 minute session the third most common length.

Use of the 53+ minute session continues to show strong growth, both in absolute terms as well as relative to declines in use of 45 minute sessions. Use of 90834 decreased by 9% decrease from 2013 to 2016, while there was a 69% increase in use of 90837 during the same period. In raw numbers, nearly 1.5 million more 53+ minute sessions were provided in 2016 than 2013, during which time there was a decline of almost 407,000 45 minute sessions. In other words, there was a 3.7-to-1 ratio of increase in 53+ minute sessions for each 45 minute session lost, and a net gain of nearly 1.1 million 53+ minute sessions relative to 45 minute sessions.

Summary/Implications

Concerns about “clinician flight” from Medicare that would affect provision of psychotherapy seem to remain unwarranted. The number of clinicians providing psychotherapy will be reported in the future, but clearly the number of therapy sessions provided continues to increase, with 11% more sessions provided in 2016 relative to 2013. Psychiatrists continue to provide fewer psychotherapy sessions (a 35% decrease since 2013), but social workers are contributing to tremendous growth — a 28% increase since 2013 — and psychologists are also increasing services, though to a lesser degree — about an 8% increase since 2013. The question remains whether the volume of therapy provided is sufficient for the needs of the Medicare population, or whether they might remain underserved.

Provision of psychotherapy has increased by an average of almost 4% per year from 2013 to 2016, with an overall increase of about 11% since 2013 (8.87 million sessions in 2013, 9.87 million sessions in 2016). Growth approaching any of the values from 2013-2017 would certainly have produced more than 10 million sessions in 2017.

The net gain in use of 53+ minutes sessions would not seem to be fully accounted for by a shift away from 45-50 minute sessions. This net increase indicates more sessions are being provided, that the growth is in use of 53+ minute sessions, and the increase is greater than a simple shift from prior use of the 45 minute session to the 53+ minute session format. The question remains, what has contributed to this net growth in provision of 53+ minute sessions over and above the decreases in 45 minute sessions, since the this service became available in 2013?