Update: Mental Health Clinician Flight from Medicare Fails to Materialize

Dire warnings of wholesale flight of mental clinicians from the Medicare system, with complaints of low and declining reimbursement, and increasing documentation and measurement burdens, did not materialize, at least from 2012 to 2014.

2015 data became available earlier this year from CMS. Here is what the continued pattern looks like.

Two percent fewer psychiatrists (435 fewer) billed services to Medicare beneficiaries in 2015 relative to 2012. Psychologists increased by 9.3% from 2012 to 2015. Social workers increased by 19% from 2012 to 2015. The growth in the number of psychologists and social workers more than offset the small reduction in psychiatrists in terms of overall numbers of these mental health professionals providing services within Medicare. Psychologists and social workers together provide 89% of all psychotherapy to Medicare beneficiaries (psychiatry provides about 7%).

There were 6.7% more mental health clinicians treating Medicare beneficiaries in 2015 than in 2012. During the same time period, the number of Medicare enrollees increased by 9.4%.

Overall, the clinician-to-beneficiary ratio remained quite stable from 2012 to 2015. In 2015, there were 39 psychiatrists per 100K, 25 psychologists per 100K, and 28 social workers per 100K. In 2012, there were 43 psychiatrists per 100K, 25 psychologists per 100K, and 26 social workers per 100K enrollees.

The feared flight of mental health clinicians from Medicare has not materialized, at least through 2015. Rather, about 7% more mental health clinicians are providing services to the Medicare population than in 2012, attributable to a 9% increase in the number of psychologists and more than double that rate of increase (19%) for social workers, with a minimal reduction (2%) in psychiatry. The overall clinician-to-beneficiary ratio remains stable.

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