The year is coming to a close, and many mental and behavioral health professionals are looking ahead to the changes and challenges 2013 has in store for the healthcare field. Nonprofit organization The Physicians Foundation recently released a report on five of the most significant issues facing medical professionals in the coming year.
While much of the document pertains solely to physicians, several of its bullet points are equally applicable to psychiatrists, psychologists and clinicians – particularly those regarding President Barack Obama’s Patient Protection and Affordable Care Act (ACA), which will be implemented over the course of 2013 and into 2014. Here are some of the biggest challenges facing mental health professionals in the new year.
30 Million New Patients
Perhaps one of the most pressing matters for clinicians is that the ACA will introduce 30 million newly insured patients into the U.S. healthcare system in 2014, according to the Physicians Foundation. This applies to both physicians and mental health professionals, who must both prepare their practices over the next year to handle the administrative and clinical burdens of treating such a large influx of people without deterring from efficiency or quality of care.
Many of these individuals will be looking for treatment of mental disorders such as depression and anxiety along with substance and alcohol abuse. In order to aid psychologists and psychiatrists in adjusting to these new patient demands, the Substance Abuse and Mental Health Services Administration (SAMHSA) and the State Associations of Addiction Services (SAAS) will be working together to fund a series of learning networks as part of BH Business: Mastering Essential Business Operations.
These courses will be available in different regions of the U.S. and will provide training and guidance on management issues like eligibility and enrollment, third party billing and compliance, meaningful use of health information technology, mastering strategic business planning and third party contract negotiations.
Another issue the Physicians Foundation raises that also applies to mental health professionals is the continuing uncertainty surrounding the ACA. The Supreme Court upheld the law in June 2012, and President Obama’s re-election signals that it will be implemented as planned, but specific details about health insurance exchanges, reimbursement and other federal mandates remain hazy.
There are several specific provisions of the ACA that relate to psychologists and psychiatrists. SAMHSA reports that substance abuse and prevention will be key focuses for mental health professionals. Benefit packages must feature treatment for conditions that include mental illnesses, substance abuse disorder services, prevention and wellness services, rehabilitation and prescription drugs by the fiscal year 2014. Pre-existing conditions will also be eliminated, which will forbid insurance providers from denying coverage to patients who have already been diagnosed with a mental health conditions or substance abuse disorder, reported the American Psychiatric Association (APA).
The ACA also encourages more mental and behavioral health professionals to become involved with community primary and integrated care programs, according to the APA Practice Central. New grants are available from the federal government to fund psychiatrists participating in interdisciplinary and interprofessional health teams of primary care practices and medical homes. There will also be considerable support for providing affordable mental health treatments and services to patients in low-income areas as part of state Medicaid options.
DSM-V vs. ICD-10
One uncertain situation facing mental and behavioral health professionals is the debate between usage of the familiar Diagnostic and Statistical Manual of Mental Disorders, Fifth Revision (DSM-V) and the upcoming International Classification of Diseases, Tenth Revision (ICD-10), according to the APA Practice Central.
While many psychologists and psychiatrists in the U.S. have relied on the APA’s DSM codes for accurately diagnosing and recording mental health conditions, the Health Insurance Portability and Accountability Act (HIPAA) of the American Recovery and Reinvestment Act (ARRA) of 2009 has mandated that clinicians adopt the World Health Organization’s (WHO) ICD-10 by Oct. 1, 2014.
The DSM-IV codes have been in use since they were last revised in 2000. Additionally, many codes in the DSM-IV have been used interchangeably with the current ICD-9 codes for years. Further complicating matters is the fact that the DSM-V will be released in May 2013 – a little more than a year before mental health professionals are expected to adopt the ICD-10. The APA has continued to oppose the government’s mandate to employ the ICD codes and has suggested numerous roads to bypass them, yet the debate is still unsettled.
Changes in DSM-V
In the meantime, there are a variety of changes from the DSM-IV to the DSM-V that clinicians must be aware of in the coming year. Clinical Psychiatry News reported that featured code differences include merging autism spectrum disorder with Asperger’s disorder, pervasive developmental disorder and childhood disintegrative disorder. There will also be new criteria for diagnosing disruptive mood dysregulation disorder and the inclusion of new conditions like hoarding disorder and excoriation disorder.
Other differences in the DSM-V include incorporating binge eating into the main text, merging the post-traumatic stress disorder with Trauma and Stressor-Related Disorder section, renaming pedophilia as pedophiliac disorder and dividing bereavement exclusion into grief and depression.
EHR Meaningful Use Audits
The ARRA of 2009 also consists of the Health Information Technology for Economic and Clinical Health (HITECH) Act, which encourages mental and behavioral health professionals to adopt electronic medical record (EHR) software into the practices while getting rid of old pen and paper methods of record keeping.
While this requires investments of time, energy and money for clinicians to train and prepare their staff members to use such health information technology programs, the federal government has offered financial incentives to psychiatrists who employ EHR software and abide by meaningful use guidelines. In order to comply with meaningful use incentives, mental health professionals must purchase and successfully implement EHRs for a period of 90 days to meet stage 1 criteria and two years to meet stage 2, states HealthIT.gov.
However, an unexpected snag has caught many clinicians by surprise, as the Centers for Medicare and Medicaid Services (CMS) has begun an extensive audit process of all mental health professionals who accepted meaningful use funding, according to the American Medical Association. Approximately 55,000 people earned meaningful use funding in 2011 and 2012, and Medicare has offered more than $1 billion since June 2012.
The federal government will employ a private auditing firm Figliozzi and Co. of Garden City, New York, for recipients of Medicare and Medicaid benefits. States and local organizations will be responsible for auditing clinics that only earned Medicaid incentives. Any clinics that have received federal funding without meeting meaningful use guidelines will be charged with penalties ranging from returning incentives to the CMS to facing federal prosecution.
In order to demonstrate meaningful use during an audit, mental health professionals must provide proof that their EHR system is certified, document that core objectives have been met and record that menu objectives were complied with.