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Saturday, May 18, 2024

Limited Availability of Psychiatrists in Medicare Advantage Plans

A recent research suggests that people with private Medicare coverage may be missing out on necessary mental health therapies due to a lack of access to psychiatrists in their plan’s network.

The researchers found that in over half of the counties they looked at, not a single psychiatrist accepted Medicare Advantage, the private sector’s answer to conventional Medicare. Approximately 30 million individuals, or slightly more than half of the total federal programme participants, are enrolled in these private plans.

Researchers discovered that less than a quarter of all psychiatrists are included in a plan’s network, and their findings were published in an article in the journal Health Affairs on Wednesday. Obamacare and Medicaid managed care plans’ networks were found to be less limited than traditional insurance company networks, with access to around 40% more psychiatrists.

Many elderly Americans are coping with isolation, the death of a loved one, or their own declining health, and the pandemic helped shed light on the broad need for mental health care in this population. According to a recent examination of mental health coverage by the Commonwealth Fund, a nonprofit organisation, nearly one in four Medicare enrollees suffers a mental disorder such as depression, anxiety, or schizophrenia, but only about half or fewer get treatment.

Medicare Advantage subscribers aren’t the only ones who have trouble finding a psychiatrist, in part because of rising demand. Finding psychiatrists, especially those who are willing to take insurance, is a challenge for many health care programmes. According to a recent study, several psychiatrists have also stopped accepting regular Medicare patients.

Dr. Jane M. Zhu, a primary care physician at Oregon Health & Science University and one of the study’s authors, said that the high expense of stepping out of network is a major reason why patients postpone or forego treatment. She said that even her own patients had trouble locating assistance.

Ms. Grow, however, criticised the Health Affairs research for its failure to compare the plans to standard Medicare and its failure to analyse the many sorts of mental health treatments that would be accessible to patients from other providers or through telehealth. She summed up the research’s methods by saying, “in essence, this study uses a very narrow definition of mental health clinician to prove a pre-existing thesis about Medicare Advantage.”

In a broader sense, regulators and legislators are concerned that Medicare beneficiaries enrolled in private plans are not receiving the treatment to which they are entitled under federal law. The lack of affordable and accessible mental health care has been a constant source of criticism.

As chair of the Senate Finance Committee, Oregon Democrat Ron Wyden conducted a hearing in May to discuss “ghost networks” of mental health doctors, whereby many of the therapists listed in the directories of Medicare Advantage plans are not really admitting patients. A poll using undercover shoppers revealed that his team was only successful 18% of the time in scheduling an appointment.

Dr. Zhu speculated that the Health Affairs research may have exaggerated the number of available psychiatrists since it surveyed only those physicians who were included in the plan’s directory.

According to Dr. Robert Trestman, chairman of the council on health care systems and financing for the American Psychiatric Association, who testified at the Senate hearing, doctors may be unwilling to participate in Medicare Advantage plans due to the low payments paid by the insurers and the extensive paperwork involved.

According to the findings, some Medicare Advantage plans pay psychiatrists less than original Medicare does for the same services. Plans may be motivated to negotiate with a smaller pool of physicians in order to have more influence on both costs and quality of treatment, according to the study’s authors.

Jonathan James
Jonathan James
I serve as a Senior Executive Journalist of The National Era
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