Access to psychiatrists is a particularly acute challenge for Medicare beneficiaries.  Why is this consequential?  Because depression among the elderly is a significant issue.

On account of its “high prevalence and substantial effect, depression is a major contributor to the burden of illness in the older population.  Its effect on function, quality of life, and use of medical services is severe.  The presence of depression is associated with increased healthcare costs, worse outcomes after acute medical events such as hip fracture and stroke, decline in physical function and poorer survival of elderly individuals.”[1]

Furthermore, “depressive disorders of late life include not only major depression but other milder conditions that are nonetheless associated with significant morbidity.”[2]

And importantly for our purposes, depression in later life is associated with increased use of hospital and outpatient services.  For example, in one study, “having depressive symptoms was associated with a 19% increase in the number of outpatient encounters and a 30% increase in total outpatient charges.”[3] 

This increase in the number of outpatient encounters and additional expense is no doubt related to frequent study findings that depression in the elderly often “exhibits a chronic remitting course.”[4]

So access to mental health services is critical for the senior population.  Unfortunately, an August 2010 National Center for Health Statistics study shows, among office-based specialty physicians who accept new Medicare patients, psychiatrists accepted the least at only 60 percent; a full 20 percentage points below internal medicine at 80 percent.[5]

Another recent study by the Center for Health Systems Change shows only 34 percent of psychiatrists accept all new Medicare patients with 35 percent accepting no new Medicare patients at all.[6] 

Steven Daviss, chair of the psychiatry department at the University of Maryland Baltimore Washington Medical Center, only two weeks ago writes in Clinical Psychiatry News  “we are already having trouble finding psychiatrists to accept Medicare patients because of the current level of fees.  [A recent MedPAC reimbursement proposal]…would result in many more psychiatrists and other mental health providers dropping out of Medicare just when the aging Baby Boomer generation will be needing us most.  This…will force these older people to either pay out of pocket for psychiatric care or wait months for a new appointment with one of the providers still accepting Medicare.”[7]  

Subsequently, Daviss shares in a professional online forum “in many states Medicare fees are at the bottom of the barrel, prompting physicians and other health care providers to stop accepting new patients or even to opt out of Medicare completely.”[8]

Poor access to psychiatric care for Medicare beneficiaries is yet another reason physician reimbursement policies relied upon in the President’s government takeover of healthcare law will hurt rather than help seniors.