A GP says his hands are tied when it comes to helping patients with their mental health | opinion
By Alexander Salerno
I am a primary care physician practicing in one of the most underserved areas of New Jersey with few doctors and even fewer mental health professionals. In the past month, I have seen more than 100 patients in my practice who are showing signs of mental illness.
Your GP is probably the first medical professional to notice if you have common mental health problems, such as anxiety or depression. Lately, AHIPthe country’s largest health insurance trading group, issued a statement pledged to improve access to mental health care. A recent study identified affordability—even more so than availability—as the main barrier to mental health care utilization.
To be honest, it’s long overdue for that. The hurdles the insurance industry has placed on your GP make it difficult for them to make that assessment and act on it. My hands are often tied.
In order to get paid for what we do, all doctors bill insurance companies using an extensive, complicated, and sometimes conflicting list of codes known as Current Procedural Terminology, or CPT. For this reason, many medical offices employ staff solely for medical coding and billing. If a doctor uses the wrong code, the claim will be denied.
This is a problem when it comes to behavioral health, as physician billing rules are like a maze with no easy exit. Mental health professionals typically rely on two codes for initial psychiatric diagnostic assessment. Psychiatrists, psychologists and other psychotherapists use them all the time.
However, your GP may not use these codes, even though your doctor will most likely make an initial mental health diagnosis. I have been a primary care physician at my primary care practice, Salerno Medical Associates, for more than 20 years. It has always been necessary for us to fill the hole left by a Shortage of mental health professionals. That’s more true than ever after the pandemic: The shortage is expected to grow to 15,000 mental health professionals by 2025, more than a third more than in 2013. I’m pleased that through AHIP, the insurance industry is finally coming to terms with this.
GPs are the frontline of mental health. Some studies say more than the half of people in their GP waiting rooms have some form of depression that is never identified. We also know that many common medical conditions can cause or worsen depression. These include heart disease, cancer and chronic pain.
This is important. If there’s one condition that everyone is prone to, it’s depression. It affects people of all races, religions and socioeconomic status equally. Diseases such as diabetes, high blood pressure and cancer affect different population groups more than others. But depression lurks around us all, and your GP is trained to spot it. She just can’t bill her insurance company for it, but maybe AHIP’s new stance will change that.
Physicians and patients alike recognize that affordable mental health care is difficult to find. That’s partly because the insurance industry — in turn, the insurance industry — has reimbursed mental health providers less than other medical specialists. But the medical training of a psychiatrist has the same price as that of a plastic surgeon. AHIP is now committed to covering mental health on an equal footing with physical health, but mental health providers must also be fairly compensated for this.
Right now, however, the insurance industry isn’t allowing internists and other first responders to take any of the burden off mental health specialists. For example, if my primary diagnosis of a patient is depression, that insurance claim is likely to be denied. Since my pay is dependent on a primary diagnosis of something like high cholesterol, low back pain, or constipation, doctors like me have no incentive to start this conversation with the patient about their behavioral health issues. In fact, we are being punished for it. It makes easy and efficient maintenance difficult.
It is not difficult to improve the situation. A simple improvement would be to open up the use of the psychiatric diagnostic assessment billing code to frontline medical providers. If society truly believes – as it should – that there is a mental health crisis in this country, then let more professionals diagnose it. Make telemedicine therapy more accessible.
Let’s care and get paid for our work. Let patients get the care they can afford.
dr Alexander Salerno is a Physician with Salerno Medical Associates, a second generation family practice serving East Orange and Newark. He is also the founder of the Urban Healthcare Initiative Program (UHIP), a community-based health and education provider.
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