Psychiatric outpatient practice: patterns and policies.

Area of Science:

• Health Services Research
• Psychiatric Practice
• Health Economics

Background:

• Medicare payment schedules significantly influence the delivery of office-based psychiatric services.
• Recent adjustments to these schedules may have unintended consequences for patient care.
• Understanding these impacts is crucial for maintaining access to psychiatric treatment.

Purpose of the Study:

• To explore the potential consequences of recent Medicare payment schedule changes.
• To analyze the characteristics and frequency of short psychiatric office visits.
• To assess the implications for patient access to care.

Main Methods:

• Utilized data from the 1985 National Ambulatory Medical Care Survey for psychiatric office visits.
• Categorized visits to approximate Physicians' Current Procedural Terminology codes.
• Focused analysis on medication visits (under 20 minutes with prescription) and brief visits (35 minutes or less).

Main Results:

• Short visits (medication and brief) constituted 27.3% of all psychiatric office visits.
• Patients with public insurance, aged over 65, nonwhite, receiving antipsychotics, or diagnosed with psychotic disorders had higher relative risk for short visits.
• These findings highlight a vulnerable patient population utilizing short-visit services.

Conclusions:

• Short psychiatric visits serve a particularly vulnerable patient demographic.
• Reduced Medicare copayments may increase demand for short medication management visits.
• Lowered physician fees under the new Medicare schedule may decrease the financial incentive for short visits, potentially limiting patient access.